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Polypoid fragments of endometrial tissue lined by epithelium on 3 sides Surface epithelium May be atrophic but often is proliferative even in postmenopausal women Papillary proliferations with fibrovascular cores occasionally occur on the surface of an endometrial polyp or within cystically dilated glands May exhibit a degree of atypia, often with degenerated appearing nuclei and sometimes, hobnail cell change Reactive surface changes can be seen, including breakdown shedding and hemorrhage Fibrous stroma, rich in collagen with abundant extracellular connective tissue Can contain a variable amount of edema, occasional myxoid change and hemosiderin pigment laden macrophages Collections of thick walled blood vessels are common; ectatic thin walled vessels may be seen Bundles of smooth muscle within the stroma may be present, often in close proximity to thick walled blood vessels More prominent smooth muscle component may be seen Int J Gynecol Pathol 2000; 19 195 See also myomatous variant below and adenomyoma in the Differential diagnosis Conventional endometrial, endocervical, or adenomyomatous pedunculated, or sessile lesion with histologic features diagnostic of polyp Glandular architecture out of phase with the background endometrium Angulated, tubular or cystically dilated Usually endometrioid in type inactive, proliferative or functional May exhibit metaplastic changes, including ciliated, eosinophilic, mucinous and squamous metaplasia Proliferative activity in a polyp in a postmenopausal woman is of no clinical importance if present in the nonpolypoid endometrium, it is useful to comment on Polyps originating at the junction of the upper endocervix lower uterine segment contain both endocervical and ciliated lower uterine segment type glands If present, the parallel arrangement of the long axis of the endometrial glands to the surface epithelium is a useful diagnostic finding; this feature is especially helpful in premenopausal women Am J Surg Pathol 2004; 28 1057 Show fibrotic, sparsely cellular stroma, metaplastic glands including mucinous metaplasia, edema, decidualization or myxoid change, periglandular stromal epithelial metaplasia and shedding Staghorn shaped glands dilated glands with stromal projections within their luminal spaces polarized along the long axis of the polyps and periglandular stromal condensations in the absence of conspicuous mitotic activity have been also reported May be multiple and can recur Int J Gynecol Pathol 1999; 18 130, Int Urogynecol J Pelvic Floor Dysfunct 2000; 11 120, Int J Gynecol Pathol 1998; 17 302, Obstet Gynecol 1992; 79 111 Endometrial polyp with atypical stromal cells Presence of bizarre atypical stromal cells in endometrial polyps and nonpolypoid endometrium has been documented in case reports and few series Am J Surg Pathol 2015; 39 116 Stromal cells show markedly atypical symplastic like nuclei, resembling those seen elsewhere in the female genital tract e cialis without prescription

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