Cervical polyp: Difference between revisions

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__NOTOC__
__NOTOC__
{{SI}}                                                                 
{{SI}}                                                                 
{{CMG}} {{AE}} {{MV}}
{{CMG}} {{AE}} {{MV}} {{ADG}}
   
   
{{SK}} Polypoid cervical lesion; Cervical polypoid lesion; Polypoid cervical growth  
{{SK}} Polypoid cervical lesion; Cervical polypoid lesion; Polypoid cervical growth  
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==Overview==
==Overview==


[[Cervical polyp]]s are defined as polypoid benign overgrowths of endocervical tissue. Usually, cervical polyps are growths projecting into the cervical canal. Cervical polyps are the most common cause of intermenstrual vaginal bleeding.<ref name="pmid8125411">{{cite journal |vauthors=Golan A, Ber A, Wolman I, David MP |title=Cervical polyp: evaluation of current treatment |journal=Gynecol. Obstet. Invest. |volume=37 |issue=1 |pages=56–8 |year=1994 |pmid=8125411 |doi= |url=}}</ref> There are no established causes for cervical polyp.<ref name="pmid8125411">{{cite journal |vauthors=Golan A, Ber A, Wolman I, David MP |title=Cervical polyp: evaluation of current treatment |journal=Gynecol. Obstet. Invest. |volume=37 |issue=1 |pages=56–8 |year=1994 |pmid=8125411 |doi= |url=}}</ref> Cervical polyps may be classified according to morphological features, such as: distribution, shape, size, and pedicle. The pathogenesis of cervical polyp is characterized by chronic inflammation of the endocervical canal. Typically, cervical polyps arise from the endocervical canal and tend to protrude in the external cervix.  The estimated prevalence of cervical polyp is approximately 1.5–10% in general population.<ref name="pmid8125411">{{cite journal |vauthors=Golan A, Ber A, Wolman I, David MP |title=Cervical polyp: evaluation of current treatment |journal=Gynecol. Obstet. Invest. |volume=37 |issue=1 |pages=56–8 |year=1994 |pmid=8125411 |doi= |url=}}</ref> Common risk factors in the development of cervical polyp, include:<ref name="pmid8125411">{{cite journal |vauthors=Golan A, Ber A, Wolman I, David MP |title=Cervical polyp: evaluation of current treatment |journal=Gynecol. Obstet. Invest. |volume=37 |issue=1 |pages=56–8 |year=1994 |pmid=8125411 |doi= |url=}}</ref>
[[Cervical polyp]]s are defined as polypoid benign overgrowths of endocervical tissue. Usually, cervical polyps are growths projecting into the cervical canal. Cervical polyps are the most common cause of intermenstrual [[vaginal bleeding]].There are no established causes for cervical polyps. They can be classified according to their morphological features such as: distribution, shape, size, and the presence of a pedicle. The pathogenesis of cervical polyp is characterized by [[chronic inflammation]] of the endocervical canal. Typically, cervical polyps arise from the endocervical canal and tend to protrude into the [[Cervix|external cervix]].  The estimated prevalence of cervical polyps is approximately 1.5–10% in the general population. Common risk factors of the development of cervical polyps, include: [[chronic inflammation]], hormonal factors, presence of [[endometrial hyperplasia]], and previous history of pregnancy.  Cervical polyps are more commonly observed among [[perimenopausal]] and [[postmenopausal]] women. Early clinical features may include abnormal vaginal bleeding, postcoital vaginal bleeding, and abnormal [[vaginal discharge]]. The diagnosis of a cervical polyp is made with a [[Biopsy|cervical biopsy]], findings may include: inflamed and dilated endocervical (mucus) glands and myxoid stroma.  Ring forceps in conjunction with biopsy is the most common approach for the treatment of cervical polyps.
chronic inflammation, hormonal factors, presence of endometrial hyperplasia, and previous history of pregnancy.  Cervical polyp is more commonly observed among perimenopausal and postmenopausal women.<ref name="pmid8125411">{{cite journal |vauthors=Golan A, Ber A, Wolman I, David MP |title=Cervical polyp: evaluation of current treatment |journal=Gynecol. Obstet. Invest. |volume=37 |issue=1 |pages=56–8 |year=1994 |pmid=8125411 |doi= |url=}}</ref> Early clinical features may include abnormal vaginal bleeding, postcoital vaginal bleeding, and abnormal vaginal discharge. The diagnosis of cervical polyp is made with a cervical biopsy, findings may include: nflamed and dilated endocervical (mucus) glands and myxoid stroma.  Ring forceps in conjunction with biopsy is the most common approach to the treatment of cervical polyp.
 
 
==Historical Perspective==
==Historical Perspective==
*Cervical polyp was first described by Peterson and Novak in 1956 following the description of endometrial polyps.<ref name="history>Peterson WF, Novak ER. Endometrial polyps. Obstet Gynecol. 1956;
Cervical polyps were first described by Peterson and Novak in 1956 following the description of [[Endometrial polyp|endometrial polyps]].<ref name="history">Peterson WF, Novak ER. Endometrial polyps. Obstet Gynecol. 1956;
8:40–49.</ref>
8:40–49.</ref><ref name="pmid8125411">{{cite journal |vauthors=Golan A, Ber A, Wolman I, David MP |title=Cervical polyp: evaluation of current treatment |journal=Gynecol. Obstet. Invest. |volume=37 |issue=1 |pages=56–8 |year=1994 |pmid=8125411 |doi= |url=}}</ref>


==Classification==
==Classification==
*Cervical polyps may be classified according to morphological features into 4 subtypes, such as:<ref name="pmid8125411">{{cite journal |vauthors=Golan A, Ber A, Wolman I, David MP |title=Cervical polyp: evaluation of current treatment |journal=Gynecol. Obstet. Invest. |volume=37 |issue=1 |pages=56–8 |year=1994 |pmid=8125411 |doi= |url=}}</ref>
Based on polyp location, cervical polyps can be classified into two types:
*''' Distribution'''
* '''Ectocervical polyps'''
:*Single
** Develop from the outer surface layer cells of the [[Cervix uteri|cervix]].
:*Multiple
** More commonly seen in [[postmenopausal]] women.
* '''Endocervical polyps'''
** Develop from cervical glands inside the cervical canal.
** The majority of cervical polyps are endocervical polyps.
** More commonly seen in [[premenopausal]] women.
 
==Pathophysiology==
 
=== Anatomy ===
* The normal [[cervix]] is fusiform in shape, with the narrowest portions at the [[Internal orifice of the uterus|internal]] and [[External orifice of the uterus|external os]]. It measures 3 to 5 cm in length and 2 to 3 cm in diameter.
* The portio vaginalis, is the visible portion of the [[cervix]] that protrudes into the [[vagina]] and is surrounded by a reflection of the vaginal wall on each side termed the anterior, posterior, and lateral [[fornix]].
** The supravaginal cervix is the intra-abdominal portion of the [[cervix]] that lies above the point of attachment of the vaginal vault
** The peritoneum posterior to the supravaginal cervix forms the lining of the posterior cul-de-sac (pouch of Douglas).
* The [[External os|external cervical os]] is small, round, and centrally placed in nulliparous women.
* In parous women who have labored into the third stage, it is more likely to be a patulous, transverse slit.
* The [[Cervical os|internal cervical os]] is normally less than 3 mm in diameter in nonpregnant women, even if parous .
* In the sagittal axis, the [[cervix]] lies between the [[bladder]] and [[rectum]].
* The [[cervix]] is supported by the [[uterosacral ligaments]], which surround the [[cervix]] and [[vagina]] and extend laterally and posteriorly toward the second to fourth [[sacral vertebra]], and the [[cardinal ligaments]], which are fibromuscular bands that fan out laterally from the lower uterine segment and cervix to the lateral pelvic walls.


*'''Shape'''
=== Blood Supply ===
:*Tear shaped
* The blood supply comes from a descending branch of the [[uterine artery]].
:*Lobular
** The [[lymphatic drainage]] is to the parametrial nodes, then to the obturator, internal iliac, and external iliac nodes with secondary drainage to the presacral, common iliac, and para-aortic lymph nodes.


*'''Size'''
=== Nerve Supply ===
:*Less than 3 cm
* The nerve supply is autonomic ([[sympathetic]] and [[Parasympathetic nervous system|parasympathetic]]).
:*More than 3 cm
* The nerves enter the upper cervix on either side and form two lateral semicircular plexuses, called Frankenhäuser plexus, a terminal part of the presacral plexus.


*'''Pedicle'''
=== Pathogenesis ===
:*Broad-based
:*Sessile
==Pathophysiology==
*The pathogenesis of cervical polyp is characterized by chronic inflammation of the endocervical canal.  
*The pathogenesis of cervical polyp is characterized by chronic inflammation of the endocervical canal.  
*Cervical polyps arise from the endocervical canal and tend to protrude in the external cervix.   
*The exact mechanism of cervical polyps origin is not clearly understood. However, cervical polyps are believed to occur due to:
** An abnormal response to increased levels of [[estrogen]]
** [[Chronic inflammation]]
** Clogged blood vessels in the cervix
*Cervical polyps arise from the endocervical canal and tend to protrude in the [[External os|external cervix]].   
*There are no genes associated with the development of cervical polyp.  
*There are no genes associated with the development of cervical polyp.  
*On gross pathology, flesh-colored, single finger-like growth, 1 cm size, are characteristic findings of cervical polyp.
*On gross pathology, flesh-colored, single finger-like growth, 1 cm size, are characteristic findings of cervical polyp.
*On microscopic histopathological analysis, inflamed and dilated endocervical (mucus) glands and myxoid stroma are characteristic findings of cervical polyp.
*On microscopic histopathological analysis, inflamed and dilated endocervical (mucus) glands and myxoid stroma are characteristic findings of cervical polyp.
==Causes==
==Causes==
* There are no established causes for cervical polyp.<ref name="pmid8125411">{{cite journal |vauthors=Golan A, Ber A, Wolman I, David MP |title=Cervical polyp: evaluation of current treatment |journal=Gynecol. Obstet. Invest. |volume=37 |issue=1 |pages=56–8 |year=1994 |pmid=8125411 |doi= |url=}}</ref>
There are no established causes for cervical polyps.<ref name="pmid8125411">{{cite journal |vauthors=Golan A, Ber A, Wolman I, David MP |title=Cervical polyp: evaluation of current treatment |journal=Gynecol. Obstet. Invest. |volume=37 |issue=1 |pages=56–8 |year=1994 |pmid=8125411 |doi= |url=}}</ref>
==Differentiating cervical polyp from other Diseases==
 
*Cervical polyp must be differentiated from other diseases that cause abnormal vaginal bleeding, dyspareunia, and abnormal vaginal discharge
==Differentiating Cervical Polyp from other Diseases==
:*Cervical intraepithelial neoplasia
Cervical polyp must be differentiated from other diseases that cause abnormal [[vaginal bleeding]], [[dyspareunia]], and abnormal vaginal discharge
:*Cervicitis
:*[[Cervical intraepithelial neoplasia]]
:*[[Cervicitis]]
:*Benign endometrial polyp
:*Benign endometrial polyp
:*Fibroepithelial stromal polyp
:*[[Fibroepithelial]] stromal polyp
:*Adenosarcoma
:*Adenosarcoma
:*Cervical  cancer
:*[[Cervical cancer|Cervical  cancer]]
:
 
{|
! colspan="12" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abnormal Uterine bleeidng differential diagnosis
!
!
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Ob-Gyn neoplasm and diseases
! colspan="7" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Clinical manifestations'''
! colspan="5" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Para-clinical findings
! colspan="1" rowspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard'''
|-
! colspan="5" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Symptoms
! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical exam
! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab Findings
! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histopathology
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abnormal
vaginal bleeding
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other Genitourinary/ Gastrointestinal symptoms
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abdominal pain
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Pelvic
pain
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |B symptoms
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Gynecological examinations
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abdominal
mass
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |HPV
Pap smear
 
STI panel
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other labs
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Ultrasound
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other
imagings
|-
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Cervical polyp]]<ref name="pmid151660702">{{cite journal |vauthors=Mitchell H |title=Vaginal discharge--causes, diagnosis, and treatment |journal=BMJ |volume=328 |issue=7451 |pages=1306–8 |date=May 2004 |pmid=15166070 |pmc=420177 |doi=10.1136/bmj.328.7451.1306 |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
*Postcoital
*Intermenstrual
*[[Postmenopausal]]
*Bleeding after exam
| style="background: #F5F5F5; padding: 5px;" |
*[[Vaginal discharge]]
*[[Dyspareunia]]
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |
*Mass on exam
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |
*↓ [[RBC]] count
*↓ [[Hemoglobin]], ↓ [[Hematocrit|Hct]]
*↓ Serum [[Iron]]
| style="background: #F5F5F5; padding: 5px;" |
*Hyper/hypoechogenic masses with or without cysts
 
*Filling the endocervical or vaginal canal
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
*[[Epithelial cells]] with no nuclear [[atypia]]/[[mitoses]]
| style="background: #F5F5F5; padding: 5px;" |
*[[Hysteroscopy]] /[[Biopsy]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
! style="background: #DCDCDC; padding: 5px; text-align: center;" |Cervical cancer<ref name="pmid23336450">{{cite journal |vauthors=Hippisley-Cox J, Coupland C |title=Symptoms and risk factors to identify women with suspected cancer in primary care: derivation and validation of an algorithm |journal=Br J Gen Pract |volume=63 |issue=606 |pages=e11–21 |date=January 2013 |pmid=23336450 |pmc=3529288 |doi=10.3399/bjgp13X660733 |url=}}</ref><ref name="DunyoEffah2018">{{cite journal|last1=Dunyo|first1=Priscilla|last2=Effah|first2=Kofi|last3=Udofia|first3=Emilia Asuquo|title=Factors associated with late presentation of cervical cancer cases at a district hospital: a retrospective study|journal=BMC Public Health|volume=18|issue=1|year=2018|issn=1471-2458|doi=10.1186/s12889-018-6065-6}}</ref><ref name="pmid30603660">{{cite journal |vauthors=Khalife D, El Housheimi A, Khalil A, Saba C S, Seoud M, Rammal R, Abdallah IE, Abdallah R |title=Treatment of cervical cancer metastatic to the abdominal wall with reconstruction using a composite myocutaneous flap: A case report |journal=Gynecol Oncol Rep |volume=27 |issue= |pages=38–41 |date=February 2019 |pmid=30603660 |pmc=6302027 |doi=10.1016/j.gore.2018.12.006 |url=}}</ref><ref>{{cite journal|doi=10.1097/PAS.0000000000000498.}}</ref><ref name="pmid8828559">{{cite journal |vauthors=Brenner PF |title=Differential diagnosis of abnormal uterine bleeding |journal=Am. J. Obstet. Gynecol. |volume=175 |issue=3 Pt 2 |pages=766–9 |date=September 1996 |pmid=8828559 |doi= |url=}}</ref><ref name="AlcázarArribas2014">{{cite journal|last1=Alcázar|first1=Juan Luis|last2=Arribas|first2=Sara|last3=Mínguez|first3=José Angel|last4=Jurado|first4=Matías|title=The Role of Ultrasound in the Assessment of Uterine Cervical Cancer|journal=The Journal of Obstetrics and Gynecology of India|volume=64|issue=5|year=2014|pages=311–316|issn=0971-9202|doi=10.1007/s13224-014-0622-4}}</ref><ref name="pmid25223869">{{cite journal |vauthors=Qing L, Xiang T, Guofu Z, Weiwei F |title=Leukemoid reaction in cervical cancer: a case report and review of the literature |journal=BMC Cancer |volume=14 |issue= |pages=670 |date=September 2014 |pmid=25223869 |pmc=4174654 |doi=10.1186/1471-2407-14-670 |url=}}</ref><ref name="pmid252238692">{{cite journal |vauthors=Qing L, Xiang T, Guofu Z, Weiwei F |title=Leukemoid reaction in cervical cancer: a case report and review of the literature |journal=BMC Cancer |volume=14 |issue= |pages=670 |date=September 2014 |pmid=25223869 |pmc=4174654 |doi=10.1186/1471-2407-14-670 |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
*Postmenopausal
*Intermenstrual
*Postcoital
*Bleeding after [[pelvic exam]]
| style="background: #F5F5F5; padding: 5px;" |
*[[Dysuria]]
*[[Urinary hesitancy]]
*[[Dyspareunia]]
*[[Vaginal discharge]]
*Itching or burning of the vulva
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
*Cervical mass on exam
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |± [[Human papilloma virus|HPV]]
*Atypical cells on [[Pap smear]]
*'''[[STI]]''': ± [[Chlamydia]]
| style="background: #F5F5F5; padding: 5px;" |
*↑ [[CA-125]]
*Leukomoid reaction
| style="background: #F5F5F5; padding: 5px;" |
*Large [[cervical cancer]]
 
*[[Angiogenesis]] on [[Doppler sonography]]
 
*[[Bladder]] involvement
 
*[[Lymph node]] involvement
| style="background: #F5F5F5; padding: 5px;" |'''T2-weighted MRI''' :
*Ovoid, heterogeneous tumor distending the cervical canal with stromal involvement.  '''PET/CT scan''':
**Detect tumor size
**[[Lymph node]] involvement,
**[[Metastases]] to [[bladder]] or [[rectum]]
| style="background: #F5F5F5; padding: 5px;" |[[Cervical intraepithelial neoplasia|'''Cervical intraepithelial neoplasia''']]:
*CIN1: mild [[dysplasia]]
 
*CIN2: moderate [[dysplasia]]
 
*CIN3: high degree of [[dysplasia]]/[[metastases]]
| style="background: #F5F5F5; padding: 5px;" |
*[[Colposcopy]]/[[biopsy]]
|-
! style="background: #DCDCDC; padding: 5px; text-align: center;" |Cervical [[leiomyoma]]<ref name="pmid27887011">{{cite journal |vauthors=Al-Habib A, Elgamal EA, Aldhahri S, Alokaili R, AlShamrani R, Abobotain A, AlRaddadi K, Alkhalidi H |title=Large primary leiomyoma causing progressive cervical deformity |journal=J Surg Case Rep |volume=2016 |issue=11 |pages= |date=November 2016 |pmid=27887011 |pmc=5159177 |doi=10.1093/jscr/rjw190 |url=}}</ref><ref name="pmid27190823">{{cite journal |vauthors=Adaikkalam J |title=Lipoleiomyoma of Cervix |journal=J Clin Diagn Res |volume=10 |issue=4 |pages=EJ01–2 |date=April 2016 |pmid=27190823 |doi=10.7860/JCDR/2016/16505.7531 |url=}}</ref><ref name="HouserCarrasco1979">{{cite journal|last1=Houser|first1=L. Murray|last2=Carrasco|first2=C. H.|last3=Sheehan|first3=C. R.|title=Lipomatous tumour of the uterus: radiographic and ultrasonic appearance|journal=The British Journal of Radiology|volume=52|issue=624|year=1979|pages=992–993|issn=0007-1285|doi=10.1259/0007-1285-52-624-992}}</ref><ref name="KeriakosMaher2013">{{cite journal|last1=Keriakos|first1=Remon|last2=Maher|first2=Mark|title=Management of Cervical Fibroid during the Reproductive Period|journal=Case Reports in Obstetrics and Gynecology|volume=2013|year=2013|pages=1–3|issn=2090-6684|doi=10.1155/2013/984030}}</ref><ref name="pmid10775744">{{cite journal |vauthors=Coronado GD, Marshall LM, Schwartz SM |title=Complications in pregnancy, labor, and delivery with uterine leiomyomas: a population-based study |journal=Obstet Gynecol |volume=95 |issue=5 |pages=764–9 |date=May 2000 |pmid=10775744 |doi= |url=}}</ref><ref name="Kamra2013">{{cite journal|last1=Kamra|first1=Hemlata T|title=Myxoid Leiomyoma of Cervix|journal=JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH|year=2013|issn=2249782X|doi=10.7860/JCDR/2013/6171.3805}}</ref><ref name="El-agwany2015">{{cite journal|last1=El-agwany|first1=Ahmed Samy|title=Lipoleiomyoma of the uterine cervix: An unusual variant of uterine leiomyoma|journal=The Egyptian Journal of Radiology and Nuclear Medicine|volume=46|issue=1|year=2015|pages=211–213|issn=0378603X|doi=10.1016/j.ejrnm.2014.10.001}}</ref><ref name="pmid14960521">{{cite journal |vauthors=Chaparala RP, Fawole AS, Ambrose NS, Chapman AH |title=Large bowel obstruction due to a benign uterine leiomyoma |journal=Gut |volume=53 |issue=3 |pages=386, 430 |date=March 2004 |pmid=14960521 |pmc=1773948 |doi= |url=}}</ref><ref name="pmid14564105">{{cite journal |vauthors=Yokoyama Y, Shinohara A, Hirokawa M, Maeda N |title=Erythrocytosis due to an erythropoietin-producing large uterine leiomyoma |journal=Gynecol. Obstet. Invest. |volume=56 |issue=4 |pages=179–83 |date=2003 |pmid=14564105 |doi=10.1159/000074104 |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
*Heavy/prolonged menstrual bleeding
*Intermenstrual bleeding
| style="background: #F5F5F5; padding: 5px;" |
*[[Urinary retention]]
*[[Constipation]]
*[[Infertility]]
*[[Bowel obstruction]]
*Increase in [[pregnancy]]/labor complications
*[[Vaginal discharge]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |
*Large,irregular [[Pelvic masses|pelvic mass]]
| style="background: #F5F5F5; padding: 5px;" |±
*
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |
*[[Erythrocytosis]]
| style="background: #F5F5F5; padding: 5px;" |
*Well circumscribed hyperechoic mass
| style="background: #F5F5F5; padding: 5px;" |'''T2-weighted MRI''':
*Hypointense masses
*Homogeneous
enhancement
*Red degeneration
| style="background: #F5F5F5; padding: 5px;" |
*Spindle shaped [[Muscle cells|smooth muscle cells]]
*Mature [[adipocytes]]
*Extracellular matrix consist of [[collagen]],[[fibronectin]].
| style="background: #F5F5F5; padding: 5px;" |
*Clinical diagnosis/ and
 
*[[Ultrasound]]
|-
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Lymphoma|Cervical lymphoma]]<ref name="pmid10422676">{{cite journal |vauthors=Grace A, O'Connell N, Byrne P, Prendiville W, O'Donnell R, Royston D, Walsh CB, Leader M, Kay E |title=Malignant lymphoma of the cervix. An unusual presentation and a rare disease |journal=Eur. J. Gynaecol. Oncol. |volume=20 |issue=1 |pages=26–8 |date=1999 |pmid=10422676 |doi= |url=}}</ref><ref name="KanaanParente2012">{{cite journal|last1=Kanaan|first1=Daniel|last2=Parente|first2=Daniella Braz|last3=Constantino|first3=Carolina Pesce Lamas|last4=Souza|first4=Rodrigo Canellas de|title=Linfoma de colo de útero: achados na ressonância magnética|journal=Radiologia Brasileira|volume=45|issue=3|year=2012|pages=167–169|issn=0100-3984|doi=10.1590/S0100-39842012000300009}}</ref><ref name="pmid17065003">{{cite journal |vauthors=Frey NV, Svoboda J, Andreadis C, Tsai DE, Schuster SJ, Elstrom R, Rubin SC, Nasta SD |title=Primary lymphomas of the cervix and uterus: the University of Pennsylvania's experience and a review of the literature |journal=Leuk. Lymphoma |volume=47 |issue=9 |pages=1894–901 |date=September 2006 |pmid=17065003 |doi=10.1080/10428190600687653 |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
*[[Postmenopausal bleeding]]
| style="background: #F5F5F5; padding: 5px;" |
*Difficulty urinating
 
*Post-coital pain
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
*Larrge [[uterine]]/[[cervix]] mass
 
*Irregularity
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |'''Pap smear:'''
*Small round blue cells
*High [[nuclear]]/[[cytoplasm]] ratio,
*Scant cytoplasm
| style="background: #F5F5F5; padding: 5px;" |'''Immunohistochemistry markers:'''
*[[CD19]], [[CD20]], [[CD79a|CD79]]<nowiki/>a, [[PAX5]]
| style="background: #F5F5F5; padding: 5px;" |
*Well-defined, solid, concentric, hypoechoic mass
| style="background: #F5F5F5; padding: 5px;" |'''MRI:'''
*Intramyometrial infiltrative nodules
| style="background: #F5F5F5; padding: 5px;" |
*Small tumor cells with large nuclei
*High [[mitoses]] and proliferation
| style="background: #F5F5F5; padding: 5px;" |
*[[Biopsy]]
*[[Diffuse large B-cell lymphoma|diffuse large B-Cell lymphoma]] ([[DLBCL]]) most frequent type.
|-
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Cervical|Cervical sarcoma]]<ref name="pmid16051326">{{cite journal |vauthors=Wright JD, Rosenblum K, Huettner PC, Mutch DG, Rader JS, Powell MA, Gibb RK |title=Cervical sarcomas: an analysis of incidence and outcome |journal=Gynecol. Oncol. |volume=99 |issue=2 |pages=348–51 |date=November 2005 |pmid=16051326 |doi=10.1016/j.ygyno.2005.06.021 |url=}}</ref><ref name="KhoslaGupta2012">{{cite journal|last1=Khosla|first1=Divya|last2=Gupta|first2=Ruchi|last3=Srinivasan|first3=Radhika|last4=Patel|first4=Firuza D.|last5=Rajwanshi|first5=Arvind|title=Sarcomas of Uterine Cervix|journal=International Journal of Gynecological Cancer|volume=22|issue=6|year=2012|pages=1026–1030|issn=1048-891X|doi=10.1097/IGC.0b013e31825a97f6}}</ref><ref name="pmid26587944">{{cite journal |vauthors=Miccò M, Sala E, Lakhman Y, Hricak H, Vargas HA |title=Imaging Features of Uncommon Gynecologic Cancers |journal=AJR Am J Roentgenol |volume=205 |issue=6 |pages=1346–59 |date=December 2015 |pmid=26587944 |pmc=5502476 |doi=10.2214/AJR.14.12695 |url=}}</ref><ref>{{cite journal|doi=10.1097/IGC.0b013e31825a97f6.}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
*Intermentrual
*[[Postmenopausal]]
| style="background: #F5F5F5; padding: 5px;" |
*Post-coital pain
*Fullness in [[pelvic]]
*[[Vaginal discharge]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |±
| style="background: #F5F5F5; padding: 5px;" |
*[[Cervical Cancer|Cervical]] mass
*Lump protruding  from vagina/vulva
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |[[Leiomyosarcoma]] markers:
*Positive for for [[S-100]] and [[vimentin]] and are negative for [[desmin]], [[myoglobin]] and [[actin]].
| style="background: #F5F5F5; padding: 5px;" |
*[[Endometrial]] mass with heterogeneous echogenicity
| style="background: #F5F5F5; padding: 5px;" |'''MRI:'''
*[[Endometrial]] polypoid mass
*Hypointense hypervascular solid components
| style="background: #F5F5F5; padding: 5px;" |
*Poorly circumscribed bulky mass protruding from cervical canal
*Different subtypes:
**[[Leiomyosarcoma]]
**Endocervical [[sarcoma]]
**Embryonal rhabdomyosarcoma( [[Sarcoma botryoides]])
| style="background: #F5F5F5; padding: 5px;" |
*[[Biopsy]]
|-
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Cervical erosion]]([[Ectropion]])<ref name="pmid28460993">{{cite journal |vauthors=Mitchell L, King M, Brillhart H, Goldstein A |title=Cervical Ectropion May Be a Cause of Desquamative Inflammatory Vaginitis |journal=Sex Med |volume=5 |issue=3 |pages=e212–e214 |date=September 2017 |pmid=28460993 |pmc=5562466 |doi=10.1016/j.esxm.2017.03.001 |url=}}</ref><ref name="pmid15166070">{{cite journal |vauthors=Mitchell H |title=Vaginal discharge--causes, diagnosis, and treatment |journal=BMJ |volume=328 |issue=7451 |pages=1306–8 |date=May 2004 |pmid=15166070 |pmc=420177 |doi=10.1136/bmj.328.7451.1306 |url=}}</ref><ref name="SharmaOjha2013">{{cite journal|last1=Sharma|first1=Abhishek|last2=Ojha|first2=Ranapratap|last3=Sengupta|first3=Parama|last4=Chattopadhyay|first4=Sarbani|last5=Mondal|first5=Soumit|title=Cervical intramural pregnancy: Report of a rare case|journal=Nigerian Medical Journal|volume=54|issue=4|year=2013|pages=271|issn=0300-1652|doi=10.4103/0300-1652.119670}}</ref><ref>{{cite journal|doi=10.12865/CHSJ.42.02.11}}</ref><ref name="pmid212702912">{{cite journal |vauthors=Casey PM, Long ME, Marnach ML |title=Abnormal cervical appearance: what to do, when to worry? |journal=Mayo Clin. Proc. |volume=86 |issue=2 |pages=147–50; quiz 151 |date=February 2011 |pmid=21270291 |pmc=3031439 |doi=10.4065/mcp.2010.0512 |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
*Light bleeding after [[pelvic exam]]
*Spotting
| style="background: #F5F5F5; padding: 5px;" |
*Post-coital pain
 
*Painful cramps
 
*[[Dyspareunia]]
*[[Vaginal discharge]]
*Itching of vulvovaginal area
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |
*Red, glandular area around os of cervix
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |N/A
| style="background: #F5F5F5; padding: 5px;" |N/A
| style="background: #F5F5F5; padding: 5px;" |N/A
| style="background: #F5F5F5; padding: 5px;" |
*[[Squamous metaplasia]]
 
*[[Vascular ectasia of the colon|Vascular ectasia]]
*[[Lymphocytic]] infiltration
| style="background: #F5F5F5; padding: 5px;" |
*[[Colposcopy]] and [[biopsy]]
| style="background: #F5F5F5; padding: 5px;" |
|-
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Cervicitis]]<ref name="pmid27243142">{{cite journal |vauthors=Mattson SK, Polk JP, Nyirjesy P |title=Chronic Cervicitis: Presenting Features and Response to Therapy |journal=J Low Genit Tract Dis |volume=20 |issue=3 |pages=e30–3 |date=July 2016 |pmid=27243142 |doi=10.1097/LGT.0000000000000225 |url=}}</ref><ref name="pmid2660084">{{cite journal |vauthors=Rosenfeld WD, Clark J |title=Vulvovaginitis and cervicitis |journal=Pediatr. Clin. North Am. |volume=36 |issue=3 |pages=489–511 |date=June 1989 |pmid=2660084 |doi= |url=}}</ref><ref name="pmid27681919">{{cite journal |vauthors=Meyer T |title=Diagnostic Procedures to Detect Chlamydia trachomatis Infections |journal=Microorganisms |volume=4 |issue=3 |pages= |date=August 2016 |pmid=27681919 |doi=10.3390/microorganisms4030025 |url=}}</ref><ref name="WoodsBailey2011">{{cite journal|last1=Woods|first1=Jennifer L.|last2=Bailey|first2=Sarabeth L.|last3=Hensel|first3=Devon J.|last4=Scurlock|first4=Amy M.|title=Cervicitis in Adolescents: Do Clinicians Understand Diagnosis and Treatment?|journal=Journal of Pediatric and Adolescent Gynecology|volume=24|issue=6|year=2011|pages=359–364|issn=10833188|doi=10.1016/j.jpag.2011.06.006}}</ref><ref name="Jayakumar2015">{{cite journal|last1=Jayakumar|first1=Naveen Kumar Bhagavathula|title=Cervicitis: How Often Is It Non-specific!|journal=JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH|year=2015|issn=2249782X|doi=10.7860/JCDR/2015/11594.5673}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
*Intermenstrual bleeding
 
*Postcoital
 
*Bleeding after [[pelvic exam]]
| style="background: #F5F5F5; padding: 5px;" |
*Pain during urination
 
*Pain during sex
*Painful menstruation
*Purulent [[vaginal discharge]]
*Itching of vulva
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
*May have fever only
| style="background: #F5F5F5; padding: 5px;" |
*Red,inflammed swollen [[cervix]]
*[[Inflammation]]/irritation of vulva/vagina
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |'''STI panel:'''
*[[Chlamydia]]
 
*[[Gonorrhea]]
*[[Herpes simplex]]
*[[Trichomonas vaginalis]]
| style="background: #F5F5F5; padding: 5px;" |
*↑ [[WBC]]
*+ [[NAAT]] for [[chlamydia]], [[gonorrhea]]
 
*
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |'''MRI:'''
May be detected as retention cysts in [[cervix]].
| style="background: #F5F5F5; padding: 5px;" |
*Non-specific, [[lymphocytic]] infiltration may be seen in microscopic histology.
 
*[[Koilocyte|Koilocytic]] changes in case of [[HPV]] as cause of chronic cervicitis.
| style="background: #F5F5F5; padding: 5px;" |
*[[Nucleic acid amplification technique|Nucleic acid amplification tests]] ([[NAAT]]<nowiki/>s)
|-
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Adenomyosis|Adenemyosis]]<ref name="pmid30486633">{{cite journal |vauthors=Filip G, Balzano A, Cagnacci A |title=Histological evaluation of the prevalence of adenomyosis, myomas and of their concomitance |journal=Minerva Ginecol |volume= |issue= |pages= |date=November 2018 |pmid=30486633 |doi=10.23736/S0026-4784.18.04291-0 |url=}}</ref><ref name="pmid1492806">{{cite journal |vauthors=Fujino T, Watanabe T, Shinmura R, Hahn L, Nagata Y, Hasui K |title=Acute abdomen due to adenomyosis of the uterus: a case report |journal=Asia Oceania J Obstet Gynaecol |volume=18 |issue=4 |pages=333–7 |date=December 1992 |pmid=1492806 |doi= |url=}}</ref><ref name="pmid14928062">{{cite journal |vauthors=Fujino T, Watanabe T, Shinmura R, Hahn L, Nagata Y, Hasui K |title=Acute abdomen due to adenomyosis of the uterus: a case report |journal=Asia Oceania J Obstet Gynaecol |volume=18 |issue=4 |pages=333–7 |date=December 1992 |pmid=1492806 |doi= |url=}}</ref><ref name="pmid9275451">{{cite journal |vauthors=Zhou Y, Wu B, Li H |title=[The value of serum CA125 assays in the diagnosis of uterine adenomyosis] |language=Chinese |journal=Zhonghua Fu Chan Ke Za Zhi |volume=31 |issue=10 |pages=590–3 |date=October 1996 |pmid=9275451 |doi= |url=}}</ref><ref name="TamaiTogashi2005">{{cite journal|last1=Tamai|first1=Ken|last2=Togashi|first2=Kaori|last3=Ito|first3=Tsuyoshi|last4=Morisawa|first4=Nobuko|last5=Fujiwara|first5=Toshitaka|last6=Koyama|first6=Takashi|title=MR Imaging Findings of Adenomyosis: Correlation with Histopathologic Features and Diagnostic Pitfalls|journal=RadioGraphics|volume=25|issue=1|year=2005|pages=21–40|issn=0271-5333|doi=10.1148/rg.251045060}}</ref><ref name="Dartmouth2014">{{cite journal|last1=Dartmouth|first1=Katherine|title=A systematic review with meta-analysis: the common sonographic characteristics of adenomyosis|journal=Ultrasound|volume=22|issue=3|year=2014|pages=148–157|issn=1742-271X|doi=10.1177/1742271X14528837}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
*Abnormal uterine bleeding
| style="background: #F5F5F5; padding: 5px;" |
*Painful menstruation
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |
*Polypoid mass protruding into the [[Endocervix|endocervical canal]].
| style="background: #F5F5F5; padding: 5px;" |
*Enlarged [[uterus]] may present as [[abdominal mass]]
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |
*↑ [[CA-125 test|CA-125]]
| style="background: #F5F5F5; padding: 5px;" |
*Subendometrial striations
*Myometrial cysts
*Asymetrical thickness in [[myometrium]] walls
*Heterogenous echotexture of [[myometrium]]
| style="background: #F5F5F5; padding: 5px;" |'''MRI:'''
*Thickened junctional zone
| style="background: #F5F5F5; padding: 5px;" |
*Presence of ectopic [[endometrial]] glands into the myometrium.
| style="background: #F5F5F5; padding: 5px;" |
*[[Histology]] findings post [[hysterectomy]]
|-
! style="background: #DCDCDC; padding: 5px; text-align: center;" |Cervical [[ectopic pregnancy]]<ref name="pmid28955106">{{cite journal |vauthors=Mouhajer M, Obed S, Okpala AM |title=Cervical Ectopic Pregnancy in Resource Deprived Areas: A Rare and Difficult Diagnosis |journal=Ghana Med J |volume=51 |issue=2 |pages=94–97 |date=June 2017 |pmid=28955106 |pmc=5611908 |doi= |url=}}</ref><ref name="RathodSamal2015">{{cite journal|last1=Rathod|first1=Setu|last2=Samal|first2=SunilKumar|title=Cervical ectopic pregnancy|journal=Journal of Natural Science, Biology and Medicine|volume=6|issue=1|year=2015|pages=257|issn=0976-9668|doi=10.4103/0976-9668.149221}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
*[[Amenorrhea]]
 
*Bleeding after [[pelvic exam]]
| style="background: #F5F5F5; padding: 5px;" |
*[[Pelvic pain]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |
*Soft and disporportionally enlarged [[uterus]].
| style="background: #F5F5F5; padding: 5px;" |±
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |
*↑ β-[[HCG]]
| style="background: #F5F5F5; padding: 5px;" |
*Empty [[uterine]]
 
*Thickened [[endometrium]]
| style="background: #F5F5F5; padding: 5px;" |'''T2-weighted MRI''':
*Hypointense large mass
'''T1-weighted MRI''':
*Partially hyperintense mass
| style="background: #F5F5F5; padding: 5px;" |
*Necrotic [[hemorrhagic]] mass with chorionic villus
| style="background: #F5F5F5; padding: 5px;" |
*[[Hysterectomy]] and biopsy
|-
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Nabothian cyst]]<ref name="pmid21270291">{{cite journal |vauthors=Casey PM, Long ME, Marnach ML |title=Abnormal cervical appearance: what to do, when to worry? |journal=Mayo Clin. Proc. |volume=86 |issue=2 |pages=147–50; quiz 151 |date=February 2011 |pmid=21270291 |pmc=3031439 |doi=10.4065/mcp.2010.0512 |url=}}</ref><ref name="Bin ParkLee2010">{{cite journal|last1=Bin Park|first1=Sung|last2=Lee|first2=Jong Hwa|last3=Lee|first3=Young Ho|last4=Song|first4=Mi Jin|last5=Choi|first5=Hye Jeong|title=Multilocular Cystic Lesions in the Uterine Cervix: Broad Spectrum of Imaging Features and Pathologic Correlation|journal=American Journal of Roentgenology|volume=195|issue=2|year=2010|pages=517–523|issn=0361-803X|doi=10.2214/AJR.09.3619}}</ref><ref name="Torky2016">{{cite journal|last1=Torky|first1=Haitham A.|title=Huge Nabothian cyst causing Hematometra (case report)|journal=European Journal of Obstetrics & Gynecology and Reproductive Biology|volume=207|year=2016|pages=238–240|issn=03012115|doi=10.1016/j.ejogrb.2016.10.042}}</ref><ref name="OkamotoTanaka2003">{{cite journal|last1=Okamoto|first1=Yoshikazu|last2=Tanaka|first2=Yumiko O.|last3=Nishida|first3=Masato|last4=Tsunoda|first4=Hajime|last5=Yoshikawa|first5=Hiroyuki|last6=Itai|first6=Yuji|title=MR Imaging of the Uterine Cervix: Imaging-Pathologic Correlation|journal=RadioGraphics|volume=23|issue=2|year=2003|pages=425–445|issn=0271-5333|doi=10.1148/rg.232025065}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
*Postcoital bleeding
| style="background: #F5F5F5; padding: 5px;" |
*Pain during sex
*[[Vaginal discharge]]
| style="background: #F5F5F5; padding: 5px;" |
*In very rare cases depending upon the size of cyst it can cause [[abdominal pain]] and [[amenorrhea]]
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |
*Majority of them are asymptomatic due to their small size( few milimeters)
 
*[[Cystic]] mass on exam
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |N/A
| style="background: #F5F5F5; padding: 5px;" |
*Anechoic well defined cystic lesions
| style="background: #F5F5F5; padding: 5px;" |'''T1-weighted'''
*Intermediate or slightly high signal intensity          '''T2-weighted'''
*High signal intensity on T2-weighted images
*Benign cystic lesion
| style="background: #F5F5F5; padding: 5px;" |
*Multiple benign cystic masses, usually few milimieters in diameter.
| style="background: #F5F5F5; padding: 5px;" |
*[[Histopathological]] exam if large cystic masses
|}


==Epidemiology and Demographics==
==Epidemiology and Demographics==
* The estimated prevalence of cervical polyp is approximately 1.5–10% in general population.<ref name="pmid8125411">{{cite journal |vauthors=Golan A, Ber A, Wolman I, David MP |title=Cervical polyp: evaluation of current treatment |journal=Gynecol. Obstet. Invest. |volume=37 |issue=1 |pages=56–8 |year=1994 |pmid=8125411 |doi= |url=}}</ref>
The estimated prevalence of cervical polyps is approximately 1.5–10% in the general population.<ref name="pmid8125411">{{cite journal |vauthors=Golan A, Ber A, Wolman I, David MP |title=Cervical polyp: evaluation of current treatment |journal=Gynecol. Obstet. Invest. |volume=37 |issue=1 |pages=56–8 |year=1994 |pmid=8125411 |doi= |url=}}</ref>


===Age===  
===Age===  
*Cervical polyp is more commonly observed among patients aged 40 to 55 years old.
*Cervical polyps are more commonly observed among patients aged 40 to 55 years old.
*Cervical polyp is more commonly observed among perimenopausal and postmenopausal women.<ref name="pmid8125411">{{cite journal |vauthors=Golan A, Ber A, Wolman I, David MP |title=Cervical polyp: evaluation of current treatment |journal=Gynecol. Obstet. Invest. |volume=37 |issue=1 |pages=56–8 |year=1994 |pmid=8125411 |doi= |url=}}</ref>
*Cervical polyps are more commonly observed among [[perimenopausal]] and [[postmenopausal]] women.<ref name="pmid8125411">{{cite journal |vauthors=Golan A, Ber A, Wolman I, David MP |title=Cervical polyp: evaluation of current treatment |journal=Gynecol. Obstet. Invest. |volume=37 |issue=1 |pages=56–8 |year=1994 |pmid=8125411 |doi= |url=}}</ref>
    
    
===Race===
===Race===
*There is no racial predilection for cervical polyp.<ref name="pmid8125411">{{cite journal |vauthors=Golan A, Ber A, Wolman I, David MP |title=Cervical polyp: evaluation of current treatment |journal=Gynecol. Obstet. Invest. |volume=37 |issue=1 |pages=56–8 |year=1994 |pmid=8125411 |doi= |url=}}</ref>
*There is no racial predilection for cervical polyps.<ref name="pmid8125411">{{cite journal |vauthors=Golan A, Ber A, Wolman I, David MP |title=Cervical polyp: evaluation of current treatment |journal=Gynecol. Obstet. Invest. |volume=37 |issue=1 |pages=56–8 |year=1994 |pmid=8125411 |doi= |url=}}</ref>


==Risk Factors==
==Risk Factors==
*Common risk factors in the development of cervical polyp, include:<ref name="pmid8125411">{{cite journal |vauthors=Golan A, Ber A, Wolman I, David MP |title=Cervical polyp: evaluation of current treatment |journal=Gynecol. Obstet. Invest. |volume=37 |issue=1 |pages=56–8 |year=1994 |pmid=8125411 |doi= |url=}}</ref>
Common risk factors in the development of cervical polyps include:<ref name="pmid8125411">{{cite journal |vauthors=Golan A, Ber A, Wolman I, David MP |title=Cervical polyp: evaluation of current treatment |journal=Gynecol. Obstet. Invest. |volume=37 |issue=1 |pages=56–8 |year=1994 |pmid=8125411 |doi= |url=}}</ref>
:*Chronic inflammation
:*[[Chronic inflammation]]
:*Hormonal factors
:*Hormonal factors
:*Presence of endometrial hyperplasia  
:*Presence of [[endometrial hyperplasia]]
:*Previous history of pregnancy  
:*Previous history of pregnancy  
   
   
== Natural History, Complications and Prognosis==
== Natural History, Complications and Prognosis==
*The majority of patients with cervical polyp remain asymptomatic for years.   
*The majority of patients with cervical polyps remain [[asymptomatic]] for years.   
*Early clinical features may include abnormal vaginal bleeding, postcoital vaginal bleeding, and abnormal vaginal discharge.
*Early clinical features may include [[Vaginal bleeding|abnormal vaginal bleeding]], [[Vaginal bleeding|postcoital vaginal bleeding]], and abnormal [[vaginal discharge]].
*If left untreated, only 0.2–1.7%  of patients with cervical polyp may progress to develop malignant transformation.  
*If left untreated, only 0.2–1.7%  of the patients with cervical polyps may progress to develop [[malignant transformation]].  
*Common complications of cervical polyp include malignant transformation, bleeding, and recurrence.
*Common complications of cervical polyps include [[malignant transformation]], [[bleeding]], and recurrence.
*Prognosis is generally excellent, and the 5-survival rate of patients with cervical polyp is approximately 100%.
*The prognosis is generally excellent, and the 5-survival rate is approximately 100%.


== Diagnosis ==
== Diagnosis ==
===Diagnostic Criteria===
===Diagnostic Criteria===
*The diagnosis of cervical polyp is made with a cervical biopsy, showing the following findings:<ref name="pmid8125411">{{cite journal |vauthors=Golan A, Ber A, Wolman I, David MP |title=Cervical polyp: evaluation of current treatment |journal=Gynecol. Obstet. Invest. |volume=37 |issue=1 |pages=56–8 |year=1994 |pmid=8125411 |doi= |url=}}</ref>
The diagnosis of cervical polyp is made with a [[Biopsy|cervical biopsy]]. Characteristic findings in a biopsy of a cervical polyp include:<ref name="pmid8125411">{{cite journal |vauthors=Golan A, Ber A, Wolman I, David MP |title=Cervical polyp: evaluation of current treatment |journal=Gynecol. Obstet. Invest. |volume=37 |issue=1 |pages=56–8 |year=1994 |pmid=8125411 |doi= |url=}}</ref>
:*Mixed epithelium (i.e. squamous and endocervical type (with eosinophilic mucin).
:*[[Squamous metaplasia]]
:*Endocervical epithelium should have nuclei
:*Inflammatory cells
:*Inflammation
:*Squamous metaplasia


=== Symptoms ===
=== Symptoms ===
*Cervical polyp is usually asymptomatic.<ref name="pmid8125411">{{cite journal |vauthors=Golan A, Ber A, Wolman I, David MP |title=Cervical polyp: evaluation of current treatment |journal=Gynecol. Obstet. Invest. |volume=37 |issue=1 |pages=56–8 |year=1994 |pmid=8125411 |doi= |url=}}</ref>
*Cervical polyp is usually [[asymptomatic]].<ref name="pmid8125411">{{cite journal |vauthors=Golan A, Ber A, Wolman I, David MP |title=Cervical polyp: evaluation of current treatment |journal=Gynecol. Obstet. Invest. |volume=37 |issue=1 |pages=56–8 |year=1994 |pmid=8125411 |doi= |url=}}</ref>
*Symptoms of cervical polyp may include the following:
*Symptoms of cervical polyp may include the following:
:*Vaginal discharge
:*Intermenstrual bleeding (most common)
:*Dyspareunia
:*[[Vaginal discharge]]
:*Dysmenorrhea
:*[[Dyspareunia]]
:*Leukorrhea
:*[[Bleeding|Postcoital bleeding]]
:*[[Dysmenorrhea]]
:*[[Leukorrhea]]


=== Physical Examination ===
=== Physical Examination ===
*Patients with cervical polyp usually are well-appearing.
* Patients with cervical polyps are usually well-appearing.
:* Digital examination findings of the cervix, may include:<ref name="pmid8125411">{{cite journal |vauthors=Golan A, Ber A, Wolman I, David MP |title=Cervical polyp: evaluation of current treatment |journal=Gynecol. Obstet. Invest. |volume=37 |issue=1 |pages=56–8 |year=1994 |pmid=8125411 |doi= |url=}}</ref>
* Digital examination findings of the cervix, may include:<ref name="pmid8125411">{{cite journal |vauthors=Golan A, Ber A, Wolman I, David MP |title=Cervical polyp: evaluation of current treatment |journal=Gynecol. Obstet. Invest. |volume=37 |issue=1 |pages=56–8 |year=1994 |pmid=8125411 |doi= |url=}}</ref>
:* Sessile or broad-based finger-like growth
:* [[Sessile]] or broad-based finger-like growth


=== Laboratory Findings ===
=== Laboratory Findings ===
*There are no specific laboratory findings associated with cervical polyp.
There are no specific laboratory findings associated with cervical polyps.


===Imaging Findings===
===Imaging Findings===
*Ultrasound is the imaging modality of choice for cervical polyp.
*[[Ultrasound]] is the imaging modality of choice for cervical polyp.
*On ultrasound, cervical polyp is characterized by the following findings:<ref name="pmid8125411">{{cite journal |vauthors=Golan A, Ber A, Wolman I, David MP |title=Cervical polyp: evaluation of current treatment |journal=Gynecol. Obstet. Invest. |volume=37 |issue=1 |pages=56–8 |year=1994 |pmid=8125411 |doi= |url=}}</ref><ref name="radio"> Cervical polyp. Dr. Henry Kenipe. Radiopedia. http://radiopaedia.org/articles/cervical-polyp Accessed on March 31,2016</ref>
*On ultrasound, cervical polyp is characterized by the following findings:<ref name="pmid8125411">{{cite journal |vauthors=Golan A, Ber A, Wolman I, David MP |title=Cervical polyp: evaluation of current treatment |journal=Gynecol. Obstet. Invest. |volume=37 |issue=1 |pages=56–8 |year=1994 |pmid=8125411 |doi= |url=}}</ref><ref name="radio">Cervical polyp. Dr. Henry Kenipe. Radiopedia. http://radiopaedia.org/articles/cervical-polyp Accessed on March 31,2016</ref>
:*Sessile or pedunculated well-circumscribed masses within the endocervical canal
:*[[Sessile]] or [[pedunculated]] well-circumscribed masses within the endocervical canal
:*May be hypoechoic or echogenic  
:*May be hypoechoic or echogenic  
:*Identifying the stalk attaching to the cervical wall helps differentiate it from an endometrial polyp
:*Identifying the stalk attaching to the cervical wall helps differentiate it from an [[endometrial polyp]]
*The image below shows a cervical polyp characterized as a well-circumscribed mass within the endocervical canal.
<div align="left"></div>


=== Other Diagnostic Studies ===
=== Other Diagnostic Studies ===
Line 107: Line 503:
*Findings on colposcopy may include:
*Findings on colposcopy may include:
:*Protruding polypoid mass
:*Protruding polypoid mass
:*Smooth, red or purple, fingerlike growths on the cervix
:*Cervical bleeding  
:*Cervical bleeding  
:*Cervical friableness
:*Cervical friableness
*A [[Biopsy|cervical biopsy]] will most often show cells that are consistent with a benign polyp.


== Treatment ==
== Treatment ==
=== Medical Therapy ===
=== Medical Therapy ===
*There is no medical treatment for cervical polyp; the mainstay of therapy is surgical excision.<ref name="pmid8125411">{{cite journal |vauthors=Golan A, Ber A, Wolman I, David MP |title=Cervical polyp: evaluation of current treatment |journal=Gynecol. Obstet. Invest. |volume=37 |issue=1 |pages=56–8 |year=1994 |pmid=8125411 |doi= |url=}}</ref>
*There is no medical treatment for cervical polyp; the mainstay of therapy is surgical excision.<ref name="pmid8125411">{{cite journal |vauthors=Golan A, Ber A, Wolman I, David MP |title=Cervical polyp: evaluation of current treatment |journal=Gynecol. Obstet. Invest. |volume=37 |issue=1 |pages=56–8 |year=1994 |pmid=8125411 |doi= |url=}}</ref>
*Response to surgery can be monitored with regular ultrasound screenings every  6 or 12 months.
*Response to surgery can be monitored with regular [[ultrasound]] screenings every  6 or 12 months.
*If the polyp is infected, an [[antibiotic]] may be prescribed.


=== Surgery ===
=== Surgery ===
*Surgery is the mainstay of therapy for cervical polyp.
*[[Surgery]] is the mainstay of therapy for cervical polyp.
*Ring forceps in conjunction with biopsy is the most common approach to the treatment of cervical polyp.
*Ring forceps in conjunction with biopsy is the most common approach to the treatment of cervical polyp.
*Surgical string may also  be performed for patients with cervical polyp.
*Surgical string may also  be performed for patients with a cervical polyp.
*Other therapies, include: laser, or cauterisation. If the polyp is infected, an antibiotic may be prescribed.
*Other therapies, include: [[laser]] or [[cauterization]].


=== Prevention ===
== Prevention ==
*Effective measures for the primary prevention of cervical polyp include periodical ultrasound and cervical screening.<ref name="pmid8125411">{{cite journal |vauthors=Golan A, Ber A, Wolman I, David MP |title=Cervical polyp: evaluation of current treatment |journal=Gynecol. Obstet. Invest. |volume=37 |issue=1 |pages=56–8 |year=1994 |pmid=8125411 |doi= |url=}}</ref>  
*Effective measures for the primary prevention of cervical polyp include [[Ultrasound|periodic ultrasound]] and cervical screening.<ref name="pmid8125411">{{cite journal |vauthors=Golan A, Ber A, Wolman I, David MP |title=Cervical polyp: evaluation of current treatment |journal=Gynecol. Obstet. Invest. |volume=37 |issue=1 |pages=56–8 |year=1994 |pmid=8125411 |doi= |url=}}</ref>  
*Once diagnosed and successfully treated, patients with cervical polyp are followed-up every 12 or 6 months.  
*Once diagnosed and successfully treated, patients with cervical polyp are followed-up every 6 or 12 months.  
*Follow-up testing includes pelvic examination, vaginal ultrasound, and colposcopy.
*Follow-up testing includes pelvic examination, [[Ultrasound|vaginal ultrasound]], and [[colposcopy]].


==References==
==References==
Line 130: Line 529:
   
   
[[Category: Oncology]]
[[Category: Oncology]]
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Gynecology]]

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2] Aditya Ganti M.B.B.S. [3]

Synonyms and keywords: Polypoid cervical lesion; Cervical polypoid lesion; Polypoid cervical growth

Overview

Cervical polyps are defined as polypoid benign overgrowths of endocervical tissue. Usually, cervical polyps are growths projecting into the cervical canal. Cervical polyps are the most common cause of intermenstrual vaginal bleeding.There are no established causes for cervical polyps. They can be classified according to their morphological features such as: distribution, shape, size, and the presence of a pedicle. The pathogenesis of cervical polyp is characterized by chronic inflammation of the endocervical canal. Typically, cervical polyps arise from the endocervical canal and tend to protrude into the external cervix. The estimated prevalence of cervical polyps is approximately 1.5–10% in the general population. Common risk factors of the development of cervical polyps, include: chronic inflammation, hormonal factors, presence of endometrial hyperplasia, and previous history of pregnancy. Cervical polyps are more commonly observed among perimenopausal and postmenopausal women. Early clinical features may include abnormal vaginal bleeding, postcoital vaginal bleeding, and abnormal vaginal discharge. The diagnosis of a cervical polyp is made with a cervical biopsy, findings may include: inflamed and dilated endocervical (mucus) glands and myxoid stroma. Ring forceps in conjunction with biopsy is the most common approach for the treatment of cervical polyps.

Historical Perspective

Cervical polyps were first described by Peterson and Novak in 1956 following the description of endometrial polyps.[1][2]

Classification

Based on polyp location, cervical polyps can be classified into two types:

  • Ectocervical polyps
    • Develop from the outer surface layer cells of the cervix.
    • More commonly seen in postmenopausal women.
  • Endocervical polyps
    • Develop from cervical glands inside the cervical canal.
    • The majority of cervical polyps are endocervical polyps.
    • More commonly seen in premenopausal women.

Pathophysiology

Anatomy

  • The normal cervix is fusiform in shape, with the narrowest portions at the internal and external os. It measures 3 to 5 cm in length and 2 to 3 cm in diameter.
  • The portio vaginalis, is the visible portion of the cervix that protrudes into the vagina and is surrounded by a reflection of the vaginal wall on each side termed the anterior, posterior, and lateral fornix.
    • The supravaginal cervix is the intra-abdominal portion of the cervix that lies above the point of attachment of the vaginal vault
    • The peritoneum posterior to the supravaginal cervix forms the lining of the posterior cul-de-sac (pouch of Douglas).
  • The external cervical os is small, round, and centrally placed in nulliparous women.
  • In parous women who have labored into the third stage, it is more likely to be a patulous, transverse slit.
  • The internal cervical os is normally less than 3 mm in diameter in nonpregnant women, even if parous .
  • In the sagittal axis, the cervix lies between the bladder and rectum.
  • The cervix is supported by the uterosacral ligaments, which surround the cervix and vagina and extend laterally and posteriorly toward the second to fourth sacral vertebra, and the cardinal ligaments, which are fibromuscular bands that fan out laterally from the lower uterine segment and cervix to the lateral pelvic walls.

Blood Supply

  • The blood supply comes from a descending branch of the uterine artery.
    • The lymphatic drainage is to the parametrial nodes, then to the obturator, internal iliac, and external iliac nodes with secondary drainage to the presacral, common iliac, and para-aortic lymph nodes.

Nerve Supply

  • The nerve supply is autonomic (sympathetic and parasympathetic).
  • The nerves enter the upper cervix on either side and form two lateral semicircular plexuses, called Frankenhäuser plexus, a terminal part of the presacral plexus.

Pathogenesis

  • The pathogenesis of cervical polyp is characterized by chronic inflammation of the endocervical canal.
  • The exact mechanism of cervical polyps origin is not clearly understood. However, cervical polyps are believed to occur due to:
  • Cervical polyps arise from the endocervical canal and tend to protrude in the external cervix.
  • There are no genes associated with the development of cervical polyp.
  • On gross pathology, flesh-colored, single finger-like growth, 1 cm size, are characteristic findings of cervical polyp.
  • On microscopic histopathological analysis, inflamed and dilated endocervical (mucus) glands and myxoid stroma are characteristic findings of cervical polyp.

Causes

There are no established causes for cervical polyps.[2]

Differentiating Cervical Polyp from other Diseases

Cervical polyp must be differentiated from other diseases that cause abnormal vaginal bleeding, dyspareunia, and abnormal vaginal discharge

Abnormal Uterine bleeidng differential diagnosis
Ob-Gyn neoplasm and diseases Clinical manifestations Para-clinical findings Gold standard
Symptoms Physical exam Lab Findings Imaging Histopathology
Abnormal

vaginal bleeding

Other Genitourinary/ Gastrointestinal symptoms Abdominal pain Pelvic

pain

B symptoms Gynecological examinations Abdominal

mass

HPV

Pap smear

STI panel

Other labs Ultrasound Other

imagings

Cervical polyp[3]
  • Mass on exam
  • Hyper/hypoechogenic masses with or without cysts
  • Filling the endocervical or vaginal canal
Cervical cancer[4][5][6][7][8][9][10][11]
  • Postmenopausal
  • Intermenstrual
  • Postcoital
  • Bleeding after pelvic exam
+ + +
  • Cervical mass on exam
+ ± HPV T2-weighted MRI :
  • Ovoid, heterogeneous tumor distending the cervical canal with stromal involvement. PET/CT scan:
Cervical intraepithelial neoplasia:
Cervical leiomyoma[12][13][14][15][16][17][18][19][20]
  • Heavy/prolonged menstrual bleeding
  • Intermenstrual bleeding
+ + ±
  • Well circumscribed hyperechoic mass
T2-weighted MRI:
  • Hypointense masses
  • Homogeneous

enhancement

  • Red degeneration
  • Clinical diagnosis/ and
Cervical lymphoma[21][22][23]
  • Difficulty urinating
  • Post-coital pain
+ + +
  • Irregularity
+ Pap smear: Immunohistochemistry markers:
  • Well-defined, solid, concentric, hypoechoic mass
MRI:
  • Intramyometrial infiltrative nodules
  • Small tumor cells with large nuclei
  • High mitoses and proliferation
Cervical sarcoma[24][25][26][27] + + ±
  • Cervical mass
  • Lump protruding from vagina/vulva
+ Leiomyosarcoma markers: MRI:
  • Endometrial polypoid mass
  • Hypointense hypervascular solid components
Cervical erosion(Ectropion)[28][29][30][31][32]
  • Post-coital pain
  • Painful cramps
+ +
  • Red, glandular area around os of cervix
N/A N/A N/A
Cervicitis[33][34][35][36][37]
  • Intermenstrual bleeding
  • Postcoital
  • Pain during urination
+ +
  • May have fever only
STI panel:
MRI:

May be detected as retention cysts in cervix.

  • Non-specific, lymphocytic infiltration may be seen in microscopic histology.
  • Koilocytic changes in case of HPV as cause of chronic cervicitis.
Adenemyosis[38][39][40][41][42][43]
  • Abnormal uterine bleeding
  • Painful menstruation
+ +
  • Subendometrial striations
  • Myometrial cysts
  • Asymetrical thickness in myometrium walls
  • Heterogenous echotexture of myometrium
MRI:
  • Thickened junctional zone
  • Presence of ectopic endometrial glands into the myometrium.
Cervical ectopic pregnancy[44][45] +
  • Soft and disporportionally enlarged uterus.
± T2-weighted MRI:
  • Hypointense large mass

T1-weighted MRI:

  • Partially hyperintense mass
Nabothian cyst[46][47][48][49]
  • Postcoital bleeding
  • Majority of them are asymptomatic due to their small size( few milimeters)
N/A
  • Anechoic well defined cystic lesions
T1-weighted
  • Intermediate or slightly high signal intensity T2-weighted
  • High signal intensity on T2-weighted images
  • Benign cystic lesion
  • Multiple benign cystic masses, usually few milimieters in diameter.

Epidemiology and Demographics

The estimated prevalence of cervical polyps is approximately 1.5–10% in the general population.[2]

Age

  • Cervical polyps are more commonly observed among patients aged 40 to 55 years old.
  • Cervical polyps are more commonly observed among perimenopausal and postmenopausal women.[2]

Race

  • There is no racial predilection for cervical polyps.[2]

Risk Factors

Common risk factors in the development of cervical polyps include:[2]

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Criteria

The diagnosis of cervical polyp is made with a cervical biopsy. Characteristic findings in a biopsy of a cervical polyp include:[2]

Symptoms

  • Cervical polyp is usually asymptomatic.[2]
  • Symptoms of cervical polyp may include the following:

Physical Examination

  • Patients with cervical polyps are usually well-appearing.
  • Digital examination findings of the cervix, may include:[2]
  • Sessile or broad-based finger-like growth

Laboratory Findings

There are no specific laboratory findings associated with cervical polyps.

Imaging Findings

  • Ultrasound is the imaging modality of choice for cervical polyp.
  • On ultrasound, cervical polyp is characterized by the following findings:[2][50]
  • Sessile or pedunculated well-circumscribed masses within the endocervical canal
  • May be hypoechoic or echogenic
  • Identifying the stalk attaching to the cervical wall helps differentiate it from an endometrial polyp
  • The image below shows a cervical polyp characterized as a well-circumscribed mass within the endocervical canal.

Other Diagnostic Studies

  • Cervical polyp may also be diagnosed with colposcopy.
  • Findings on colposcopy may include:
  • Protruding polypoid mass
  • Smooth, red or purple, fingerlike growths on the cervix
  • Cervical bleeding
  • Cervical friableness
  • A cervical biopsy will most often show cells that are consistent with a benign polyp.

Treatment

Medical Therapy

  • There is no medical treatment for cervical polyp; the mainstay of therapy is surgical excision.[2]
  • Response to surgery can be monitored with regular ultrasound screenings every 6 or 12 months.
  • If the polyp is infected, an antibiotic may be prescribed.

Surgery

  • Surgery is the mainstay of therapy for cervical polyp.
  • Ring forceps in conjunction with biopsy is the most common approach to the treatment of cervical polyp.
  • Surgical string may also be performed for patients with a cervical polyp.
  • Other therapies, include: laser or cauterization.

Prevention

  • Effective measures for the primary prevention of cervical polyp include periodic ultrasound and cervical screening.[2]
  • Once diagnosed and successfully treated, patients with cervical polyp are followed-up every 6 or 12 months.
  • Follow-up testing includes pelvic examination, vaginal ultrasound, and colposcopy.

References

  1. Peterson WF, Novak ER. Endometrial polyps. Obstet Gynecol. 1956; 8:40–49.
  2. 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 Golan A, Ber A, Wolman I, David MP (1994). "Cervical polyp: evaluation of current treatment". Gynecol. Obstet. Invest. 37 (1): 56–8. PMID 8125411.
  3. Mitchell H (May 2004). "Vaginal discharge--causes, diagnosis, and treatment". BMJ. 328 (7451): 1306–8. doi:10.1136/bmj.328.7451.1306. PMC 420177. PMID 15166070.
  4. Hippisley-Cox J, Coupland C (January 2013). "Symptoms and risk factors to identify women with suspected cancer in primary care: derivation and validation of an algorithm". Br J Gen Pract. 63 (606): e11–21. doi:10.3399/bjgp13X660733. PMC 3529288. PMID 23336450.
  5. Dunyo, Priscilla; Effah, Kofi; Udofia, Emilia Asuquo (2018). "Factors associated with late presentation of cervical cancer cases at a district hospital: a retrospective study". BMC Public Health. 18 (1). doi:10.1186/s12889-018-6065-6. ISSN 1471-2458.
  6. Khalife D, El Housheimi A, Khalil A, Saba C S, Seoud M, Rammal R, Abdallah IE, Abdallah R (February 2019). "Treatment of cervical cancer metastatic to the abdominal wall with reconstruction using a composite myocutaneous flap: A case report". Gynecol Oncol Rep. 27: 38–41. doi:10.1016/j.gore.2018.12.006. PMC 6302027. PMID 30603660. Vancouver style error: name (help)
  7. . doi:10.1097/PAS.0000000000000498. Check |doi= value (help). Missing or empty |title= (help)
  8. Brenner PF (September 1996). "Differential diagnosis of abnormal uterine bleeding". Am. J. Obstet. Gynecol. 175 (3 Pt 2): 766–9. PMID 8828559.
  9. Alcázar, Juan Luis; Arribas, Sara; Mínguez, José Angel; Jurado, Matías (2014). "The Role of Ultrasound in the Assessment of Uterine Cervical Cancer". The Journal of Obstetrics and Gynecology of India. 64 (5): 311–316. doi:10.1007/s13224-014-0622-4. ISSN 0971-9202.
  10. Qing L, Xiang T, Guofu Z, Weiwei F (September 2014). "Leukemoid reaction in cervical cancer: a case report and review of the literature". BMC Cancer. 14: 670. doi:10.1186/1471-2407-14-670. PMC 4174654. PMID 25223869.
  11. Qing L, Xiang T, Guofu Z, Weiwei F (September 2014). "Leukemoid reaction in cervical cancer: a case report and review of the literature". BMC Cancer. 14: 670. doi:10.1186/1471-2407-14-670. PMC 4174654. PMID 25223869.
  12. Al-Habib A, Elgamal EA, Aldhahri S, Alokaili R, AlShamrani R, Abobotain A, AlRaddadi K, Alkhalidi H (November 2016). "Large primary leiomyoma causing progressive cervical deformity". J Surg Case Rep. 2016 (11). doi:10.1093/jscr/rjw190. PMC 5159177. PMID 27887011.
  13. Adaikkalam J (April 2016). "Lipoleiomyoma of Cervix". J Clin Diagn Res. 10 (4): EJ01–2. doi:10.7860/JCDR/2016/16505.7531. PMID 27190823.
  14. Houser, L. Murray; Carrasco, C. H.; Sheehan, C. R. (1979). "Lipomatous tumour of the uterus: radiographic and ultrasonic appearance". The British Journal of Radiology. 52 (624): 992–993. doi:10.1259/0007-1285-52-624-992. ISSN 0007-1285.
  15. Keriakos, Remon; Maher, Mark (2013). "Management of Cervical Fibroid during the Reproductive Period". Case Reports in Obstetrics and Gynecology. 2013: 1–3. doi:10.1155/2013/984030. ISSN 2090-6684.
  16. Coronado GD, Marshall LM, Schwartz SM (May 2000). "Complications in pregnancy, labor, and delivery with uterine leiomyomas: a population-based study". Obstet Gynecol. 95 (5): 764–9. PMID 10775744.
  17. Kamra, Hemlata T (2013). "Myxoid Leiomyoma of Cervix". JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH. doi:10.7860/JCDR/2013/6171.3805. ISSN 2249-782X.
  18. El-agwany, Ahmed Samy (2015). "Lipoleiomyoma of the uterine cervix: An unusual variant of uterine leiomyoma". The Egyptian Journal of Radiology and Nuclear Medicine. 46 (1): 211–213. doi:10.1016/j.ejrnm.2014.10.001. ISSN 0378-603X.
  19. Chaparala RP, Fawole AS, Ambrose NS, Chapman AH (March 2004). "Large bowel obstruction due to a benign uterine leiomyoma". Gut. 53 (3): 386, 430. PMC 1773948. PMID 14960521.
  20. Yokoyama Y, Shinohara A, Hirokawa M, Maeda N (2003). "Erythrocytosis due to an erythropoietin-producing large uterine leiomyoma". Gynecol. Obstet. Invest. 56 (4): 179–83. doi:10.1159/000074104. PMID 14564105.
  21. Grace A, O'Connell N, Byrne P, Prendiville W, O'Donnell R, Royston D, Walsh CB, Leader M, Kay E (1999). "Malignant lymphoma of the cervix. An unusual presentation and a rare disease". Eur. J. Gynaecol. Oncol. 20 (1): 26–8. PMID 10422676.
  22. Kanaan, Daniel; Parente, Daniella Braz; Constantino, Carolina Pesce Lamas; Souza, Rodrigo Canellas de (2012). "Linfoma de colo de útero: achados na ressonância magnética". Radiologia Brasileira. 45 (3): 167–169. doi:10.1590/S0100-39842012000300009. ISSN 0100-3984.
  23. Frey NV, Svoboda J, Andreadis C, Tsai DE, Schuster SJ, Elstrom R, Rubin SC, Nasta SD (September 2006). "Primary lymphomas of the cervix and uterus: the University of Pennsylvania's experience and a review of the literature". Leuk. Lymphoma. 47 (9): 1894–901. doi:10.1080/10428190600687653. PMID 17065003.
  24. Wright JD, Rosenblum K, Huettner PC, Mutch DG, Rader JS, Powell MA, Gibb RK (November 2005). "Cervical sarcomas: an analysis of incidence and outcome". Gynecol. Oncol. 99 (2): 348–51. doi:10.1016/j.ygyno.2005.06.021. PMID 16051326.
  25. Khosla, Divya; Gupta, Ruchi; Srinivasan, Radhika; Patel, Firuza D.; Rajwanshi, Arvind (2012). "Sarcomas of Uterine Cervix". International Journal of Gynecological Cancer. 22 (6): 1026–1030. doi:10.1097/IGC.0b013e31825a97f6. ISSN 1048-891X.
  26. Miccò M, Sala E, Lakhman Y, Hricak H, Vargas HA (December 2015). "Imaging Features of Uncommon Gynecologic Cancers". AJR Am J Roentgenol. 205 (6): 1346–59. doi:10.2214/AJR.14.12695. PMC 5502476. PMID 26587944.
  27. . doi:10.1097/IGC.0b013e31825a97f6. Check |doi= value (help). Missing or empty |title= (help)
  28. Mitchell L, King M, Brillhart H, Goldstein A (September 2017). "Cervical Ectropion May Be a Cause of Desquamative Inflammatory Vaginitis". Sex Med. 5 (3): e212–e214. doi:10.1016/j.esxm.2017.03.001. PMC 5562466. PMID 28460993.
  29. Mitchell H (May 2004). "Vaginal discharge--causes, diagnosis, and treatment". BMJ. 328 (7451): 1306–8. doi:10.1136/bmj.328.7451.1306. PMC 420177. PMID 15166070.
  30. Sharma, Abhishek; Ojha, Ranapratap; Sengupta, Parama; Chattopadhyay, Sarbani; Mondal, Soumit (2013). "Cervical intramural pregnancy: Report of a rare case". Nigerian Medical Journal. 54 (4): 271. doi:10.4103/0300-1652.119670. ISSN 0300-1652.
  31. . doi:10.12865/CHSJ.42.02.11. Missing or empty |title= (help)
  32. Casey PM, Long ME, Marnach ML (February 2011). "Abnormal cervical appearance: what to do, when to worry?". Mayo Clin. Proc. 86 (2): 147–50, quiz 151. doi:10.4065/mcp.2010.0512. PMC 3031439. PMID 21270291.
  33. Mattson SK, Polk JP, Nyirjesy P (July 2016). "Chronic Cervicitis: Presenting Features and Response to Therapy". J Low Genit Tract Dis. 20 (3): e30–3. doi:10.1097/LGT.0000000000000225. PMID 27243142.
  34. Rosenfeld WD, Clark J (June 1989). "Vulvovaginitis and cervicitis". Pediatr. Clin. North Am. 36 (3): 489–511. PMID 2660084.
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