Definition/General

Introduction:
-Cervical endocervical polyp is a common benign growth arising from the endocervical canal, composed of mature endocervical glands and stroma
-It represents localized hyperplastic response, often hormone-related, with minimal malignant potential.
Origin:
-Arises from endocervical canal mucosa through localized hyperplastic process
-Develops from normal endocervical glands and stroma
-Usually hormone-responsive growth.
Classification:
-WHO Classification categorizes as benign epithelial lesion
-Simple hyperplastic polyp
-May show inflammatory or reactive changes.
Epidemiology:
-Most common in reproductive age women (30-50 years)
-Hormone-related occurrence
-Increased incidence with estrogen exposure
-Generally benign with excellent prognosis.

Clinical Features

Presentation:
-Abnormal vaginal bleeding (intermenstrual, postcoital)
-Visible polyp protruding from cervix
-Abnormal vaginal discharge
-May be asymptomatic.
Symptoms:
-Intermenstrual bleeding
-Postcoital bleeding
-Menorrhagia
-Mucoid vaginal discharge
-Pelvic pressure (large polyps).
Risk Factors:
-Reproductive age
-Estrogen exposure
-Pregnancy
-Hormone replacement therapy
-Tamoxifen use
-Chronic inflammation.
Screening:
-Often detected on routine pelvic examination
-Visible on speculum examination
-May be found during colposcopy
-Ultrasound may identify large polyps.

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Gross Description

Appearance:
-Smooth, round to oval, pedunculated mass
-Pink to red coloration
-Soft, fleshy consistency
-Single or multiple polyps possible.
Characteristics:
-Size variable (few mm to 3-4 cm)
-Smooth, glistening surface
-Soft consistency
-Pink to red coloration
-Usually pedunculated.
Size Location:
-Arises from endocervical canal
-May protrude through external os
-Size typically <3 cm
-Attached by narrow stalk.
Multifocality:
-Usually single but may be multiple
-Occasionally extensive polyposis
-May be associated with endometrial polyps.

Microscopic Description

Histological Features:
-Mature endocervical glands in fibrous stroma
-Surface lined by endocervical-type epithelium
-May show inflammatory changes, squamous metaplasia, or reactive atypia.
Cellular Characteristics:
-Normal endocervical epithelium with columnar cells
-Minimal nuclear atypia
-Mucin-producing cells
-Occasional ciliated cells.
Architectural Patterns:
-Branching endocervical glands
-Fibrous to edematous stroma
-Surface epithelium may show erosion
-Thick-walled blood vessels.
Grading Criteria:
-Benign lesion (no grading)
-May show reactive changes
-Absence of significant atypia
-Normal maturation pattern.

Immunohistochemistry

Positive Markers:
-CK7 positive in glandular epithelium
-CEA may be positive
-Estrogen receptor positive
-Progesterone receptor positive.
Negative Markers:
-p16 negative (no HPV association)
-CK20 negative
-TTF-1 negative
-Neuroendocrine markers negative.
Diagnostic Utility:
-Hormone receptors confirm hormone responsiveness
-p16 negativity excludes dysplastic changes
-Normal glandular markers present.
Molecular Subtypes:
-Hormone-responsive benign polyp
-No specific molecular subtypes.

Molecular/Genetic

Genetic Mutations:
-Generally no significant mutations
-May have clonal growth pattern
-HMGA2 rearrangements possible in some cases.
Molecular Markers:
-Normal p53 expression
-Low Ki-67 proliferation index
-Hormone receptor positivity.
Prognostic Significance:
-Excellent prognosis
-Benign lesion with minimal malignant potential
-Low recurrence rate after complete excision.
Therapeutic Targets:
-Hormonal modulation possible
-Complete excision curative
-Estrogen reduction may prevent recurrence.

Differential Diagnosis

Similar Entities:
-Cervical cancer (polypoid)
-Endometrial polyp prolapsing through cervix
-Adenofibroma
-Adenosarcoma (rare)
-Placental site nodule.
Distinguishing Features:
-Endocervical polyp: Benign glands, hormone receptors+
-Cancer: Malignant features, invasion
-Endometrial polyp: Different glandular pattern.
Diagnostic Challenges:
-Exclusion of malignancy in large polyps
-Distinction from endometrial polyp
-Assessment of reactive atypia vs dysplasia.
Rare Variants:
-Atypical polypoid adenomyoma
-Polyp with focal atypia
-Inflamed polyp with reactive changes.

Sample Pathology Report

Template Format

Sample Pathology Report

Complete Report: This is an example of how the final pathology report should be structured for this condition.

Specimen Information

[specimen type], measuring [size] cm in greatest dimension

Diagnosis

[diagnosis name]

Classification

Classification: [classification system] [grade/type]

Histological Features

Shows [architectural pattern] with [nuclear features] and [mitotic activity]

Size and Extent

Size: [X] cm, extent: [local/regional/metastatic]

Margins

Margins are [involved/uninvolved] with closest margin [X] mm

Lymphovascular Invasion

Lymphovascular invasion: [present/absent]

Lymph Node Status

Lymph nodes: [X] positive out of [X] examined

Special Studies

IHC: [marker]: [result]

Molecular: [test]: [result]

[other study]: [result]

Prognostic Factors

Prognostic factors: [list factors]

Final Diagnosis

Final diagnosis: [complete diagnosis]