Difference between revisions of "Cervical polyps"

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'''Cervical polyps''' are common entities that can be bothersome and are thus removed by a gynecologist.  The vast majority are benign.
'''Cervical polyps''' are common entities that can be bothersome and are thus removed by a gynecologist.  The vast majority are benign. An introduction to the ''uterine cervix'' is in the [[uterine cervix]] article.


==Benign endocervical polyps==
==Benign endocervical polyp==
===Clinical===
:''Endocervical polyp'' redirects here.
===General===
*Usually 30-50 years old.
*Usually 30-50 years old.
*Cause bleeding - due to trauma (???).
*May cause bleeding.


===Microscopic===
===Microscopic===
Features:
Features:<ref>URL: [http://pathologyoutlines.com/cervix.html#endocervpolyp http://pathologyoutlines.com/cervix.html#endocervpolyp]. Accessed on: 22 October 2011.</ref>
*May have mixed epithelium, i.e. squamous and endocervical type (with eosinophilic mucin).
*May have mixed epithelium, i.e. squamous and endocervical type (with eosinophilic mucin).
**Endocervical epithelium should have nuclei like that in the colon, i.e. small, round & basal.
**Endocervical epithelium should have nuclei like that in the colon, i.e. small, round & basal.
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*No histologic features separate cervical polyps from benign endocervical mucosa; ergo, they are often signed-out as "... consistent with cervical polyp."
*No histologic features separate cervical polyps from benign endocervical mucosa; ergo, they are often signed-out as "... consistent with cervical polyp."


Ref.:<ref>[http://pathologyoutlines.com/cervix.html#endocervpolyp http://pathologyoutlines.com/cervix.html#endocervpolyp]</ref>
DDx:
*[[Benign endometrial polyp]].
*[[Fibroepithelial stromal polyp]].
*[[Adenosarcoma]].
*[[Papillary adenofibroma of the uterine cervix]].<ref name=pmid8927449>{{Cite journal  | last1 = Fratini | first1 = D. | last2 = Cavaliere | first2 = A. | title = Papillary adenofibroma of the uterine cervix. A case report. | journal = Pathologica | volume = 88 | issue = 2 | pages = 135-6 | month = Apr | year = 1996 | doi =  | PMID = 8927449 }}</ref>
*[[Nabothian cyst]]s.
 
====Images====
<gallery>
Image: Xanthomatous endocervical polyp -- low mag.jpg | EP - low mag.
Image: Xanthomatous endocervical polyp -- intermed mag.jpg | EP - intermed. mag.
</gallery>
 
===Sign out===
<pre>
CERVICAL POLYP, EXCISION:
- CONSISTENT WITH BENIGN ENDOCERVICAL POLYP.
</pre>
 
<pre>
CERVICAL POLYP, EXCISION:
- CONSISTENT WITH BENIGN ENDOCERVICAL POLYP WITH ACUTE AND CHRONIC INFLAMMATION.
</pre>
 
<pre>
CERVICAL POLYP, EXCISION:
- CONSISTENT WITH BENIGN ENDOCERVICAL POLYP WITH AN EROSION AND INFLAMMATION.
- NEGATIVE FOR MALIGNANCY.
</pre>
 
====Significant squamous epithelium present====
<pre>
CERVICAL POLYP, EXCISION:
- BENIGN CERVICAL POLYP WITH ACUTE AND CHRONIC INFLAMMATION.
</pre>
 
====History provided====
<pre>
CERVICAL POLYP, EXCISION:
- BENIGN ENDOCERVICAL POLYP.
</pre>
 
==Papillary adenofibroma of the uterine cervix==
*[[AKA]] ''cervical papillary adenofibroma''.<ref name=pmid16041681>{{Cite journal  | last1 = Haberal | first1 = A. | last2 = Cil | first2 = AP. | last3 = Gunes | first3 = M. | last4 = Cavusoglu | first4 = D. | title = Papillary adenofibroma of the cervix: a case report. | journal = Ultrasound Obstet Gynecol | volume = 26 | issue = 2 | pages = 186-7 | month = Aug | year = 2005 | doi = 10.1002/uog.1948 | PMID = 16041681 }}</ref>
===General===
*Rare.<ref name=pmid8927449>{{Cite journal  | last1 = Fratini | first1 = D. | last2 = Cavaliere | first2 = A. | title = Papillary adenofibroma of the uterine cervix. A case report. | journal = Pathologica | volume = 88 | issue = 2 | pages = 135-6 | month = Apr | year = 1996 | doi =  | PMID = 8927449 }}</ref>
 
Clinical:<ref name=pmid8927449/>
*[[Menorrhagia]].
 
===Gross===
*Polypoid mass.
 
DDx:
*[[Benign endocervical polyp]].
 
===Microscopic===
Features:
*Branching nipple like projections (papillae) covered by endocervical epithelium +/- metaplastic squamous epithelium.
*Fibrous stroma.
 
DDx:
*[[Adenosarcoma]].


==Fibroepithelial stromal polyp==
==Fibroepithelial stromal polyp==
Line 29: Line 92:


===Microscopic===
===Microscopic===
Features:<ref name=pmid10680891/> (???)
Features:<ref name=pmid10680891/>
*Bland nuclei.
*Bland nuclei.
*Hypocellular.
*Hypocellular.


Features:<ref>{{Ref GP|31}}</ref>
<br>
*Polypoid lesions.
Note:
*Squamous epithelium.
*The Foundation series books appears to lump together ''fibroepithelial stromal polyp'' and ''pseudosarcomatous fibroepithelial stromal polyp''.
*Variable cellularity.
**Features as per ''Foundation series'' book:<ref>{{Ref GP|31}}</ref>
*Multinucleated cells.
***Polypoid lesions.
***Squamous epithelium.
***Variable cellularity.
***Multinucleated cells.
 
Image:
*[http://www.surgpath4u.com/caseviewer.php?case_no=450 FSP (surgpath4u.com)].


==Pseudosarcomatous fibroepithelial stromal polyp==
==Pseudosarcomatous fibroepithelial stromal polyp==
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*No identifiable margin between lesion and normal - important feature.
*No identifiable margin between lesion and normal - important feature.
*Scattered multinucleated stromal cells - usu. close to epithelium.
*Scattered multinucleated stromal cells - usu. close to epithelium.
DDx:
*[[Adenosarcoma]].


===IHC===
===IHC===
*Desmin +ve (common).
*Desmin +ve (common).
*SMA usu. -ve.
*SMA usu. -ve.
 
==Adenosarcoma==
==Adenosarcoma==
===General===
{{Main|Adenosarcoma}}
*Malignant.
 
===Microscopic===
Features:
*Sarcoma.
*Benign epithelial component (glands).


==See also==
==See also==
*[[Cervix]].
*[[Cervix]].
*[[Endometrial polyp]].
*[[Endometrial polyp]].
*[[Gynecologic_pathology]].
*[[Gynecologic pathology]].


==References==
==References==

Latest revision as of 03:51, 2 February 2017

Cervical polyps are common entities that can be bothersome and are thus removed by a gynecologist. The vast majority are benign. An introduction to the uterine cervix is in the uterine cervix article.

Benign endocervical polyp

Endocervical polyp redirects here.

General

  • Usually 30-50 years old.
  • May cause bleeding.

Microscopic

Features:[1]

  • May have mixed epithelium, i.e. squamous and endocervical type (with eosinophilic mucin).
    • Endocervical epithelium should have nuclei like that in the colon, i.e. small, round & basal.
  • Polypoid shape.
  • +/-Inflammation.
  • +/-Squamous metaplasia.

Negatives:

  • No mitoses.
  • No nuclear atypia.
  • No stromal proliferation.

Notes:

  • No histologic features separate cervical polyps from benign endocervical mucosa; ergo, they are often signed-out as "... consistent with cervical polyp."

DDx:

Images

  • EP - low mag.

  • EP - intermed. mag.

Sign out

CERVICAL POLYP, EXCISION:
- CONSISTENT WITH BENIGN ENDOCERVICAL POLYP.

CERVICAL POLYP, EXCISION:
- CONSISTENT WITH BENIGN ENDOCERVICAL POLYP WITH ACUTE AND CHRONIC INFLAMMATION.

CERVICAL POLYP, EXCISION:
- CONSISTENT WITH BENIGN ENDOCERVICAL POLYP WITH AN EROSION AND INFLAMMATION.
- NEGATIVE FOR MALIGNANCY.

Significant squamous epithelium present

CERVICAL POLYP, EXCISION:
- BENIGN CERVICAL POLYP WITH ACUTE AND CHRONIC INFLAMMATION.

History provided

CERVICAL POLYP, EXCISION:
- BENIGN ENDOCERVICAL POLYP.

Papillary adenofibroma of the uterine cervix

  • AKA cervical papillary adenofibroma.[3]

General

Clinical:[2]

Gross

  • Polypoid mass.

DDx:

Microscopic

Features:

  • Branching nipple like projections (papillae) covered by endocervical epithelium +/- metaplastic squamous epithelium.
  • Fibrous stroma.

DDx:

Fibroepithelial stromal polyp

General

  • Usually easy to recognize.[4]

Microscopic

Features:[4]

  • Bland nuclei.
  • Hypocellular.


Note:

  • The Foundation series books appears to lump together fibroepithelial stromal polyp and pseudosarcomatous fibroepithelial stromal polyp.
    • Features as per Foundation series book:[5]
      • Polypoid lesions.
      • Squamous epithelium.
      • Variable cellularity.
      • Multinucleated cells.

Image:

Pseudosarcomatous fibroepithelial stromal polyp

General

  • Uncommon.
  • Wide age range.
  • May be misdiagnosed as a sarcoma and overtreated.[4]
  • Similar lesions in vagina and vulva.

Microscopic

Features:[4]

  • Hypercellularity.
  • Marked nuclear pleomorphism (common).
  • +/-High mitotic rate ( > 10 mitoses / 10 HPF).
  • +/-Atypical mitoses.
  • No identifiable margin between lesion and normal - important feature.
  • Scattered multinucleated stromal cells - usu. close to epithelium.

DDx:

IHC

  • Desmin +ve (common).
  • SMA usu. -ve.

Adenosarcoma

Main article: Adenosarcoma

See also

References

  1. ↑ URL: http://pathologyoutlines.com/cervix.html#endocervpolyp. Accessed on: 22 October 2011.
  2. ↑ 2.0 2.1 2.2 Fratini, D.; Cavaliere, A. (Apr 1996). "Papillary adenofibroma of the uterine cervix. A case report.". Pathologica 88 (2): 135-6. PMID 8927449.
  3. ↑ Haberal, A.; Cil, AP.; Gunes, M.; Cavusoglu, D. (Aug 2005). "Papillary adenofibroma of the cervix: a case report.". Ultrasound Obstet Gynecol 26 (2): 186-7. doi:10.1002/uog.1948. PMID 16041681.
  4. ↑ 4.0 4.1 4.2 4.3 Nucci, MR.; Young, RH.; Fletcher, CD. (Feb 2000). "Cellular pseudosarcomatous fibroepithelial stromal polyps of the lower female genital tract: an underrecognized lesion often misdiagnosed as sarcoma.". Am J Surg Pathol 24 (2): 231-40. PMID 10680891.
  5. ↑ Nucci, Marisa R.; Oliva, Esther (2009). Gynecologic Pathology: A Volume in Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 31. ISBN 978-0443069208.
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