Definition/General

Introduction:
-Cervical polyps are benign, localized proliferations of endocervical epithelium and stroma that project into the cervical canal or extend through the external os
-They are among the most common benign cervical lesions.
Origin:
-Arise from hyperplastic proliferation of endocervical glands and stroma, often in response to chronic inflammation, hormonal stimulation, or local irritation.
Classification:
-WHO Classification categorizes as benign epithelial proliferation
-May be classified as endocervical (most common) or ectocervical based on epithelial lining
-Usually single but can be multiple.
Epidemiology:
-Common in reproductive-age women (20-50 years)
-Peak incidence 40-50 years
-Rare before menarche and after menopause
-Associated with chronic cervicitis and hormonal factors.

Clinical Features

Presentation:
-Abnormal vaginal bleeding (intermenstrual, post-coital)
-Vaginal discharge
-Visible polypoid lesion protruding from cervical os
-Often asymptomatic and incidental finding.
Symptoms:
-Intermenstrual bleeding (most common)
-Post-coital bleeding
-Menorrhagia
-Vaginal discharge (watery or bloody)
-Cramping pain if large
-Often asymptomatic.
Risk Factors:
-Reproductive age
-Chronic cervicitis
-Hormonal imbalance
-Multiparty
-Hypertension
-Diabetes mellitus
-Previous cervical procedures.
Screening:
-Speculum examination reveals polypoid lesion
-Pelvic ultrasound may identify polyps
-Hysteroscopy for detailed evaluation
-Routine during gynecological examination.

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Gross Description

Appearance:
-Smooth, soft, polypoid lesions with narrow stalk or broad base
-Pink to red coloration
-Lobulated or smooth surface
-Single or multiple polyps.
Characteristics:
-Size variable (few mm to 4-5 cm)
-Soft, fleshy consistency
-Pink to red color
-Smooth or slightly lobulated surface
-May be pedunculated or sessile.
Size Location:
-Arise from endocervical canal
-May protrude through external os
-Can extend into vagina
-Usually attached by narrow stalk to cervical wall.
Multifocality:
-Usually solitary but can be multiple
-May be associated with endometrial polyps
-Can coexist with other cervical lesions.

Microscopic Description

Histological Features:
-Central fibrovascular stalk covered by endocervical-type columnar epithelium
-Mature fibrous stroma with scattered chronic inflammatory cells
-May show surface erosion.
Cellular Characteristics:
-Surface epithelium: tall columnar cells with basally located nuclei
-Stromal cells: mature fibroblasts and smooth muscle cells
-Inflammatory cells: lymphocytes and plasma cells.
Architectural Patterns:
-Polypoid architecture with central stalk
-Endocervical glands may be present
-Surface epithelium may show reactive changes
-Stromal edema common.
Grading Criteria:
-Benign lesion (no grading system)
-May show mild reactive atypia in epithelium
-Absence of significant cytologic atypia or mitotic activity.

Immunohistochemistry

Positive Markers:
-CK7 positive in epithelium
-CEA positive in glandular epithelium
-Estrogen receptor (ER) variable
-Progesterone receptor (PR) variable.
Negative Markers:
-p16 typically negative (unless HPV-related changes present)
-CK20 negative
-TTF-1 negative
-Neuroendocrine markers negative.
Diagnostic Utility:
-Usually morphological diagnosis
-IHC rarely needed
-CK7 and CEA confirm glandular nature
-p16 testing if dysplastic changes suspected.
Molecular Subtypes:
-No specific molecular subtypes
-May show hormonal responsiveness similar to normal endocervical tissue.

Molecular/Genetic

Genetic Mutations:
-No specific genetic alterations
-Represents hyperplastic response to chronic stimulation
-Normal chromosomal complement in most cases.
Molecular Markers:
-Variable hormone receptor expression
-Ki-67 proliferation index typically low
-Normal p53 expression pattern
-No significant genomic instability.
Prognostic Significance:
-Excellent prognosis as benign lesion
-Low risk of malignant transformation (<1%)
-May recur if incompletely excised.
Therapeutic Targets:
-Complete surgical excision (polypectomy)
-Hormonal evaluation if multiple or recurrent
-Treatment of underlying cervicitis.

Differential Diagnosis

Similar Entities:
-Endometrial polyp prolapsed through cervix
-Cervical adenocarcinoma (polypoid variant)
-Endocervical adenocarcinoma
-Fibroid polyp
-Placental polyp.
Distinguishing Features:
-Cervical polyp: benign epithelium, fibrous stalk
-Adenocarcinoma: malignant features, invasion
-Endometrial polyp: endometrial-type stroma.
Diagnostic Challenges:
-Large polyps may show surface ulceration mimicking malignancy
-Distinction from prolapsed endometrial polyp
-Assessment of stalk for complete excision.
Rare Variants:
-Atypical polypoid adenomyoma
-Microglandular hyperplasia in polyp
-Polyp with squamous metaplasia
-Inflamed polyp with reactive atypia.

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]