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Uterine Polyp

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N84.0 Uterine Polyp

Polyp: endometrium. uterus BDU Excluded: endometrial polyplasm hyperplasia (N85.0)

N84.1 Cervical Polyp

Polyp mucous membrane of the cervix

N84.2 Vaginal Polyp

N84.3 Polyp of the vulva

Labia polyp

N84.8 Polyp of other departments of the female genital organs

N84.9 Female genital polyp, unspecified

In the treatment of female genital polyp, medications are used:

The International Statistical Classification of Diseases and Health Related Problems is a document used as a leading foundation in health care. The IBC is a regulatory document ensuring the unity of methodological approaches and international comparability of materials. The International Classification of Diseases of the Tenth Revision (ICD-10, ICD-10) is currently in force. In Russia, health authorities and institutions carried out the transition of statistical accounting to ICD-10 in 1999.

© 2013-2017 ICD 10 - International Classification of Diseases, 10th Revision

Definition and General Information [edit]

Endometrial polyps are found in 5.3-25% gynecological patients of all ages, but more often in pre- and postmenopausal women.

Depending on the histological structure, there are glandular (functional, basal) types, fibrous fibrosis and fibrous endometrial polyps. Adenomatous polyps are referred to as precancerous conditions of the uterine lining.

Clinical manifestations [edit]

With large endometrial polyps, there may be cramping abdominal pain. Sometimes endometrial polyps are asymptomatic. Often in the reproductive age of complaints of infertility, usually primary. The role of endometrial polyps in infertility and miscarriage is discussed, but in 24% of women with infertility endometrial polyps are found.

Uterine Polyp: Diagnosis [edit]

With endometrial polyps, ultrasound sensitivity reaches 80–98%. Informative studies reduce obesity, adhesions in the pelvis, MM (uterine fibroids) and adenomyosis, low resolution of the equipment. Facilitates the diagnosis of the presence of fluid in the uterus (menstrual blood, serosometer), thanks to which the uterus cavity is contrasted and clarity of polyp visualization is achieved. Diagnostic signs of endometrial polyp: local or uniform (with large polyps) thickening of M-echo, including increased or uneven echogenicity of a round or ovoid shape in the structure of M-echo. In 40% of observations in the structure of the polyp, blood flow is recorded during a Doppler study. With ultrasound, it is difficult to diagnose glandular polyps, which, due to the shape of the uterus, have a flattened leaf-like shape, and their sound conductivity is close to that of the endometrium.

In the case of the polypous form of the GpE, its surface looks uneven in the form of pits, cysts, grooves, and sections of the polypous form of a pale pink color. The size of polyps varies from 0.1 to 1.5 cm. As a rule, in the area of ​​the bottom of the uterus, the described changes are more pronounced.

Polypous hyperplasia of the endometrium, especially on the eve of menstruation, is difficult to distinguish from the endometrium in the late secretion phase. In such cases, the hysteroscopic and clinical picture of the disease, the day of the menstrual cycle are compared.

During hysteroscopy, endometrial fibrous polyps look like single pale formations of a round or oval shape, unvascularized, usually of a small size (0.5–1.5 cm), with a dense leg and a smooth surface. When a polyp is found, it is examined from all sides, the size, location, attachment, and size of the leg are estimated.

Glandular-cystic polyps are more often of a large size (0.5-6 cm), single formations, but there can be several polyps at the same time. The shape of the polyps is oblong, conical, irregular (with bridges). The surface is smooth, even, in some cases cystic formations with a thin wall and transparent contents protrude above it. The color of polyps is pale pink, pale yellow, grayish-pink. Not rarely the top of a polyp is dark-purple or bluish-purple. On the surface of the polyp visible vessels in the form of a capillary network.

Endometrial adenomatous polyps are more often localized closer to the mouths of the fallopian tubes, are small in size (0.5-1.5 cm), look dull, gray, loose.

A characteristic feature of endometrial polyps is the variability of their shape when changing the flow rate of a liquid or gas into the uterine cavity. At the same time, polyps flatten, increase in diameter, with a decrease in pressure, they stretch in length and make oscillatory movements.

Postmenopausal endometrial polyps are usually solitary, rarely two, and very rarely three. They are always determined against the background of an atrophic mucous membrane. Sometimes they reach a large size and, going beyond the external opening of the cervix, imitate polyps of the cervical canal

Uterine Polyp: Treatment [edit]

Polypectomy. Therapeutic and diagnostic curettage of the uterine mucosa, carried out without endoscopic control, often does not completely remove the endometrial polyp, especially if it has fibrous and muscular components. Complete removal of the endometrial polyp is possible only when using hysteroscopy.

Single leg polyps are removed with forceps or scissors inserted through the hysteroscope surgical channel.

Great difficulties arise when removing an endometrial polyp in the area of ​​the mouths of the fallopian tubes (the zone of the greatest proliferative activity of the endometrium) due to the high risk of uterine perforation, since the thickness of the walls of the uterus in this area is no more than 3-4 mm. The mechanical method of targeted polypectomy is the safest and most effective with similar localization of polyps.

For removal of large endometrial polyps, fibrous and parietal polyps, the use of a resectoscope with a loop electrode is optimal. The loop of the electrode is led to the base of the polyp and cut the polyp together with the base to the muscle layer. With the mechanical removal of large endometrial polyps, the cervical canal is further expanded with Gegar's dilators to No. 12-13. Then, an abortion is precisely fixed to the polyp and removed by unscrewing and then controlling hysteroscopy. This method is difficult to remove the leg of the fibrous polyp, and you have to additionally excise the leg of the polyp with scissors or forceps held through the surgical channel of the hysteroscope.

Further tactics may be different. It is believed that hormonal treatment after removal of polyps is indicated for functional glandular polyps and adenomatous polyps, as well as for the combination of endometrial polyps with HPE.

Endometriosis by ICD-10

Pathological growth of the endometrium refers to hormone-dependent gynecological diseases. Experts attributed endometriosis according to the latest ICD-10 to the interval N80-N98, code N80. The class is divided into the following subsections:

  • N0 - endometriosis of the uterus,
  • N1 - ovarian endometriosis,
  • N2 - endometriosis of the fallopian tubes,
  • N3 - pelvic peritoneum endometriosis,
  • N4 - endometriosis of the rectovaginal septum and vagina,
  • N5 - intestinal endometriosis,
  • N6 - endometriosis of the skin scar,
  • N8 - other endometriosis (endometriosis of the chest),
  • N9 - endometriosis, unspecified.

In endometriosis, the glandular tissue of the uterus grows beyond the limits of this organ. Once in other parts of the female body, the endometrium is subject to the same cyclical changes as the endometrium of the uterus.

It depends on the phase of the menstrual cycle, is subject to cyclic bleeding, increasing the volume and changing the functioning of the organ in which it is located.

The foci of endometriosis, or heterotopia, have a size from a few millimeters to several centimeters. 4 degrees of the disease are diagnosed depending on the depth or distribution of heterotopies.

Symptoms of the disease:

  • Periodic or permanent pelvic pain,
  • Painful menstruation,
  • Pain when urinating, defecating, intercourse,
  • Anemia (weakness, drowsiness, headaches),
  • Infertility.

A complication of the disease - adhesions in the pelvis and in the abdominal cavity, the formation of "chocolate" cysts filled with old menstrual blood, neurological symptoms due to compression of the nerve endings with heterotopies. Malignant degeneration of endometrial foci is rarely diagnosed.

Endometrial hyperplasia according to ICD-10

Hyperplasia refers to endometrial hyperplastic processes. This disease is manifested by excessive growth of the stroma or glandular cells of the mucous membrane of the uterus. According to the current classification version, endometrial hyperplasia takes the place of N85 in the ICD in the range of N80-N98. There are also subsections:

  • N0 - endometrial glandular hyperplasia,
  • N1 - endometrial adenomatous hyperplasia.

Hyperplastic processes depend on hormonal regulation and the balance of female sex hormones. If it is broken, the maturation and rejection of the endometrium, as well as the menstrual cycle, occurs in a distorted manner.

The most frequent symptom of the disease is heavy bleeding between menstruations, which can be smearing. There may be lower abdominal pain, infertility. If bleeding becomes abundant, signs of anemia increase - weakness, dizziness, pallor of the skin.

Against the background of hyperplasia, atypical cells can develop, leading to the development of malignant tumors of the uterus. Such a degeneration most often leads to a diffuse or focal form of hyperplasia, or endometrial adenomatosis.

It can be both focal and diffuse, that is, to cover the entire uterine cavity. The mucosa of the uterus is subject to this transformation in 10% of patients suffering from endometrial hyperplasia.

ICD-10 endometrial polyp

Polyps can form on the female genital organs - on the body and cervix, in the cervical canal, on the vulva and in the vagina. Polyps by classification belong to the class N80-N98, where they have the code N84.

Subsections:

  • N0 - uterine body polyp,
  • N1 - cervical polyp,
  • N2 is a vaginal polyp,
  • N3 - vulvar polyp
  • N8 - a polyp of other parts of the female genital organs,
  • N9 - female genital polyp, unspecified.

In this protocol, the endometrial polyp has IC84-10 code N84.0by entering the category of uterine body polyp.

Separately, the C00-D48 interval includes neoplasms, D10-D36 is benign tumors, a place in the D28 classification, which includes polyps of the vulva, vagina, fallopian tubes and ligaments, adenomatous polyps and polyps of the skin of the female genital organs.

A polyp is a pedicle formation that has minimal chances of self-withdrawal. Endometrial polyps are divided into the following types:

  • Fibrous,
  • Ferrous,
  • Glandular fibrous,
  • Adenomatous.

The most dangerous of them are adenomatous formations, prone to transformation into a malignant tumor. The causes of the development of polyposis is a hormonal imbalance in the female body, provoking enhanced cell division. Symptoms of polyposis of the female genital organs:

  • Abnormal bleeding
  • Lower abdominal pain
  • Menstrual disorders,
  • Manifestations of anemia.

Severe effects of polyposis - infertility, miscarriage, necrotization of the polyp, the development of atypical cells.

Treatment of gynecological diseases depends on the severity of the pathology, the stage of development of the disease and its type.

ICD-10 classes

In Russia International Classification of Diseases 10th revision (ICD-10) adopted as a single regulatory document to account for the incidence, causes of public calls to medical institutions of all departments, causes of death.

ICD-10 introduced into the practice of health care throughout the territory of the Russian Federation in 1999 by order of the Ministry of Health of Russia dated May 27, 1997. №170

The release of a new revision (ICD-11) is planned by WHO in 2017 2018

Short description

Endometrial polyp referred to as benign formation, which is formed due to the proliferation of the mucous membrane of the uterus - the endometrium.

Polyp of the cervical canal (cervical polyp) is a tumor-like formation that grows from the wall of the cervical canal into its lumen, having a stem or a broad base. Polyps are usually located in the area of ​​the external pharynx and are clearly visible to the naked eye, but often the base of the polyp is located in the middle or upper third of the cervical canal. Polyps can be single or multiple.

I. INTRODUCTORY PART

Protocol name: "Female genital polyps"
Protocol code:

ICD-10 code (s):
N84 Female Genital Polyp
N84.0 Uterine Polyp
N84.1 Cervical Polyp
N84.2 Vaginal Polyp
N84.3 Polyp of the vulva
N84.8 Polyp of other departments of the female genital organs
N84.9 Female genital polyp, unspecified

Abbreviations used in the protocol:
Ultrasound - ultrasound
OMT - pelvic organs
MRI magnetic resonance imaging

Protocol development date: May 2013
Patient category: gynecological patients
Protocol users: obstetricians-gynecologists, GPs, midwives, examination rooms, gynecological oncologists

Classification

Clinical classification

Polyps located in the uterus are called endometrial polyps and, depending on the results of histological examination, the following types of uterus polyps are distinguished:
- Uterine glandular polyps are polyps formed from endometrial tissue (the inner lining of the uterus) that contains glands.
- Glandular fibrous polyps - consist of the endometrial glands and their supporting connective tissue (stroma).
- Fibrous polyps mainly consist of dense fibrous tissue and can contain only single glands. As a rule, fibrous polyps develop in women after 40 years.
- Adenomatous polyps are endometrial polyps that have a high probability of transition to endometrial cancer (the inner lining of the uterus).

Polyps located in the cervical canal are called cervical polyps and there are the following types:
- Ferruginous (covering single row cylindrical epithelium),
- Epidermized (covered with metaplastic multilayered epiethial).

Classification of polyps of other parts of the female genital organs does not exist.

Diagnostics

Ii. METHODS, APPROACHES AND PROCEDURES FOR DIAGNOSTICS AND TREATMENT

List of main and additional diagnostic measures:
Main
1. Examination of the external genital organs
2. Inspection of the vagina and cervix on the mirrors
3. Bimanual research
4. ultrasound
5. Hysteroscopy
6. Histological examination

Additional
1. Colposcopy
2. Smear on oncocytology

Minimum checkup list for planned hospitalization
According to the instructions for the examination of patients for planned surgical treatment

Diagnostic criteria

Complaints and anamnesis - intermenstrual vaginal bleeding, spotting bleeding from the vagina during and after sexual intercourse (a polyp is mechanically injured during sexual intercourse), heavy menstrual bleeding, copious mucous discharge from the vagina, pain and discomfort during sexual intercourse.

Physical examination:
- examination of the external genital organs
- examination of the vagina and cervix on the mirrors. On examination of the cervix on the mirrors, an education with distinct contours, often pear-shaped, with a smooth surface, bright pink color, which is attached to the mucous membrane of the cervical canal and may protrude beyond the external cervix of the cervix, is detected.
- vaginal examination

Laboratory research: the decisive method for the diagnosis of polyps is histological examination of the material.

Instrumental studies:
1. Ultrasonography allows the doctor to see a thickening of the endometrium (inner layer of the uterus), as well as the presence of outgrowths in the uterus (polyps). Modern ultrasound equipment with high resolution allows you to diagnose polyps of small size, not beyond the outer os. They look like inclusions of increased or medium echogenicity in the cervical canal.
2. Hysteroscopy - growths of various size and shape are determined in the uterine cavity.

Endometrial fibrous polyps during hysteroscopy are defined as pale single formations, round or oval, more often of small size (from 0.5x1 to 0.5x1.5 cm), usually on the leg, dense structure, with a smooth surface, there is little vascularisation. Sometimes fibrous endometrial polyps reach large sizes, and during hysteroscopy, the surface of a polyp that fits tightly against the wall of the uterus is mistakenly considered an atrophic mucous membrane and the polyp is not diagnosed. When a polyp is detected, it is necessary to examine it from all sides, to estimate the size, localization, place of attachment, the size of the leg. Fibrous polyps resemble submucous myomatous nodes.

Endometrial glandular polyps, unlike fibrous, more often large (from 0.5x1 to 5x6 cm), isolated, although there may be several polyps. The shape of the polyps is oblong, conical, irregular (with bridges), the surface is smooth, even, in some cases, above it are cystic formations with a thin wall and transparent contents). The color of polyps is pale pink, pale yellow, grayish-pink. Often the top of a polyp is dark purple or bluish purple. On the surface of the polyp are visible vessels in the form of a capillary network).

Endometrial adenomatous polyps чаще локализуются ближе к ус­тьям маточных труб и, как правило, бывают небольших размеров (от 0,5x1 до 0,5x1,5 см), выглядят тусклыми, серыми, рыхлыми. Adenomatous changes can be determined in the tissue of glandular-cystic polyps, in this case, the nature of the polyp during endoscopic examination can not be determined.

Endometrial polyps change shape when changing the rate of flow of liquid or gas into the uterus. At the same time, polyps flatten, increase in diameter, and when pressure decreases, they stretch out in length and oscillate.

Indications for expert advice - not.

What does this concept include?

The polyp is formed from the components of the endometrial growth part, which excludes the chance of neoplasm self-elimination. It has the form of an elevation on a leg, it can consist of different cells, which determines its appearance:

  • Glandular. Appears more often in the reproductive period, because its development is dependent on the nuances of menstrual disorders. These polyps consist mainly of glandular tissue. They have a light pink or gray color with a vascular pattern, are located at the bottom or in the corners of the uterus,
  • Fibrous. It forms less often than the previous type, consists of a connecting material. These formations have the shape of an oval, pink or yellowish color, smooth shell and a wide area of ​​the base. Most of them grow up alone
  • Glandular fibrous. It is a mix of two fabrics in which connective prevails. The color is pale gray or pink, a shell with markedly enlarged vessels,
  • Adenomatous. Initially formed from the glands, but is characterized by rapid growth and therefore the danger of becoming a malignant tumor. They are more often found in menopause. Adenomatous neoplasms have bluish or gray color, their configuration is uneven. These are the most dangerous tumors, therefore, this type of endometrial polyp has a special code of μB 10 - under number D 28.

Despite the fact that, according to the classification, a tumor is part of a hyperplastic process, before menopause and long before it, they can also occur with a usually developing mucous membrane. In postmenopausal polyps appear on the background of atrophic changes in the endometrium.

What causes the appearance of polyps

Polyp endometrium appears on the background of hormonal failure with excess estrogen concentration. The substance stimulates the growth of tissues due to the increased division of their cells, and also provokes a disorder of menstrual function. Replacing the functional layer of the mucosa occurs with all sorts of problems, which causes changes in some of its segments. There are localized polyps. "Help" this can:

  • Abortions performed with organ damage
  • Inflammatory processes in the endometrium,
  • Uterine fibroids,
  • Internal endometriosis,
  • Diabetes,
  • Benign neoplasms on the ovaries (cysts, polyps, tumors),
  • Adrenal dysfunction,
  • Obesity,
  • Incorrect use of hormonal medications.

The excess estrogen is usually supplemented by progesterone deficiency, often by anovulation. Hormone disorder is total, which also affects the work of other organs. It has been recorded that women with a diagnosis of endometrial polyp often have chronic cholecystitis, dysfunction of the gallbladder.

How a polyp makes you aware of your presence

Since the processes that cause hyperplastic changes in the mucous membrane, have a noticeable effect on the body, MCC 10 classifies the endometrial polyp according to the following symptoms:

  • Increased menstrual flow
  • The irregularity of the arrival of critical days
  • Bleeding on other days of the cycle,
  • Contact with blood,
  • Pain in the lower abdomen, if the tumor is not one or a noticeable magnitude.

When an adenomatous polyp occurs, women also have complaints about:

  • Headaches,
  • Unreasonable weight gain
  • Somnological disorders
  • The appearance of hair where there was none before
  • Quick tiredness, irritability.

We recommend to read the article on menstruation with a polyp. You will learn about the causes of its occurrence, the effect of education on the nature of menstruation and cycle, methods of treatment of the disease.

The consequences of the development of endometrial polyps

Endometrial polyp mkb included in the subheading "polyps of the uterus". The consequences of its presence on the mucous surface of an organ can interfere with many of its tasks and the reproductive system in general. Among the most serious:

  • Anemia. Discharges appearing in a disease result in a large volume of blood loss, which the body cannot compensate. There is a deficiency of hemoglobin, lack of oxygen in the tissues, as a result of this, fatigue, constant drowsiness, fainting,

  • Infertility and miscarriage. The imbalance of female hormones caused by the violation of the cycle due to the formation prevents the maturation of the sex cell, and conception does not occur. If ovulation has occurred, and then pregnancy has occurred, the incorrectly forming uterine membrane is unable to receive the fertilized egg,
  • Problems with pregnancy. The existence of a polyp does not exclude conception by 100%, but seriously complicates the development of a new state. Because of the inferiority of the endometrium, the threat of abortion, bleeding, placental abruption is constantly living. The fetus may not be required for the development of substances due to insufficient blood supply to the uterus,
  • Transformation of normal cells into atypical. Uterine cancer is much more dangerous and more difficult to eliminate disease,
  • Dying off a polyp. When the necrosis process starts in his area, it occurs with heavy bleeding and pain. It requires urgent care, which consists in removing the tumor or the entire organ.

If the scraping and cauterization are carried out qualitatively, the return of the indisposition to the woman is not threatened.

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