Clinical and Experimental Reproductive Medicine

The Korean Society for Reproductive Medicine (대한생식의학회)
권호 표지

Increased Incidence of Endometrial Polyps in Women with Endometriosis; the Association with Severity

자궁내막증 여성에서 증가된 자궁내막용종의 빈도; 질환의 중증도와의 관련성

  • Chang, Hye Jin (Department of Obstetrics and Gynecology, Ajou University School of Medicine) ;
  • Hwang, Kyung Joo (Department of Obstetrics and Gynecology, Ajou University School of Medicine) ;
  • Kim, Mi Ran (Department of Obstetrics and Gynecology, Ajou University School of Medicine) ;
  • Ahn, Sang Tae (Department of Obstetrics and Gynecology, Ajou University School of Medicine) ;
  • Byun, Jae Guang (Department of Obstetrics and Gynecology, Ajou University School of Medicine) ;
  • Lee, Eun Hee (Department of Obstetrics and Gynecology, Ajou University School of Medicine) ;
  • Park, Jin Young (Department of Obstetrics and Gynecology, Ajou University School of Medicine)
  • 장혜진 (아주대학교 의과대학 산부인과학교실) ;
  • 황경주 (아주대학교 의과대학 산부인과학교실) ;
  • 김미란 (아주대학교 의과대학 산부인과학교실) ;
  • 안상태 (아주대학교 의과대학 산부인과학교실) ;
  • 변재광 (아주대학교 의과대학 산부인과학교실) ;
  • 이은희 (아주대학교 의과대학 산부인과학교실) ;
  • 박진영 (아주대학교 의과대학 산부인과학교실)
  • Published : 2006.09.30
Download PDF
⟨ Previous Next ⟩

Abstract

Objective: The aim of this study was to evaluate the correlation between severity of endometriosis and the incidence of endometrial polyp. Methods: The study population consisted of six hundred thirty-one women who had undergone laparoscopic operation due to infertility, severe dysmenorrhea or ovarian tumors. We divided two groups: 434 women with endometriosis (study group) and 197 women without the disease (control group). The presence of endometriosis was documented by diagnostic or therapeutic laparoscopic operation and the disease severity was scored according to revised The American Fertility Society classification. We confirmed the endometrial polyps by pathologic examination after hysteroscopic polypectomy, and compared endometrial polyp incidence according to severity of endometriosis. Results: There was no significant difference between groups with regard to age, mean duration of infertility. Endometrial polyps were found in 274 women (63.0%) with endometriosis and in 58 controls (29.8%, p=0.0000). The incidence of endometrial polyps differed significantly according to stage of endometriosis. The incidence of endometrial polyps were 77/142 (54.2%), 58/90 (64.4%), 73/108 (67.6%, p<0.05), 66/94 (70.2%, p<0.05) in endometriosis stage I, II, III, and IV. There was a linear correlation between stage of endometriosis and endometrial polyps incidence (p=0.008). Conclusion: Endometriosis is accompanied by endometrial polyps. This results showed positive correlation between severity of the endometriosis and incidence of endometrial polyps. It is the possible mechanism for low pregnancy rate in the severe endometriosis.

목 적: 자궁내막증에서 발견되는 자궁내막용종의 발생빈도와 자궁내막증 질환의 중증도와의 연관성에 대해 알아보고자 한다. 연구방법: 불임, 심한 월경통, 난소종양 등을 주소로 복강경 수술이 필요했던 여성 631명을 대상으로 하였다. 복강경 수술로 확인된 자궁내막증을 가진 434명과 자궁내막증이 없었던 197명의 여성에서 자궁내시경을 이용한 조직학적인 검사를 통해 자궁내막용종의 발생 빈도를 비교하였다. 또한 자궁내막증 질환의 중증도는 American Fertility Society classification 에 따라 나누었고, 그에 따른 자궁내막용종의 빈도를 비교하였다. 결 과: 자궁내막증을 가진 군 (434명)과 정상 대조군 (197명) 간에 나이, 불임기간, 호르몬 수치 등의 임상적인 차이는 보이지 않았고, 자궁내막용종은 자궁내막증을 가진 여성에서는 274명 (63%)에서 관찰되었고, 자궁내막증이 없는 대조군에서는 58명 (29.8%)에서 관찰되었다(p=0.001). 자궁내막증 1기와 2기에서는 자궁내막용종이 동반된 경우가 각각 54.2%와 64.4% 이었으나, 자궁내막증 3기와 4기에서는 67.6%와 70.2%로 통계적으로 유의하게 정상 대조군에 비해 자궁내막용종의 동반 확률이 높았고, 자궁내막증 중증도에 따라 자궁내막용종의 빈도가 유의하게 증가하는 양상을 보였다(p=0.008). 결 론: 자궁내막증을 가진 여성에서 자궁내막용종을 동반할 확률이 정상인에 비해 높았고, 중증 자궁내막증일수록 동반되는 자궁내막용종의 빈도가 증가하였다.

Keywords

References

  1. Snesky TE, Liu DT. Endometriosis: associations with menorrhagia, infertility, and oral contraceptives. Int J Gynaecol Obstet 1980; 17: 573-76 https://doi.org/10.1002/j.1879-3479.1980.tb00210.x
  2. Houston DE. Evidence for the risk of pelvic endometriosis by age, race, and socioeconomic status. Epidemiol Rev 1984; 6: 167-91 https://doi.org/10.1093/oxfordjournals.epirev.a036270
  3. Eskenazi B, Warner ML. Epidemiology of endometriosis. Obstet Gynecol Clin North Am 1997; 24: 235-58 https://doi.org/10.1016/S0889-8545(05)70302-8
  4. Sampson JA. The development of the implantation theory for the origin of peritoneal endometriosis. Am H Obstet Gynecol 1940; 40: 549-57 https://doi.org/10.1016/S0002-9378(40)91238-8
  5. Vinatier D, Orazi G, Cosson M, Dufour P. Theories of endometriosis. Eur J Obstet Gynecol Reprod Biol 2001; 96: 21-34 https://doi.org/10.1016/S0301-2115(00)00405-X
  6. Loh FH, Bongso A, Fong CY, Koh DR, Lee SH, Zhao HQ. Effects of peritoneal macrophages from women with endometriosis on endometrial cellular proliferation in an in vitro coculture model. Fertil Steril 1999; 72: 533-8 https://doi.org/10.1016/S0015-0282(99)00292-7
  7. Meresman GF, Vighi S, Buquet RA, Contreras-Ortiz 0, Tesone M, Rumi LS. Apoptosis and expression of Bcl-2 and Bax in eutopic endometrium from women with endometriosis. Fertil Steril 2000; 74: 760-6 https://doi.org/10.1016/S0015-0282(00)01522-3
  8. Noble LS, Takayama K, Zeitoun KM, Putman JM, Johns DA, Hinshelwood MM, et al. Prostaglandin E2 stimulates aromatase expression in endometriosis-derived stromal cells. J Clin Endocrinol Metab 1997; 82: 600-6 https://doi.org/10.1210/jc.82.2.600
  9. Salm R. The incidence and significance of early carcinoma in endometrial polyps. J Pathlo 1972; 108: 47-53 https://doi.org/10.1002/path.1711080106
  10. Varasteh NN, Neuwirth RS, Levin B, Keltz MD. Pregnancy rate after hysteroscopic polypectomy and myomectomy in infertile women. Obstet Gynecol 1999; 94: 168-71 https://doi.org/10.1016/S0029-7844(99)00278-1
  11. Perez-Medina T, Bajo-Arenas J, Salazar F, Redondo T, Sanfrutos L, Alvarez P, et al. Endometrial polyps and their implication in the pregnancy rates of patients undergoing intrauterine insemination: a prospective, randomized study. Hum Reprod 2005; 20(6): 1632-5 https://doi.org/10.1093/humrep/deh822
  12. McBean JH, Gibson M, Brumsted JR. The association of intrauterine filling defects on hysterosalping-ogram with endometriosis. Fertil Steril 1996; 66: 522-6 https://doi.org/10.1016/S0015-0282(16)58562-8
  13. 손병철, 김미란, 황경주, 김영아, 류종만, 오기석. 자궁내막증과 자궁내막용종 간의 밀접한 연관성; 자궁경 시술의 필요성에 관한 연구. 대한산부회지 2001; 44: 319-23
  14. Kim MR, Kim YA, Jo MY, Hwang KJ, Ryu HS. High frequency of endometrial polyps in endometriosis. J Am Assoc Gynecol Laparosc 2003; 1: 46-8
  15. The American Fertility Society. Revised American Fertility Society classification of endometriosis. 1985; 115: 79-83
  16. 김미란, 이재훈, 서성석, 장혜진, 황경주, 김영아 등. 자궁내막증 자궁내막에서의 세포증식도와 bcl-2 단백질 발현의 증가. 대한산부회지 2005; 48: 1942-9
  17. Koninckx PR, Kennedy SH, Barlow DH. Endometriosis disease; the role of peritoneal fluid. Hum Reprod Update 1998; 4: 741-51 https://doi.org/10.1093/humupd/4.5.741
  18. Harada T, Iwabe T, Terakawa N. Role of cytokines in endometriosis. Fertil Steril 2001; 76: 1-10 https://doi.org/10.1016/S0015-0282(01)01816-7
  19. Brumsted JR, Chapitis J, Deaton JL, Riddick DH, Gibson M. Prostaglandin $F_{2\alpha}$ synthesis and metabolism by luteal phase endometrium in vitro. Fertil Steril 1989; 52: 769-73 https://doi.org/10.1016/S0015-0282(16)61029-4
  20. Loh FH, Bongso A, Fong CY, Koh DR, Lee SH, Zhao HQ. Effects of peritoneal macrophages from women with endometriosis on endometrial cellular proliferation in an in vitro coculture model. Fertil Steril 1999; 72: 533-8 https://doi.org/10.1016/S0015-0282(99)00292-7
  21. Barnhart KT, Dunsmoor-Su R, Coutifaris C. Effect of endometriosis on in-vitro fertilization. Fertil Steril 2002; 77: 1148-55 https://doi.org/10.1016/S0015-0282(02)03112-6
  22. Watanabe H, Kanzaki H, Narukawa S, Inoue T, Katsuragawa H, Kaneko Y, et al. Bcl-2 and Fas expression in eutopic and ectopic human endometrium during the menstrual cycle in relation to endometrial cell apoptosis. Am J Obstet Gynecol 1997; 176: 360-8 https://doi.org/10.1016/S0002-9378(97)70499-X
  23. Johns RK, Searle RF, Bulmer JN. Apoptosis and bcl-2 expression in normal human endometrium, endometriosis and adenomyosis. Hum Reprod 1998
  24. Brosens I. Endometriosis and the outcome of in vitro fertilization. Fertil Steril 2004; 81: 1198-200 https://doi.org/10.1016/j.fertnstert.2003.09.071
  25. Preutthipan S, Herabutya Y. Hysteroscopic polypectomy in 240 premenopausal and postmenopausal women. Fertil Steril 2005; 83: 705-9 https://doi.org/10.1016/j.fertnstert.2004.08.031
  26. van Bogaert LJ. Clinicopathologic findings in endometrial polyps. Obstet Gynecol 1988; 71: 771-3