Hyperplastic Endometrial Polyp with Architectural and Cytological Atypia: Clinical Case and Literature Review

Abstract

Introduction. Endometrial polyps are a common benign pathology of the uterine lining; however, a subset may exhibit architectural and cytological atypia associated with a significant risk of malignant transformation. Atypical endometrial hyperplasia is considered a true premalignant condition. The aim of this study was to present a clinical case and a review of the literature emphasizing the diagnostic value of hysteroscopic polypectomy and the importance of optimal management. Methods. A clinical case of a 50-year-old woman is presented. The diagnostic included ultrasound evaluation of the lesion, hysteroscopic resection of the polyp, and histopathological assessment of the excised tissue. A literature review was conducted focusing on the epidemiology, diagnosis, histological features, and management of atypical endometrial polyps. Results. During hysteroscopic polypectomy, a uterine body polyp was removed and histologically confirmed as a hyperplastic endometrial polyp with architectural and cytological atypia and reduced PAX2 protein expression. Evidence from the literature indicate that atypia identified within a polyp often does not reflect the condition of the entire endometrium: carcinoma is detected in the surrounding endometrium in up to 30.8% of cases, and residual premalignant lesions are found in up to 88% of hysterectomy specimens. Therefore, atypia within an endometrial polyp should be considered a high-risk finding for endometrial cancer. Conclusions. An atypical endometrial polyp represents a premalignant condition and should be managed similarly to atypical endometrial hyperplasia. Hysteroscopic polypectomy is an essential diagnostic method allowing reliable identification of localized atypia. In patients not planning future pregnancy, total hysterectomy with bilateral salpingo-oophorectomy is recommended; conservative management—particularly in the postmenopausal period—is not advised due to the high risk of malignant transformation.