Definition/General

Introduction:
-Cervical fibroid polyp is a benign polypoid lesion of the cervix composed predominantly of smooth muscle fibers with a fibrovascular stalk
-It represents a localized proliferation of smooth muscle elements forming a pedunculated mass.
Origin:
-Arises from smooth muscle cells within the cervical wall, forming a pedunculated or sessile polypoid growth
-May develop from pre-existing small leiomyomas or de novo smooth muscle proliferation.
Classification:
-WHO Classification categorizes as benign smooth muscle proliferation
-Distinguished from typical cervical polyps by predominant smooth muscle component
-May be pedunculated or sessile.
Epidemiology:
-Uncommon lesion, accounting for <5% of cervical polyps
-Peak incidence 30-50 years
-More common in reproductive-age women
-Associated with hormonal factors.

Clinical Features

Presentation:
-Visible polypoid cervical mass
-Abnormal vaginal bleeding (intermenstrual, post-coital)
-Vaginal discharge
-May cause cervical irregularity on examination.
Symptoms:
-Abnormal vaginal bleeding (most common)
-Vaginal discharge (watery or bloody)
-Pelvic pressure if large
-Dyspareunia
-Often asymptomatic.
Risk Factors:
-Reproductive age
-Hormonal factors (estrogen, progesterone)
-Previous cervical trauma
-Chronic cervicitis
-Genetic predisposition to smooth muscle tumors.
Screening:
-Speculum examination reveals polypoid lesion
-Pelvic ultrasound may identify echogenic mass
-MRI shows characteristic smooth muscle signal intensity.

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Gross Description

Appearance:
-Firm, smooth, polypoid lesion with narrow stalk or broad base
-White to tan coloration
-Whorled cut surface characteristic of smooth muscle.
Characteristics:
-Size variable (few mm to 5 cm)
-Firm, rubbery consistency
-White to tan color
-Smooth surface
-Whorled pattern on cut section.
Size Location:
-Arises from cervical wall, usually near external os
-May protrude through cervical canal
-Can extend into vagina if pedunculated.
Multifocality:
-Usually solitary lesion
-May be associated with other cervical or uterine leiomyomas
-Rarely multiple polyps present.

Microscopic Description

Histological Features:
-Polypoid lesion composed predominantly of mature smooth muscle fibers arranged in interlacing fascicles
-Central fibrovascular stalk with overlying epithelium.
Cellular Characteristics:
-Smooth muscle cells: elongated, spindle-shaped with cigar-shaped nuclei
-Abundant eosinophilic cytoplasm
-Minimal nuclear atypia
-Low mitotic activity.
Architectural Patterns:
-Polypoid architecture with central stalk
-Interlacing fascicles of smooth muscle
-Surface covered by squamous or endocervical epithelium.
Grading Criteria:
-Benign lesion (no grading system)
-Distinguished from leiomyosarcoma by low mitotic count, lack of necrosis, minimal cellular atypia.

Immunohistochemistry

Positive Markers:
-Smooth muscle actin (SMA) diffusely positive
-Desmin positive
-Caldesmon positive
-Estrogen receptor (ER) variable
-Progesterone receptor (PR) variable.
Negative Markers:
-CD117 (c-kit) negative
-CD34 negative
-S100 protein negative
-Cytokeratin negative
-EMA negative.
Diagnostic Utility:
-SMA and desmin confirm smooth muscle differentiation
-Caldesmon helps distinguish from other spindle cell lesions
-IHC differentiates from other mesenchymal tumors.
Molecular Subtypes:
-No specific molecular subtypes
-Similar genetic profile to uterine leiomyomas in some cases.

Molecular/Genetic

Genetic Mutations:
-Limited data available
-May share genetic alterations with uterine leiomyomas (MED12 mutations, chromosomal rearrangements)
-Generally normal karyotype.
Molecular Markers:
-Smooth muscle markers positive
-Ki-67 proliferation index typically low (<1%)
-Normal p53 expression
-Hormone receptor variable expression.
Prognostic Significance:
-Excellent prognosis as benign lesion
-Complete excision curative
-No malignant potential
-Rare recurrence if incompletely excised.
Therapeutic Targets:
-Complete surgical excision (polypectomy)
-No adjuvant therapy required
-Hormonal factors may influence growth.

Differential Diagnosis

Similar Entities:
-Cervical leiomyoma
-Conventional cervical polyp
-Inflammatory myofibroblastic tumor
-Solitary fibrous tumor
-Leiomyosarcoma (rare).
Distinguishing Features:
-Fibroid polyp: polypoid, SMA+
-Conventional polyp: fibrous stalk, epithelium-lined
-Leiomyosarcoma: high mitoses, necrosis, atypia.
Diagnostic Challenges:
-Distinction from conventional polyp requires recognition of smooth muscle component
-Cellular variants may raise concern for malignancy.
Rare Variants:
-Atypical fibroid polyp
-Cellular fibroid polyp
-Mixed epithelial-smooth muscle polyp.

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]