mvjrМедицинский вестник Юга РоссииMedical Herald of the South of Russia2219-80752618-7876The Rostov State Medical University10.21886/2219-8075-2022-13-3-148-154mvjr-1645Research ArticleАКУШЕРСТВО И ГИНЕКОЛОГИЯOBSTETRICS AND GYNECOLOGYФакторы риска развития полипов эндометрия у женщин репродуктивного возрастаRisk factors for endometrial polyps’ development in reproductive-age womenhttps://orcid.org/0000-0002-1767-5536ОразовМ. Р.OrazovM. R.

Оразов Мекан Рахимбердыевич – доктор медицинских наук, профессор, профессор кафедры акушерства и гинекологии с курсом перинатологии медицинского института.

Москва.

Mekan R. Orazov - Dr. Sci. (Med.), Professor, Professor at the Department of Obstetrics and Gynecology with a Course of Perinatology, Peoples’ Friendship University of Russia (RUDN).

Moscow.

omekan@mail.ruhttps://orcid.org/0000-0003-2052-914XМихалеваЛ. М.MihalevaL. M.

Михалева Людмила Михайловна - доктор медицинских наук, профессор, директор, НИИ морфологии человека.

Москва.

Lyudmila M. Mikhaleva - Dr. Sci. (Med.), Professor, Director of the A.P. Avtsyn Research Institute of Human Morphology.

Moscow.

https://orcid.org/0000-0002-2150-7818ПоймановаО. Ф.PoymanovaO. F.

Пойманова Ольга Федоровна - аспирант кафедры акушерства и гинекологии с курсом перинатологии медицинского института.

Москва.

Olga А Poymanova - Postgraduate Student, Department of Obstetrics, and Gynecology with a Course in Perinatology, Institute of Medicine, Peoples' Friendship University of Russia (RUDN).

Moscow.

polya_88@mail.ruhttps://orcid.org/0000-0002-5773-6399МуллинаИ. A.MullinaI. A.

Муллина Ирина Александровна - аспирант кафедры акушерства и гинекологии с курсом перинатологии медицинского института.

Москва.

Irina A. Mullina - Postgraduate Student, Department of Obstetrics, and Gynecology with a Course in Perinatology, Institute of Medicine, Peoples' Friendship University of Russia (RUDN).

Moscow.

Российский университет дружбы народовРоссияPeoples’ Friendship University of Russia (RUDN)Russian FederationНаучно-исследовательский институт морфологии человекаРоссияResearch Institute of Human MorphologyRussian Federation202230092022133148154Copyright © Оразов М.Р., Михалева Л.М., Пойманова О.Ф., Муллина И.A., 20222022Оразов М.Р., Михалева Л.М., Пойманова О.Ф., Муллина И.A.Orazov M.R., Mihaleva L.M., Poymanova O.F., Mullina I.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.medicalherald.ru/jour/article/view/1645

Полипы эндометрия являются наиболее часто наблюдаемой патологической находкой в полости матки. Однако на сегодняшний день имеется мало данных, касающихся факторов развития полипов эндометрия у женщин репродуктивного возраста. Данный факт и определил направленность нашего исследования. Проведён поиск среди научных работ в базах данных Science Direct, CochraneLibrary, PubMed по ключевым словам (полипы, эндометрий, факторы развития, репродуктивный возраст) за 1994–2022 гг. Анализ научной литературы показал следующее: распространённость полипов эндометрия зависит от изучаемой популяции, при этом реальную распространённость сложно определить, поскольку эндометриальные полипы могут протекать бессимптомно и со временем регрессировать; реализация эндометриальных полипов, по-видимому, зависит не от одного, а от многих факторов (генетических, гормональных, метаболических, лекарственных); увеличение количества эндогенного эстрогена, введение экзогенных эстрогенов без прогестеронового компонента и возраст являются наиболее важными предрасполагающими факторами риска развития полипов эндометрия.

Endometrial polyps are the most commonly observed pathological finding in the uterus. However, to date, there is little data regarding the factors for the development of endometrial polyps in reproductive-age women. This fact determined the direction of our study. A search was conducted among scientific papers in the Science Direct, CochraneLibrary, PubMed databases by keywords (polyps, endometrium, risk factors, reproductive age) for 1994–2022. As a result of the analysis of the scientific literature, we came to the following conclusions: 1. The prevalence of endometrial polyps depends on the studied population, while the actual prevalence is difficult to determine, since the endometrial polyps can be asymptomatic and regress over time. 2. Implementation of endometrial polyps, apparently, depend not on one, but on many factors: genetic, hormonal, metabolic, medicinal. 3. Increasing the amount of endogenous estrogen, the introduction of exogenous estrogen without progesterone component and age are the most important predisposing risk factors for the development of endometrial polyps.

полипыэндометрийфакторы развитиярепродуктивный возрастобзорpolypsendometriumrisk factorsreproductive agereviewReferencesTanos V, Berry KE, Seikkula J, Abi Raad E, Stavroulis A, et al. The management of polyps in female reproductive organs. Int J Surg. 2017;43:7-16. DOI: 10.1016/j.ijsu.2017.05.012.Tanos V, Berry KE, Seikkula J, Abi Raad E, Stavroulis A, et al. The management of polyps in female reproductive organs. Int J Surg. 2017;43:7-16. DOI: 10.1016/j.ijsu.2017.05.012.Yuksel S, Tuna G, Celik HG, Salman S. Endometrial polyps: Is the prediction of spontaneous regression possible? Obstet Gynecol Sci. 2021;64(1):114-121. DOI: 10.5468/ogs.20242.Yuksel S, Tuna G, Celik HG, Salman S. Endometrial polyps: Is the prediction of spontaneous regression possible? Obstet Gynecol Sci. 2021;64(1):114-121. DOI: 10.5468/ogs.20242.Чернуха Г.Е., Асатурова А.В., Иванов И.А., Думановская М.Р. Структура патологии эндометрия в различные возрастные периоды. Акушерство и гинекология. 2018;8:129-135. DOI: 10.18565/aig.2018.8.129-134Chernukha G.E., Asaturova A.V., Ivanov I.A., Dumanovskaya M.R. Endometrial lesion’s pattern in different age groups. Obstetrics and Gynegology. 2018;8:129-135. (In Russ.). DOI: 10.18565/aig.2018.8.129-134Capmas P, Pourcelot AG, Giral E, Fedida D, Fernandez H. Office hysteroscopy: A report of 2402 cases. J Gynecol Obstet Biol Reprod (Paris). 2016;45(5):445-50. DOI: 10.1016/j.jgyn.2016.02.007Capmas P, Pourcelot AG, Giral E, Fedida D, Fernandez H. Office hysteroscopy: A report of 2402 cases. J Gynecol Obstet Biol Reprod (Paris). 2016;45(5):445-50. DOI: 10.1016/j.jgyn.2016.02.007Dreisler E, Stampe Sorensen S, Ibsen PH, Lose G. Prevalence of endometrial polyps and abnormal uterine bleeding in a Danish population aged 20-74 years. Ultrasound Obstet Gynecol. 2009;33(1):102-8. DOI: 10.1002/uog.6259.Dreisler E, Stampe Sorensen S, Ibsen PH, Lose G. Prevalence of endometrial polyps and abnormal uterine bleeding in a Danish population aged 20-74 years. Ultrasound Obstet Gynecol. 2009;33(1):102-8. DOI: 10.1002/uog.6259.Bakour SH, Khan KS, Gupta JK. The risk of premalignant and malignant pathology in endometrial polyps. Acta Obstet Gynecol Scand. 2000;79(4):317-20. PMID: 10746849.Bakour SH, Khan KS, Gupta JK. The risk of premalignant and malignant pathology in endometrial polyps. Acta Obstet Gynecol Scand. 2000;79(4):317-20. PMID: 10746849.Moon SH, Lee SE, Jung IK, Jeong JE, Park WY, et al. A giant endometrial polyp with tamoxifen therapy in postmenopausal woman. Korean J Obstet Gynecol. 2011;54(12):836–840. DOI: 10.5468/KJOG.2011.54.12.836Moon SH, Lee SE, Jung IK, Jeong JE, Park WY, et al. A giant endometrial polyp with tamoxifen therapy in postmenopausal woman. Korean J Obstet Gynecol. 2011;54(12):836–840. DOI: 10.5468/KJOG.2011.54.12.836Lopes RG, Baracat EC, de Albuquerque Neto LC, Ramos JF, Yatabe S, et al. Analysis of estrogen- and progesterone-receptor expression in endometrial polyps. J Minim Invasive Gynecol. 2007;14(3):300-3. DOI: 10.1016/j.jmig.2006.10.022.Lopes RG, Baracat EC, de Albuquerque Neto LC, Ramos JF, Yatabe S, et al. Analysis of estrogen- and progesterone-receptor expression in endometrial polyps. J Minim Invasive Gynecol. 2007;14(3):300-3. DOI: 10.1016/j.jmig.2006.10.022.Mittal K, Schwartz L, Goswami S, Demopoulos R. Estrogen and progesterone receptor expression in endometrial polyps. Int J Gynecol Pathol. 1996;15(4):345-8. DOI: 10.1097/00004347-199610000-00007.Mittal K, Schwartz L, Goswami S, Demopoulos R. Estrogen and progesterone receptor expression in endometrial polyps. Int J Gynecol Pathol. 1996;15(4):345-8. DOI: 10.1097/00004347-199610000-00007.Chan SS, Tam WH, Yeo W, Yu MM, Ng DP, et al. A randomised controlled trial of prophylactic levonorgestrel intrauterine system in tamoxifen-treated women. BJOG. 2007;114(12):1510-5. DOI: 10.1111/j.1471-0528.2007.01545.xChan SS, Tam WH, Yeo W, Yu MM, Ng DP, et al. A randomised controlled trial of prophylactic levonorgestrel intrauterine system in tamoxifen-treated women. BJOG. 2007;114(12):1510-5. DOI: 10.1111/j.1471-0528.2007.01545.xNijkang NP, Anderson L, Markham R, Manconi F. Endometrial polyps: Pathogenesis, sequelae and treatment. SAGE Open Med. 2019;7:2050312119848247. DOI: 10.1177/2050312119848247.Nijkang NP, Anderson L, Markham R, Manconi F. Endometrial polyps: Pathogenesis, sequelae and treatment. SAGE Open Med. 2019;7:2050312119848247. DOI: 10.1177/2050312119848247.McGurgan P, Taylor LJ, Duffy SR, O'Donovan PJ. Does tamoxifen therapy affect the hormone receptor expression and cell proliferation indices of endometrial polyps? An immunohistochemical comparison of endometrial polyps from postmenopausal women exposed and not exposed to tamoxifen. Maturitas. 2006;54(3):252-9. DOI: 10.1016/j.maturitas.2005.11.007.McGurgan P, Taylor LJ, Duffy SR, O'Donovan PJ. Does tamoxifen therapy affect the hormone receptor expression and cell proliferation indices of endometrial polyps? An immunohistochemical comparison of endometrial polyps from postmenopausal women exposed and not exposed to tamoxifen. Maturitas. 2006;54(3):252-9. DOI: 10.1016/j.maturitas.2005.11.007.Gokmen Karasu A.F., Sonmez F.C., Aydin S. Survivin expression in simple endometrial polyps and tamoxifen-associated endometrial polyps. Int J Gynecol Pathol 2018; 37(1): 27–31. DOI: 10.1097/PGP.0000000000000376.Gokmen Karasu AF, Sonmez FC, Aydin S, Adanir I, Marasli M, Ilhan GK. Survivin Expression in Simple Endometrial Polyps and Tamoxifen-associated Endometrial Polyps. Int J Gynecol Pathol. 2018;37(1):27-31. DOI: 10.1097/PGP.0000000000000376.Goldstein SR. Unusual ultrasonographic appearance of the uterus in patients receiving tamoxifen. Am J Obstet Gynecol. 1994;170(2):447-51. DOI: 10.1016/s0002-9378(94)70209-8Goldstein SR. Unusual ultrasonographic appearance of the uterus in patients receiving tamoxifen. Am J Obstet Gynecol. 1994;170(2):447-51. DOI: 10.1016/s0002-9378(94)70209-8Oguz S, Sargin A, Kelekci S, Aytan H, Tapisiz OL, Mollamahmutoglu L. The role of hormone replacement therapy in endometrial polyp formation. Maturitas. 2005;50(3):231-6. DOI: 10.1016/j.maturitas.2004.06.002Oguz S, Sargin A, Kelekci S, Aytan H, Tapisiz OL, Mollamahmutoglu L. The role of hormone replacement therapy in endometrial polyp formation. Maturitas. 2005;50(3):231-6. DOI: 10.1016/j.maturitas.2004.06.002Hassa H. Independent risk factors for endometrial polyps: diabetes, hypertension, and obesity. Asian Pacific Journal of Reproduction. 2012;1(4):312-314. DOI: 10.1016/S2305-0500(13)60099-8Hassa H. Independent risk factors for endometrial polyps: diabetes, hypertension, and obesity. Asian Pacific Journal of Reproduction. 2012;1(4):312-314. DOI: 10.1016/S2305-0500(13)60099-8Nappi L, Indraccolo U, Di Spiezio Sardo A, Gentile G, Palombino K, et al. Are diabetes, hypertension, and obesity independent risk factors for endometrial polyps? J Minim Invasive Gynecol. 2009;16(2):157-62. DOI: 10.1016/j.jmig.2008.11.004.Nappi L, Indraccolo U, Di Spiezio Sardo A, Gentile G, Palombino K, et al. Are diabetes, hypertension, and obesity independent risk factors for endometrial polyps? J Minim Invasive Gynecol. 2009;16(2):157-62. DOI: 10.1016/j.jmig.2008.11.004.Gregoriou O, Konidaris S, Vrachnis N, Bakalianou K, Salakos N, et al. Clinical parameters linked with malignancy in endometrial polyps. Climacteric. 2009;12(5):454-8. DOI: 10.1080/13697130902912605.Gregoriou O, Konidaris S, Vrachnis N, Bakalianou K, Salakos N, et al. Clinical parameters linked with malignancy in endometrial polyps. Climacteric. 2009;12(5):454-8. DOI: 10.1080/13697130902912605.Багдасарян Л.Ю., Пономаревич В.В., Карахалис Л.Ю., Стебло Е.И., Пенжоян Г.А. Факторы, влияющие на развитие полипов эндометрия. Кубанский научный медицинский вестник. 2018;25(2):25-28. DOI: 10.25207 / 1608-6228-2018-25-2-25-28Bagdasaryan L.Yu., Ponomarev V.V., Karakhalis L.Yu., Steblo E.I., Penzhoyan G.A. Factors influencing the development of endometrial polyps. Kuban Scientific Medical Bulletin. 2018;25(2):25-28. (In Russ.) DOI: 10.25207/1608-6228-2018-25-2-25-28Tabrizi AD. Histologic Features and Differential Diagnosis of Endometrial Polyps; An Update and Review. IJWHR. 2016;4(4):152-156. DOI: 10.15296/ijwhr.2016.35Tabrizi AD. Histologic Features and Differential Diagnosis of Endometrial Polyps; An Update and Review. IJWHR. 2016;4(4):152-156. DOI: 10.15296/ijwhr.2016.35Annan JJ, Aquilina J, Ball E. The management of endometrial polyps in the 21st century. The Obstetrician & Gynaecologist. 2012;14(1):33-38. DOI: 10.1111/j.1744-4667.2011.00091.xAnnan JJ, Aquilina J, Ball E. The management of endometrial polyps in the 21st century. The Obstetrician & Gynaecologist. 2012;14(1):33-38. DOI: 10.1111/j.1744-4667.2011.00091.xTaylor LJ, Jackson TL, Reid JG, Duffy SR. The differential expression of oestrogen receptors, progesterone receptors, Bcl-2 and Ki67 in endometrial polyps. BJOG. 2003;110(9):794-8. PMID: 14511960.Taylor LJ, Jackson TL, Reid JG, Duffy SR. The differential expression of oestrogen receptors, progesterone receptors, Bcl-2 and Ki67 in endometrial polyps. BJOG. 2003;110(9):794-8. PMID: 14511960.Mourits MJ, Hollema H, De Vries EG, Ten Hoor KA, Willemse PH, Van Der Zee AG. Apoptosis and apoptosis-associated parameters in relation to tamoxifen exposure in postmenopausal endometrium. Hum Pathol. 2002;33(3):341-6. DOI: 10.1053/hupa.2002.32226Mourits MJ, Hollema H, De Vries EG, Ten Hoor KA, Willemse PH, Van Der Zee AG. Apoptosis and apoptosis-associated parameters in relation to tamoxifen exposure in postmenopausal endometrium. Hum Pathol. 2002;33(3):341-6. DOI: 10.1053/hupa.2002.32226Altaner S, Gucer F, Tokatli F, Guresci S, Ozdemir C, et al. Expression of Bcl-2 and Ki-67 in tamoxifen-associated endometrial polyps: comparison with postmenopausal polyps. Onkologie. 2006;29(8-9):376-80. DOI: 10.1159/000094443Altaner S, Gucer F, Tokatli F, Guresci S, Ozdemir C, et al. Expression of Bcl-2 and Ki-67 in tamoxifen-associated endometrial polyps: comparison with postmenopausal polyps. Onkologie. 2006;29(8-9):376-80. DOI: 10.1159/000094443Antunes A Jr, Andrade LA, Pinto GA, Leão R, Pinto-Neto AM, Costa-Paiva L. Is the immunohistochemical expression of proliferation (Ki-67) and apoptosis (Bcl-2) markers and cyclooxigenase-2 (COX-2) related to carcinogenesis in postmenopausal endometrial polyps? Anal Quant Cytopathol Histpathol. 2012;34(5):264-72. PMID: 23301386.Antunes A Jr, Andrade LA, Pinto GA, Leão R, Pinto-Neto AM, Costa-Paiva L. Is the immunohistochemical expression of proliferation (Ki-67) and apoptosis (Bcl-2) markers and cyclooxigenase-2 (COX-2) related to carcinogenesis in postmenopausal endometrial polyps? Anal Quant Cytopathol Histpathol. 2012;34(5):264-72. PMID: 23301386.Hu J, Yuan R. The expression levels of stem cell markers importin13, c-kit, CD146, and telomerase are decreased in endometrial polyps. Med Sci Monit. 2011;17(8):BR221-227. DOI: 10.12659/msm.881901.Hu J, Yuan R. The expression levels of stem cell markers importin13, c-kit, CD146, and telomerase are decreased in endometrial polyps. Med Sci Monit. 2011;17(8):BR221-227. DOI: 10.12659/msm.881901.Banas T, Pitynski K, Mikos M, Cielecka-Kuszyk J. Endometrial Polyps and Benign Endometrial Hyperplasia Have Increased Prevalence of DNA Fragmentation Factors 40 and 45 (DFF40 and DFF45) Together With the Antiapoptotic B-Cell Lymphoma (Bcl-2) Protein Compared With Normal Human Endometria. Int J Gynecol Pathol. 2018;37(5):431-440. DOI: 10.1097/PGP.0000000000000442.Banas T, Pitynski K, Mikos M, Cielecka-Kuszyk J. Endometrial Polyps and Benign Endometrial Hyperplasia Have Increased Prevalence of DNA Fragmentation Factors 40 and 45 (DFF40 and DFF45) Together With the Antiapoptotic B-Cell Lymphoma (Bcl-2) Protein Compared With Normal Human Endometria. Int J Gynecol Pathol. 2018;37(5):431-440. DOI: 10.1097/PGP.0000000000000442.Miranda SP, Traiman P, Cândido EB, Lages EL, Freitas GF, et al. Expression of p53, Ki-67, and CD31 proteins in endometrial polyps of postmenopausal women treated with tamoxifen. Int J Gynecol Cancer. 2010;20(9):1525-30. DOI: 10.1111/IGC.0b013e3181f7b33b.Miranda SP, Traiman P, Cândido EB, Lages EL, Freitas GF, et al. Expression of p53, Ki-67, and CD31 proteins in endometrial polyps of postmenopausal women treated with tamoxifen. Int J Gynecol Cancer. 2010;20(9):1525-30. DOI: 10.1111/IGC.0b013e3181f7b33b.Al-Jefout M, Black K, Schulke L, Berbic M, Luscombe G, et al. Novel finding of high density of activated mast cells in endometrial polyps. Fertil Steril. 2009;92(3):1104-1106. DOI: 10.1016/j.fertnstert.2009.02.016.Al-Jefout M, Black K, Schulke L, Berbic M, Luscombe G, et al. Novel finding of high density of activated mast cells in endometrial polyps. Fertil Steril. 2009;92(3):1104-1106. DOI: 10.1016/j.fertnstert.2009.02.016.El-Hamarneh T, Hey-Cunningham AJ, Berbic M, Al-Jefout M, Fraser IS, Black K. Cellular immune environment in endometrial polyps. Fertil Steril. 2013;100(5):1364-72. DOI: 10.1016/j.fertnstert.2013.06.050.El-Hamarneh T, Hey-Cunningham AJ, Berbic M, Al-Jefout M, Fraser IS, Black K. Cellular immune environment in endometrial polyps. Fertil Steril. 2013;100(5):1364-72. DOI: 10.1016/j.fertnstert.2013.06.050.Norrby K. Mast cells and angiogenesis. APMIS. 2002;110(5):355-71. DOI: 10.1034/j.1600-0463.2002.100501.x.Norrby K. Mast cells and angiogenesis. APMIS. 2002;110(5):355-71. DOI: 10.1034/j.1600-0463.2002.100501.x.Белов А. И., Пономарева Н. А. Факторы риска развития полипов эндометрия у женщин разных возрастных групп. Молодежь-практическому здравоохранению. 2019:23-28. eLIBRARY ID: 42461478Belov A. I., Ponomareva N. A. Faktory riska razvitiya polipov endometriya u zhenshchin raznyh vozrastnyh grupp. Molodezh'-prakticheskomu zdravoohraneniyu. 2019:23-28. (In Russ.) eLIBRARY ID: 42461478Xuebing P, TinChiu L, Enlan X, Jing L, Xiaowu H. Is endometrial polyp formation associated with increased expression of vascular endothelial growth factor and transforming growth factor-beta1? Eur J Obstet Gynecol Reprod Biol. 2011;159(1):198-203. DOI: 10.1016/j.ejogrb.2011.06.036.Xuebing P, TinChiu L, Enlan X, Jing L, Xiaowu H. Is endometrial polyp formation associated with increased expression of vascular endothelial growth factor and transforming growth factor-beta1? Eur J Obstet Gynecol Reprod Biol. 2011;159(1):198-203. DOI: 10.1016/j.ejogrb.2011.06.036.Richlin SS, Ramachandran S, Shanti A, Murphy AA, Parthasarathy S. Glycodelin levels in uterine flushings and in plasma of patients with leiomyomas and polyps: implications for implantation. Hum Reprod. 2002;17(10):2742-7. DOI: 10.1093/humrep/17.10.2742.Richlin SS, Ramachandran S, Shanti A, Murphy AA, Parthasarathy S. Glycodelin levels in uterine flushings and in plasma of patients with leiomyomas and polyps: implications for implantation. Hum Reprod. 2002;17(10):2742-7. DOI: 10.1093/humrep/17.10.2742.Stenchever M.A., Droegemueller W., Herbst A.L., Mishell D.R. Benign gynecologic lesions. Comprehensive Gynecology. St. Louicis: Mosby Inc; 2001. DOI: 10.1016/S0015-0282(01)02972-7Stenchever M.A., Droegemueller W., Herbst A.L., Mishell D.R. Benign gynecologic lesions. Comprehensive Gynecology. St. Louicis: Mosby Inc; 2001. DOI: 10.1016/S0015-0282(01)02972-7Dal Cin P, Vanni R, Marras S, Moerman P, Kools P, et al. Four cytogenetic subgroups can be identified in endometrial polyps. Cancer Res. 1995;55(7):1565-8. PMID: 7882366.Dal Cin P, Vanni R, Marras S, Moerman P, Kools P, et al. Four cytogenetic subgroups can be identified in endometrial polyps. Cancer Res. 1995;55(7):1565-8. PMID: 7882366.Su T, Sui L. [Expression and significance of p63, aromatase P450 and steroidogenic factor-1 in endometrial polyp]. Zhonghua Fu Chan Ke Za Zhi. 2014;49(8):604-8. (Шт Chinese). PMID: 25354862.Su T, Sui L. [Expression and significance of p63, aromatase P450 and steroidogenic factor-1 in endometrial polyp]. Zhonghua Fu Chan Ke Za Zhi. 2014;49(8):604-8. (Шт Chinese). PMID: 25354862.Stewart CJ, Bharat C, Crook M. p16 immunoreactivity in endometrial stromal cells: stromal p16 expression characterises but is not specific for endometrial polyps. Pathology. 2015;47(2):112-7. DOI: 10.1097/PAT.0000000000000211.Stewart CJ, Bharat C, Crook M. p16 immunoreactivity in endometrial stromal cells: stromal p16 expression characterises but is not specific for endometrial polyps. Pathology. 2015;47(2):112-7. DOI: 10.1097/PAT.0000000000000211.Takeda T, Banno K, Kobayashi Y, Adachi M, Yanokura M, et al. Mutations of RAS genes in endometrial polyps. Oncol Rep. 2019;42(6):2303-2308. DOI: 10.3892/or.2019.7353.Takeda T, Banno K, Kobayashi Y, Adachi M, Yanokura M, et al. Mutations of RAS genes in endometrial polyps. Oncol Rep. 2019;42(6):2303-2308. DOI: 10.3892/or.2019.7353.Wang JH, Zhao J, Lin J. Opportunities and risk factors for premalignant and malignant transformation of endometrial polyps: management strategies. J Minim Invasive Gynecol. 2010;17(1):53-8. DOI: 10.1016/j.jmig.2009.10.012.Wang JH, Zhao J, Lin J. Opportunities and risk factors for premalignant and malignant transformation of endometrial polyps: management strategies. J Minim Invasive Gynecol. 2010;17(1):53-8. DOI: 10.1016/j.jmig.2009.10.012.Ferrazzi E, Zupi E, Leone FP, Savelli L, Omodei U, et al. How often are endometrial polyps malignant in asymptomatic postmenopausal women? A multicenter study. Am J Obstet Gynecol. 2009;200(3):235.e1-6. DOI: 10.1016/j.ajog.2008.09.876.Ferrazzi E, Zupi E, Leone FP, Savelli L, Omodei U, et al. How often are endometrial polyps malignant in asymptomatic postmenopausal women? A multicenter study. Am J Obstet Gynecol. 2009;200(3):235.e1-6. DOI: 10.1016/j.ajog.2008.09.876.

The authors declare that there are no conflicts of interest present.