Looking for a polyp, we found a...crab!
© Springer-Verlag 2010
Received: 6 April 2010
Accepted: 19 April 2010
Published: 29 April 2010
Chronic endometritis (CE) is an infectious or reactive process with multiple etiologies. The lesion is reportedly often associated with pelvic inflammatory disease, inter-menstrual bleeding, and pelvic pain .
Recently, Cicinelli and coworkers [2, 3] identified the hysteroscopic appearance of CE as characterized by the presence of endometrial micropolyps (less than 1 mm of size) associated with stromal edema, endometrial thickening and peri-glandular hyperhemia. These subtle lesions may be sporadic or may cover most of the endometrial surface. The detection of plasma cells in the stromal tissue of micropolyps is considered a marker of CE .
The association between endometrial polyps and CE is still unclear. However, it is likely that in both cases, impaired endometrial proliferative processes are involved.
Multiple endometrial biopsies were performed with grasping forceps with teeth and histology confirmed the hysteroscopically suspected diagnosis of CE
Antibiotic therapy (doxiciclin 100 mg twice a day) was administered to our patient for 15 days. An office hysteroscopy was performed 2 months later showing a normal pinkish endometrial mucosa with the polyp crab-like being completely removed by means of 5Fr bipolar electrode (Versapoint Twizzle electrode, Gynaecare, Ethicon) and grasping forceps.
The hysteroscospic findings are often out of the ordinary and difficult to be interpreted; images taken from every-day life can help the operator to better describe such uncommon findings. Endometrial biopsy is recommended mostly to rule out infective or neoplastic endometrial conditions.
The authors thank Dr Anna De Lucia for her kind collaboration to the study as a graphic designer.
Declaration of interest
The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
- Smith M, Hagerty KA, Skipper B, Bocklage T (2010) Chronic endometritis: a combined histopathologic and clinical review of cases from 2002 to 2007. Int J Gynecol Pathol 29(1):44–50View ArticlePubMedGoogle Scholar
- Cicinelli E, Resta L, Nicoletti R, Tartagni M, Marinaccio M, Bulletti C, Colafiglio G (2005) Detection of chronic endometritis at fluid hysteroscopy. J Minim Invasive Gynecol 12(6):514–518View ArticlePubMedGoogle Scholar
- Cicinelli E, Resta L, Nicoletti R, Zappimbulso V, Tartagli M, Saliani N (2005) Endometrial micropolyps at fluid hysteroscopy suggest the existence of chronic endometritis. Hum Reprod 20(5):1386–1389View ArticlePubMedGoogle Scholar
- Yudin MH, Hillier SL, Wiesenfeld HC, Krohn MA, Amortegui AA, Sweet RL (2003) Vaginal polymorphonuclear leukocytes and bacterial vaginosis as markers for histologic endometritis among women without symptoms of pelvic inflammatory disease. Am J Obstet Gynecol 188:318–323View ArticlePubMedGoogle Scholar