title: Functional endometrial polyps in infertile asymptomatic patients: a possible evolution of vascular changes secondary to endometritis.
abstract: OBJECTIVE
  Functional polyps and chronic endometritis are among the most common abnormalities seen in the endometrium of patients with implantation failures and recurrent miscarriages. In this study we describe morphological vascular changes in endometrial samples from asymptomatic infertile patients and their association with chronic endometritis and polyp.
  
  
  METHODS
  We selected 435 asymptomatic infertility patients submitted to office-based diagnostic hysteroscopy and endometrial biopsy. We described vascular changes and searched for histologic signs of endometritis and functional polyps in the endometrial samples. We explored the associations between these conditions.
  
  
  RESULTS
  Signs of endometritis, vascular changes and polyps were identified in 176 (40.5%), 168 (38.6%) and 102 (23.4%) cases, respectively. There was a significant association between endometritis and vascular changes. The more frequent vascular alteration (70%) was the hyaline thickening of vessels, a morphological pattern very similar to the thick-walled vessels of polyps. Polyps were associated with endometritis in 28 (27.4%) cases and with other vascular changes besides the vascular stalk in 14 (13.7%). All the polyps with vascular changes had histologic evidence of endometritis. There was a significant association between inflammatory phenomena and vascular changes, even among cases of polyps.
  
  
  CONCLUSIONS
  Endometrial samples from infertile patients present a broad spectrum of vascular changes, most of them associated with endometritis. This association is also identified in functional polyps. Our results suggest that these alterations may be etiologically related. It is possible that the vessel axis of functional polyps actually may originate from the evolution of the vascular changes associated with endometritis. This would place functional polyps among the spectrum of inflammatory endometrial diseases.
authors.affiliation: Department of Pathology of Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP 01246-903, Brazil. Electronic address: filomena@usp.br.
authors.forename: Filomena Marino
authors.initials: FM
authors.lastname: Carvalho
authors.forename: Fernando Nalesso
authors.initials: FN
authors.lastname: Aguiar
authors.forename: Renato
authors.initials: R
authors.lastname: Tomioka
authors.forename: Ricardo M
authors.initials: RM
authors.lastname: de Oliveira
authors.forename: Nilo
authors.initials: N
authors.lastname: Frantz
authors.forename: Joji
authors.initials: J
authors.lastname: Ueno
mesh_terms: D000328:Adult; D004716:Endometritis / Q000150:complications* / Q000473:pathology; D004717:Endometrium / Q000098:blood supply / Q000473:pathology*; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000209:etiology* / Q000473:pathology; D008875:Middle Aged; D009389:Neovascularization, Pathologic; D011127:Polyps / Q000150:complications* / Q000473:pathology; D055815:Young Adult
keywords: Endometrial biopsy; Endometrial polyps; Endometrial vasculopathy; Endometritis; Infertility