Endometrial polyp (EMP) is one of the most common diagnoses in the evaluation of women with abnormal uterine bleeding. Understanding the malignancy risk associated with EMPs and related risk factors is essential for guiding both pathology practice and clinical management. This study aimed to explore risk factors for malignancy in EMPs.
The pathology database was searched for women diagnosed with EMP between 2021 and 2022. Patient age, polyp size, background endometrium, recurrence, and (if applicable) cancer types were recorded. Immunohistochemistry (IHC) for p53 and p16 was performed on selected cases. Risk factors for malignancy were analyzed using Chi-square and analysis of variance tests.
Among the 740 EMP cases analyzed, 94% were benign, 2% were premalignant, and 4% were malignant. The median patient age was 54 years (range: 19–92). Minimal serous carcinoma (n = 14, 2%) was the most prevalent cancer. Among the 52 cases with p53 IHC, 38 were diagnosed as benign, supported by a wild-type p53 pattern, while 14 were diagnosed as serous carcinoma, supported by a mutant p53 pattern. Malignant polyps were found to be significantly associated with advanced age and malignant background endometrium ( p < 0.001). Large size and recurrence were not identified as significant risk factors.
Our investigation has elucidated that while EMPs carry a low risk for malignancy, this risk is notably more pronounced in the elderly female population. Contrary to what might be expected, our findings reveal that neither the size of the polyps nor their recurrence serves as a reliable predictor for an increased malignancy risk. These findings would aid in the formulation of more informed clinical decisions regarding the management and follow-up care of women diagnosed with EMPs. Our findings further underscore the importance of routinely sampling the background endometrium during polypectomy, particularly in postmenopausal patients, to identify occult premalignant lesions. In patients over 65 years of age, where malignancy risk is heightened, we recommend considering p53 IHC and/or additional endometrial sampling to aid in early detection of serous carcinoma. Vigilance in examining the background endometrium enhances the diagnostic utility of EMP evaluation and informs appropriate patient management.
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https://www.xiahepublishing.com/2771-165X/JCTP-2025-00013
The study was recently published in the Journal of Clinical and Translational Pathology .
Journal of Clinical and Translational Pathology (JCTP) is the official scientific journal of the Chinese American Pathologists Association (CAPA). It publishes high quality peer-reviewed original research, reviews, perspectives, commentaries, and letters that are pertinent to clinical and translational pathology, including but not limited to anatomic pathology and clinical pathology. Basic scientific research on pathogenesis of diseases as well as application of pathology-related diagnostic techniques or methodologies also fit the scope of the JCTP.
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Journal of Clinical and Translational Pathology
A Clinicopathologic Analysis of 740 Endometrial Polyps: Risk of Premalignant Changes and Malignancy
19-Dec-2025