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.[1] There are no established causes for cervical polyp.[1] 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.[1] 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.[1] 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.[2]
Classification
Cervical polyps may be classified according to morphological features into 4 subtypes, such as:[1]
- Distribution
- Single
- Multiple
- Shape
- Tear shaped
- Lobular
- Size
- Less than 3 cm
- More than 3 cm
- Pedicle
- Broad-based
- Sessile
Pathophysiology
Anatomy
- The normal cervix is fusiform in shape, with the narrowest portions at the internal and external os and 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 no more 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 vertebrae, 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.
- 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.
- 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.[1]
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.[1]
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.[1]
Race
- There is no racial predilection for cervical polyp.[1]
Risk Factors
Common risk factors in the development of cervical polyp, include:[1]
- 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:[1]
- 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.[1]
- Symptoms of cervical polyp may include the following:
- Intermenstrual bleeding (most common)
- Vaginal discharge
- Dyspareunia
- Bleeding after sex
- Dysmenorrhea
- Leukorrhea
Physical Examination
Patients with cervical polyp usually are well-appearing.
- Digital examination findings of the cervix, may include:[1]
- 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:[1][3]
- 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
- 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.[1]
- 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.[1]
- 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.
References
- ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 1.14 1.15 Golan A, Ber A, Wolman I, David MP (1994). "Cervical polyp: evaluation of current treatment". Gynecol. Obstet. Invest. 37 (1): 56–8. PMID 8125411.
- ↑ Peterson WF, Novak ER. Endometrial polyps. Obstet Gynecol. 1956; 8:40–49.
- ↑ Cervical polyp. Dr. Henry Kenipe. Radiopedia. http://radiopaedia.org/articles/cervical-polyp Accessed on March 31,2016