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Long axis view of the Uterus and Cervix on Transvaginal Ultrasonography with thickened Endometrium. Large lobulated hyperechoic Endocervical mass with polypoidal protrusion beyond the external cervical os.

Power Doppler shows internal vascularity within the polypoidal mass with a vascular stalk extending from the body of Uterus.

3D reformatted image shows the thickened Endometrium within the Uterus continuing distally as a large polyp protruding from the external cervical os.

3D reformatted image with Power Doppler shows the internal vascularity within the polyp and the long vascular stalk from the body of Uterus. The other blood vessels that are seen are normal myometrial blood vessels.

Diagnosis: Large Pedunculated Endometrial Polyp protruding through the Cervix into the Vaginal cavity.

An Endometrial Polyp is a localized overgrowth of endometrial glands and stroma that project beyond the surface of the endometrium. Usually soft and pliable, and may be single or multiple. Most polyps arise from the fundus of the uterus. Endometrial polyps vary from a few mm to several cm in diameter, and it is possible for a single large polyp to fill the endometrial cavity. Endometrial polyps may have a broad base (sessile) or be attached by a slender pedicle (pedunculated). The peak incidence is between the ages of 40 and 49. Endometrial polyps are noted in approximately 10% of women when the uterus is examined at autopsy. The aetiology of endometrial polyps is unknown. Because polyps are often associated with endometrial hyperplasia, unopposed oestrogen may be the cause. The majority of endometrial polyps are asymptomatic. Those that are symptomatic are associated with a wide range of abnormal bleeding patterns. Occasionally a pedunculated endometrial polyp with a long pedicle may protrude from the external cervical os. Recently, unusual polyps have been described in association with chronic administration of the anti-oestrogen tamoxifen.¹

Endometrial polyps are a common cause of postmenopausal bleeding and are most frequently seen in patients receiving tamoxifen. Although endometrial polyps may be visualized at transvaginal US as nonspecific endometrial thickening, they are frequently identified as focal masses within the endometrial canal. Polyps are best seen at sonohysterography and appear as echogenic, smooth, intracavitary masses outlined by fluid. Cystic spaces corresponding to dilated glands filled with proteinaceous fluid may be seen within the polyp. The polyp may be broad-based and sessile or pedunculated. The point of attachment should not disrupt the endometrial lining. Polyps may also be seen at hysterosalpingography as pedunculated filling defects within the uterine cavity or at T2-weighted MR imaging as low signal intensity intracavitary masses surrounded by high-signal-intensity fluid and endometrium. Color Doppler US may be used to image vessels within the stalk. Fibroids or foci of endometrial hyperplasia or carcinoma can mimic a sessile polyp, and foci of atypical hyperplasia are sometimes found within polyps.³

References & Further Reading:

1. Medcyclopedia - Endometrial Polyp
2. Mayo Clinic online article on Uterine Polyps
3. Nalaboff KM, Pellerito JS, Ben-Levi E. Imaging the Endometrium: Disease and Normal Variants. RadioGraphics 2001; 21:1409 –1424. [Full text article]
4. American Society for Reproductive Medicine Patient’s Fact Sheet on Saline Infusion Sonohysterography [download pdf file]
5. Davis PC, O’Neill MJ, Yoder IC, Lee SI, Mueller PR. Sonohysterographic Findings of Endometrial and Subendometrial Conditions. RadioGraphics 2002; 22:803–816  [Full text article]

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