閉経後に子宮鏡下ポリープ切除術を施行した症例の検討

抄録

Objective: Endometrial polyps are relatively common lesions. Although most of the endometrial polyps are benign, some of them are either malignant or premalignant lesions, like atypical endometrial hyperplasia (AEMH) or atypical polypoid adenomyoma. This study retrospectively examined postmenopausal patients who underwent hysteroscopic endometrial polypectomy, a population considered to include a relatively large number of cases for diagnostic purposes.

Methods: We retrospectively examined 21 cases of postmenopausal women who underwent transcervical resection at our institution between January 2016 and April 2020. The indications for surgery included irregular bleeding or discharge in symptomatic cases and polyps larger than 15 mm in asymptomatic cases.

Results: In all 21 cases, preoperative endometrial cytology or histology was benign, with no abnormal findings by hysteroscopy. Among these cases, two were endometrial adenocarcinoma (G1) cases and one was AEMH case. Both the patients with endometrial adenocarcinoma were obese with a body mass index of ≥30; and one of them had hypertension and diabetes, which are the risk factors for type 1 uterine cancer.

Conclusion: To treat postmenopausal endometrial polyps, removal of the polyps without remnants under hysteroscopy for diagnostic purposes in symptomatic cases with bleeding, asymptomatic cases with large polyp diameters, and cases with a background risk of uterine cancer was necessary, even if no abnormalities were revealed on hysteroscopic findings or pathological cytology and histology.