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]