Investigation of the development of endometrial polyps in endometrial cancer

Abstract

Endometrial polyps are often asymptomatic and detected incidentally.Polyps are also a common cause of vaginal bleeding, most frequently in both, premenopausal and postmenopausal women; occurring in more than 25% of the general population. Endometrial polyp (EP) appears to be a disorder of aging but the influence of other risk factors is still unknown. The risk of endometrial cancer in women with endometrial polyps has been reported to range from 0% to 4,8%. This common disease is often in association with diverse clinical symptoms/signs ranging from abnormal uterine bleeding to infertility. These conditions are usually diagnosed by office procedures, such as hysteroscopy, transvaginal sonography and hydrosonography, which have replaced the classic and ancient dilatation and curettage by being more accurate and less invasive. However consensus guidelines for the management of women with endometrial polyps are lacking; and the pathogenesis is poorly understood. Given these facts, over time, would it be possible to occur the development of polyps without atypia and with atypia to endometrial cancer?The aim of the current transversal and clinical study, is to compare the results of histological material obtained through oriented (blind biopsy using Novak curettage or Pipelle suction device) or directed (using Bettocchi system) biopsies during the office hysteroscopy and polypectomy; also determining the possible immunohistochemical expression of estrogen and progesterone receptors in endometrial polyps, as well as, Ki-67, an indicator of cell mitotic activity - a marker of proliferation and endoglin (CD105) and (CD34); claudin-1, claudin-3 and claudin-4 expression and matrix metalloproteinase MMP- 2 and metalloproteinase MMP- 9. And analyze whether it is possible the evolution of polyps with atypia to endometrial cancer by immunohistochemical study of protein expression.Between 2012 and 2014, one hundred and twenty women will be evaluated by office diagnostic hysteroscopy followed by oriented/blind endometrial biopsy or directed biopsy and further polypectomy and hysterectomy in cancer endometrial.The present study will be carried out at the Sector of Gynecological Endoscopy and Family Planning of the Botucatu School of Medicine - São Paulo State University- Brazil.Demography characteristics, clinical and pathologic features will be compared with the protein expressions such as age, obesity, arterial hypertension, diabetes mellitus, menopause, breast cancer, use of hormonal therapy, parity, smoking and use of tamoxifen. Finally, the study of the immunohistochemical protein expression will be compared and also the results of hysteroscopic findings and pathological ones. (AU)