Case report
Histopathological and Immunohistochemical Evaluation of Endometrial Polyp with Endometrial Intraepithelial Neoplasia in a Postmenopausal Woman: A Case Report
ED04-ED06
Correspondence
Dr. Aslima Banu,
Department of Pathology, Sree Balaji Medical College and Hospital, Chennai-600044, Tamil Nadu, India.
E-mail: aslimabanu1998@gmail.com
Endometrial Intraepithelial Neoplasia (EIN) is a premalignant lesion recognised as a precursor to endometrioid endometrial carcinoma. Although endometrial polyps are predominantly benign, they may rarely harbour atypical or premalignant lesions, particularly in postmenopausal women presenting with abnormal uterine bleeding. A 60-year-old postmenopausal woman presented with postmenopausal bleeding. Pelvic ultrasonography demonstrated a bulky retroverted uterus with a diffusely thickened endometrium measuring 3 cm and no focal myometrial lesion. Magnetic Resonance Imaging (MRI) confirmed diffuse endometrial thickening and additionally revealed an intramural fibroid. Owing to persistent endometrial thickening and clinical suspicion of endometrial pathology, total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. Gross examination revealed a 2.5×1.5 cm endometrial polyp within a diffusely thickened endometrium. Histopathological examination demonstrated focal EIN involving both the endometrium and the endometrial polyp, confirming the lesion originated within the polyp. The myometrium showed adenomyosis without evidence of myometrial invasion or concurrent malignancy. The cervix exhibited chronic cervicitis, while both fallopian tubes and ovaries were histologically unremarkable. Immunohistochemical analysis for Bcl-2 (B-cell lymphoma 2) demonstrated intense staining in the endometrial glands and stroma with focal loss of expression, supporting the diagnosis. The final diagnosis was focal EIN arising within an endometrial polyp in a background of adenomyosis without associated endometrial carcinoma. No clinical evidence of recurrent disease was observed during the six-month follow-up. This case highlights the importance of meticulous histopathological evaluation of endometrial polyps in postmenopausal women with abnormal uterine bleeding, as premalignant lesions such as EIN may occur within polyps despite the absence of invasive carcinoma, thereby improving early detection, risk assessment, and optimal patient management.