Cervical polyp

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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]

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 polyp. 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. Common risk factors in the development of cervical polyp, include: chronic inflammation, hormonal factors, presence of endometrial hyperplasia, and previous history of pregnancy. Cervical polyp is 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 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 to the treatment of cervical polyp.

Historical Perspective

• Cervical polyp was first described by Peterson and Novak in 1956 following the description of endometrial polyps.

Classification

• Cervical polyps may be classified according to morphological features into 4 subtypes, such as:
• Distribution

• Single
• Multiple

• Shape

• Tear shaped
• Lobular

• Size

• Less than 3 cm
• More than 3 cm

• Pedicle

• Broad-based
• Sessile

Pathophysiology

• 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.
• 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 polyp.

Differentiating cervical polyp from other Diseases

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

• Cervical intraepithelial neoplasia
• Cervicitis
• Benign endometrial polyp
• Fibroepithelial stromal polyp
• Adenosarcoma
• Cervical cancer

Epidemiology and Demographics

• The estimated prevalence of cervical polyp is approximately 1.5–10% in general population.

Age

• Cervical polyp is more commonly observed among patients aged 40 to 55 years old.
• Cervical polyp is more commonly observed among perimenopausal and postmenopausal women.

Race

• There is no racial predilection for cervical polyp.

Risk Factors

• Common risk factors in the development of cervical polyp, include:

• Chronic inflammation
• Hormonal factors
• Presence of endometrial hyperplasia
• Previous history of pregnancy

Natural History, Complications and Prognosis

• The majority of patients with cervical polyp remain asymptomatic for years.
• Early clinical features may include abnormal 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.
• Common complications of cervical polyp include malignant transformation, bleeding, and recurrence.
• Prognosis is generally excellent, and the 5-survival rate of patients with cervical polyp is approximately 100%.

Diagnosis

Diagnostic Criteria

• The diagnosis of cervical polyp is made with a cervical biopsy, showing the following findings:

• Mixed epithelium (i.e. squamous and endocervical type (with eosinophilic mucin).
• Endocervical epithelium should have nuclei
• Inflammation
• Squamous metaplasia

Symptoms

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

• Vaginal discharge
• Dyspareunia
• Dysmenorrhea
• Leukorrhea

Physical Examination

• Patients with cervical polyp usually are well-appearing.

• Digital examination findings of the cervix, may include:
• Sessile or broad-based finger-like growth

Laboratory Findings

• There are no specific laboratory findings associated with cervical polyp.

Imaging Findings

• Ultrasound is the imaging modality of choice for cervical polyp.
• On ultrasound, cervical polyp is characterized by the following findings:

• 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.

• 

  Image: Transverse ultrasound 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
• Cervical bleeding
• Cervical friableness

Treatment

Medical Therapy

• There is no medical treatment for cervical polyp; the mainstay of therapy is surgical excision.
• Response to surgery can be monitored with regular ultrasound screenings every 6 or 12 months.

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 cervical polyp.
• Other therapies, include: laser, or cauterisation. If the polyp is infected, an antibiotic may be prescribed.

Prevention

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