Cervical Polyp Research Articles

An Innovative Approach: Using Simulation to Teach Primary Care Gynecologic Procedures.

In response to the growing body of evidence that simulation is a satisfactory way to instruct procedural skills, we developed an innovative model to teach common gynecologic procedures such as cervical cancer screening, cervical polyp removal, intrauterine device removal, and endometrial biopsy. The objectives of this study were to describe the construction of the model and to assess participants' satisfaction and confidence in applying the learning objectives to their clinical practice. The researchers created the model with reusable and readily available materials. During a hands-on skills workshop, practicing clinicians performed simulated cervical cancer screening, endocervical polyp removal, intrauterine device removal, and an endometrial biopsy on a low-fidelity gynecologic model. Using convenience sampling, each participant completed a survey designed to measure satisfaction with the workshop and self-confidence in their newly acquired skills. All (N = 30,100%) of the participants agreed at the "agree" or "strongly agree" level that the gynecologic skills workshop using lecture and a hands-on model was a satisfying and self-confidence-building experience. An easily reproducible and reusable gynecologic procedure simulator was highly rated as a means of teaching common primary care gynecologic procedures. The simulated model provided an opportunity for hands-on skills learning for clinicians who wish to expand their gynecologic procedure skill set.

HPV-negative Gastric Type Adenocarcinoma In Situ of the Cervix: A Spectrum of Rare Lesions Exhibiting Gastric and Intestinal Differentiation.

In recent years, a number of benign and malignant cervical glandular lesions exhibiting gastric differentiation have been described but premalignant gastric-type lesions have not been well characterized. We report a series of 9 cases of a rare form of cervical adenocarcinoma in situ (AIS) distinguished by gastric and sometimes intestinal differentiation and lack of association with human papillomavirus (HPV) infection. The lesions occurred in women aged 25 to 73 years (mean age 51 y). All cases were located at (or just proximal to) the cervical transformation zone and there was extension to the lower uterine segment in 3 cases, 2 of which also involved the endometrium. In all cases, the normal cervical glandular architecture was largely preserved but in 5 cases there was a mild degree of increased intraglandular architectural complexity. The glandular epithelium ranged from almost purely gastric in type (4 cases) to mixed gastric and intestinal (5 cases), with varying proportions of intermixed goblet cells. In contrast to the basophilic cytoplasm of normal endocervical glands, the gastric-type epithelium was typically predominantly composed of cells with eosinophilic or pale pink cytoplasm, but conspicuous foamy or clear cell cytoplasm was present in some cases. Nuclear atypia was present in all cases but was considered low-grade in 8. High-grade features such as marked nuclear pleomorphism and hyperchromasia were evident in only 1 case. Mitotic activity and apoptotic bodies were present but both were noted to be less frequent than in usual type (HPV-related) AIS. Immunohistochemically, there was usually positive staining with CK 7 (7/7 cases) and MUC 6 (7/8 cases) and some cases were positive with CK 20 (3/7), CDX2 (5/9), PAX 8 (5/9) and CEA (2/6). Estrogen receptor and progesterone receptor were usually negative, although Estrogen receptor was positive in 3 of 9 cases. p16 was negative or exhibited mosaic-type staining (nonblock staining) in all cases and there was mutation-type p53 staining in 2 of 9 cases. HPV molecular testing was negative in all 4 cases tested. We believe this unusual subtype of AIS, which we term "gastric-type AIS (gAIS)," represents a precursor to gastric-type adenocarcinoma of the cervix and suggest that gAIS and so-called "atypical lobular endocervical glandular hyperplasia" are related entities within a spectrum of premalignant gastric-type lesions for which we propose the umbrella term gAIS. The malignant potential and optimal management of gAIS are currently unknown but in one of our cases a gastric-type adenocarcinoma developed 6 years after removal of a cervical polyp which contained gAIS. The introduction of HPV vaccination will result in a relative increase in incidence of premalignant and malignant cervical glandular lesions exhibiting gastric differentiation and these will not be detected by HPV-based screening programs.

Clinical Study of Postmenopausal Bleeding

Background: Women with postmenopausal bleeding (PMB) should be thoroughly evaluated. A thorough examination may help in the diagnosis of vulval, vaginal, cervical or pelvic pathology.Objective: This study was carried out to find the probable causes in patients presenting with postmenopausal bleeding.Materials and method: This observational study included 50 women with postmenopausal bleeding and was conducted in the department of Obstetrics and Gynaecology of Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorder (BIRDEM) Hospital, Dhaka, Bangladesh, from January 2004 to December 2004. Transvaginal ultrasonogram (TVS), diagnostic curettage and cervical biopsy were done and histopathology report was collected.Results: The mean age of the patients was 57.74 years (range 48-75 years), and the median age of menopause was 50 years. Among the patients 18 (36%) had only diabetes and 25 (50%) patients had both diabetes and hypertension. Nineteen patients (38%) were overweight, 5 patients (10%) were obese and 2 (4%) were morbidly obese. Per speculum examination revealed suspected cervical carcinoma in 5 cases (10%) and cervical polyp in 1 case (2%). The most common clinical finding was atrophy of the uterus and vagina in 26 patients (52%). TVS revealed endometrial thickness of 5mm or more in 17 cases (37.7%) and < 5mm in 26 cases (57.7%). Nine patients (18%) had carcinoma, 16 patients (32%) had benign pathology and 19 (38%) patients had endometrial atrophy on histology.Conclusion: A detailed history taking, thorough physical examination and relevant investigations can lead to a correct detection of cause of postmenopausal bleeding. Those who have normal adnexae and thin endometrium (endometrium <5mm) may not need endometrial biopsy.Delta Med Col J. Jul 2017 5(2): 83-88

Overexpression of dendritic cell-specific intercellular adhesion molecule-3-grabbing nonintegrin-related protein in cervical cancer and correlation with squamous cell carcinoma antigen.

Dendritic cell-specific intercellular adhesion molecule-3-grabbing nonintegrin-related protein (DC-SIGNR) is a type II transmembrane protein that has been reported to bind to various pathogens and participate in immunoregulation and tumorigenesis. However, further research is required to investigate whether the level of DC-SIGNR and cervical cancer are associated. The present study aimed to explore the clinical diagnostic significance of DC-SIGNR in cervical cancer. Immunohistochemical staining of DC-SIGNR was performed in samples from 25 patients with early stage cervical cancer, 14 patients with cervical intraepithelial neoplasia (CIN) and cervical polyp samples from 15 individuals. DC-SIGNR expression in cervical cancer tissue was significantly higher compared with that in CIN and cervical polyp tissue (P=0.0184 and P=0.0236, respectively). However, there was no significant difference in DC-SIGNR expression between CIN and cervical polyp tissue (P=0.8103). Additionally, the serum DC-SIGNR levels in 84 cervical cancer patients and 69 healthy female individuals were measured using an ELISA. Serum (s)DC-SIGNR levels were significantly higher in cervical cancer patients compared with healthy female individuals (P<0.0001). A sDC-SIGNR level of 93.7 ng/ml was revealed by receiver operating characteristic curve analysis to predict the presence of cervical cancer with 69.57% sensitivity and 66.67% specificity (area under the curve, 0.6989; P<0.0001). Levels of sDC-SIGNR in cervical cancer patients were also correlated with serum levels of squamous cell carcinoma antigen (r=0.2583; P=0.0348). The results of the present study demonstrate that DC-SIGNR is overexpressed in cervical cancer tissue, and suggest that DC-SIGNR could serve as a biomarker for the early diagnosis of cervical cancer. Nevertheless, further studies are required to demonstrate what role DC-SIGNR serves in cervical cancer.

Should women with postcoital bleeding be referred for colposcopy?

Electronic searches of literature published between 1980 and 2014 were undertaken using MEDLINE, Embase, CINHAL, and the Cochrane Database of Systemic reviews. Search items included: post coital bleeding, colposcopy, cervical cancer. Postcoital bleeding remains a cardinal warning sign of lower genital tract cancer and it is important to remember that it can also occur in the absence of cancer. In the vast majority of cases, there will be no sinister pathological abnormality. The common causes are usually benign conditions such as cervical ectopy and benign cervical polyps. Only a small number of women with PCB will have invasive disease of the lower genital tract.

Sonovaginography: A Useful Technique in the Assessment of the Lower Genital Tract.

Conventional sonographic evaluation of the cervix and vagina is compromised by inattention, poor subject contrast, and obscuring artifacts. We describe a technique involving distention of the vaginal canal and fornices with ultrasound gel, providing an acoustic window for improved definition of the cervix and vagina. This exam is usually performed in concert with transvaginal sonography, but a transabdominal or transperineal approach may be more useful in selected scenarios. A wide variety of formerly sonographically inconspicuous conditions are demonstrable with this technique, many of which were undetected or inadequately characterized on the physical exam. Cervical polyps were the most commonly seen abnormality.

Assessment of Endometrial Sampling and Histopathological Results: Analysis of 4,247 Cases.

This study aimed to investigate the relationship between indications and histopathological results in patients undergoing endometrial sampling. Data of 4,247 patients undergoing endometrial sampling due to non-obstetric gynecological causes between January 2010 and October 2016 were retrospectively evaluated using the archives of the Gynecology and Obstetrics Clinic of Konya Training and Research Hospital. The mean age of patients was 46.8 ± 8.22 years; the most common indication was menometrorrhagia/menorrhagia (70.66%), and the least common indication was cervical polyp (1.34%). The most common histopathological result was proliferative-secretory endometrium (63.62%); simple hyperplasia with atypia (0.56%) was determined to be the least common result. Endometrial cancer was observed more frequently in the post-menopausal bleeding and increased endometrial thickness group (23.11%). Of patients in whom biopsy was performed, 52.18% had undergone hysterectomy, as a result of which proliferative-secretory endometrium was most commonly (59.52%) and simple hyperplasia with atypia least commonly found as the histopathological diagnosis. Although sampling should be performed following endometrial evaluation in patients with post-menopausal bleeding or increased endometrial thickness, according to the results of our study, routine endometrial biopsy should not be preferred in the other indications.

An Unusually Big Cervical Fibroid Polyp : A Case Report

Fibroid Uterus is the most common benign solid tumor in female. Most of fibroids situated in the body of the uterus, cervical myoma account 3% -8% of uterine myoma. Cervical myoma are uncommon in different presentation, resembling inversion of uterus, malignancy &amp; various sizes are reported in literature. A case of big cervical fibroid polyp has been reported here. Patient presented something coming down per vagina with foul smelling discharge. On examinations there was a hugely enlarged, infected mass about 15cm x 12cm which was arising from posterior lip of the cervix &amp; outside the introitus. As the patient was 45 years &amp; had menorrhagia, Non Descend Vaginal Hysterectomy (NDVH) was done without resecting the polyp priorly. Patient was discharged in good condition. Histopathology confirmed the diagnosis and reported leiomyoma with areas of degeneration which was mainly composed of involuntary smooth muscle cells &amp; fibrous connective tissue from cervix which probably expelled out as a polyp attached to posterior lip of cervix.Chatt Maa Shi Hosp Med Coll J; Vol.15 (2); Jul 2016; Page 65-67

Comorbidity profiles among women with postcoital bleeding: a nationwide health insurance database.

Most of the existing studies on postcoital bleeding (PCB) in Western countries. To date, no study has focused on the various PCB-related comorbidities in Taiwan women. This work aims to analyze and compare the presence or absence of PCB among Taiwanese women with gynecological comorbidity. This study is a population-based retrospective cohort investigation. Outpatients with PCB after the index date were considered. A total of 2377 female patients with PCB (ICD-9 626.7) were identified using a nationwide outpatient sample from 2001 to 2010. For comparison, 7131 cases were randomly matched with the study group in terms of gender and age. The PCB incidence rate was 39-59 cases/100,000 Taiwanese women, with mean age (±SD) of 36.74 ± 10.79 years, median age of 36 years, and mode age of 29 years. Women with PCB exhibited 1.47-fold risk of cervical dysplasia and 1.59-fold risk for malignant neoplasm of cervix. Young women with PCB showed high risk of cervical cancer. The most common benign diseases among PCB- related comorbidities were cervical erosion and ectropion (20.66%), followed by vaginitis and vulvovaginitis (19.18%). Comparison between PCB and non-PCB groups indicated several significant high-risk comorbidities including cervical polyps, cervical erosion, leukoplakia of cervix, intrauterine contraceptive device, cervicitis, vaginitis, menopause, dyspareunia, and vulvodynia. This study provides evidence that PCB-related comorbidities manifested benign diseases (51.58%), lower genital tract infection (46.11%), and cervical cancer (2.31%). Thus, healthcare providers must ensure that appropriate routine screening tests and counseling are given to women with PCB.

Spectrum of Histopathological Findings in Postmenopausal Bleeding.

To determine the frequencies of histopathological findings in endometrial and endocervical biopsy samples with clinical history of Postmenopausal Bleeding (PMB). Descriptive cross-sectional study. Section of Histopathology, Department of Pathology and Laboratory Medicine, The Aga Khan University Hospital, Karachi, from February 2012 to January 2013. A total of 157 consecutive endometrial and endocervical biopsy specimens with history of postmenopausal bleeding were included. After microscopic examination, frequencies of histological findings in different age groups were generated. Chi-square and independent sample t-tests were applied to see whether the difference was significant which was set at p < 0.05. One hundred and twenty-one (77.1%) specimens showed benign pathologies while 36 (22.9%) were malignant. Endometrial polyp was seen in 67 (42.7%) cases followed by endometrial carcinomas in 25 (15.9%), endometrial hyperplasia in 21 (13.4%), cervical carcinoma in 12 (7.6%) and cervical polyps in 9 (5.7%) cases. A highly significant increase in the percentage of malignant and pre-malignant lesions was seen with increasing age group (p < 0.001). Mean age of patients with type-2 endometrial carcinoma was higher than type-1 endometrial carcinoma but statistical significance was not observed (70.2 ±6.5 vs. 61.8 ±9.1 years respectively, p=0.069). Although benign pathologies were more common in postmenopausal bleeding but the collective proportion of endometrial and cervical malignancies and pre-malignant conditions was quite high. Therefore, PMB should be urgently evaluated for cause and early commencement of treatment.

Adenolipoleiomyoma of the cervix – a unique cervical polyp: a case report and review of literature

Adenolipoleiomyoma of the cervix – a unique cervical polyp: a case report and review of literature

Hysteroscopic Resection of a Giant Cervical Polyp with Preservation of Hymen

Objectives: To report a patient who had hysteroscopic cervical polyp removal in a day care setting with preservation of the hymen. Setting: In a tertiary academic referral center, hysteroscopic cervical polyp resection was performed for a 26-year-old female with menorrhagia. Patient: 26 years old female with a giant cervical polyp. Intervention: Hysteroscopic cervical polypectomy, case study. Main outcome measures: successful hysteroscopic resection of a 5 cm polyp with preservation of the hymen. Results: Hysteroscopic resection of a 5 cm cervical polyp along with preservation of the hymen, is a more conservative alternative to conventional cervical poylpectomy. The result was the improvement of menorrhagia and patient satisfaction in terms of preserving her hymen. Conclusions: Hysteroscopic resection of a cervical polyp in virgin females is possible with preservation of their hymen and this should be considered as a first option in patients wishing to conserve their virginity.

Giant Polyp of Uterine Cervix: A Case Report and Brief Literature Review

Cervical polyps are most commonly seen in the female with uterine bleeding. On the other hand, giant cervical polyps with a size greater than 4 cm are rare and until now only several cases have been described in literature. The size and the clinical presentation can mimic a cervical neoplasia. The management is surgical and can be conservative regarding to the benign pathological feature of this entity. We report the case of a giant cervical polyp of 12.0 cm which was protruding from the external cervical os and that developed spontaneously in a multiparous 48-year-old woman who clinically presented vaginal bleeding. Colposcopic examination showed a mass originating from posterior lip of external cervical os. On MRI, there was the appearance of multicystic lesion with an inner solid component. We performed that the lesion was resected by the ultrasonic harmonic scalpel. The histological examination showed benign polyp. At 10 months’ follow-up, there was no recurrence seen after surgery. Although carcinomatous change occurs in 1.7% of cervical polyps, malignant degeneration did not occur in the previous reported cases. The diagnosis, management and outcome of this rare entity had been reviewed according to the literature.

Botryoid rhabdomyosarcoma of cervix - A Rare case report

Botryoid Rhabdomyosarcoma of the female genital tract is rare in the cervix. It tends to occur in children and young women and has comparatively better prognosis than sarcoma botryoides of the vagina and uterus. We report a case of 20 year old female with Botryoid Rhabdomyosarcoma presenting as a cervical polyp. Only a few cases are reported in literature till now.. The definitive diagnosis can be confirmed by histopathology only.

Gel Sonovaginography: A New Way of Evaluating a Variety of Local Vaginal and Cervical Disorders.

Gel sonovaginography is a new way of assessing local cervical and vaginal disorders, in which regular transvaginal sonography is known to have limitations. In gel sonovaginography, 20 mL of ultrasound gel is instilled into the vagina, followed by examination with a transvaginal transducer. In a study involving 28 women with known or suspected disorders such as cervical and vaginal cancer, cervical polyps, vaginal septa, and deep infiltrating endometriosis, a substantial improvement in visualization and assessment of local lesions and structures was noted with gel sonovaginography. This simple technique appears to be valuable for accurate diagnosis of local cervical and vaginal disorders.

Diagnostic Value of Visual Examination of Cervical Polypoid Lesions and Predictors of Misdiagnosis

This study reviews occasions when cervical polyps removed in an outpatient setting proved not to be cervical polyps histologically. We aimed to identify any anatomical and/or clinical characteristics that predict 'incorrect diagnosis" in general practice. A retrospective study of consecutive 345 patients who were initially diagnosed with cervical polyps based on a routine gynecological examination in an outpatient setting was included. After histopathological examination, the patients were divided into 2 groups: those with cervical (correct diagnosis, n = 307) and falsely diagnosed with cervical polyps (FDP, n = 38). These 2 groups were compared in terms of age, signs and symptoms, and size of the polypoid lesions. The initial clinical diagnosis was correct in 307, giving a positive predictive value of 89%. There were no significant difference between the groups with respect to age of patients (p = 0.59) and the size of the lesions (p = 0.42). According to our study, among misdiagnosed patients, nabothian cysts and cervicitis were the most common histological findings; FDPs were more often symptomatic (p < 0.001) and coexisted more frequently with inflammation or ulceration (p < 0.001). All FDPs were developing within the endocervical canal. There were no instances of FDPs that arise from ectocervix. Symptomatic polypoids have a higher risk of preliminary misdiagnosis (OR = 13.0; 95% confidence interval, 3.0-55.1). All cervical polypoid lesions must be sent to pathology because visual diagnosis is not sufficiently accurate to direct patient care.

A Case Report of Cervical Embroynal Rhabdomyosarcoma Treated with Multimodality Approach

Embryonal rhabdomyosarcoma of the female genital tract is a rare and highly malignant entity. It is usually diagnosed in adolescence, in contrast to vaginal rhabdomyosarcoma, which occurs mostly in infants. With the advent of multimodality treatment, prognosis seems to be improved. We report a case of a 20-year old young female presenting with a protruding mass from vaginal introitus and irregular bleeding. Polypectomy was done and microscopic findings were confirmed as a cervical embryonalrms.Neoadjuvant chemotherapy showed excellent response, after which Total Abdominal Hysterectomy and bilateral Lymphadenectomy was done. Histopathology showed embroyonalrhabdomyosarcoma involving cervical lip, infiltrating more than half thickness of cervical wall.Patient was treated with post-operative radiotherapy and she is on regular follow-up. The presence of a cervical polyp in an adolescent is a gynecological oddity and should be histologically examined. The prognosis of the cervical embryonal RMS depends on clinical and histological features. The current treatment protocols are based on trials.Patients with unfavorableprognosis characteristics, the multimodality approach including surgery, adjuvant chemo and radiotherapy can be effective. Otherwise, surgery alone can be effectively proposed.

Abnormal Uterine Bleeding: American College of Nurse-Midwives.

Variations in uterine bleeding, termed abnormal uterine bleeding, occur commonly among women and often are physiologic in nature with no significant consequences. However, abnormal uterine bleeding can cause significant distress to women or may signify an underlying pathologic condition. Most women experience variations in menstrual and perimenstrual bleeding in their lifetimes; therefore, the ability of the midwife to differentiate between normal and abnormal bleeding is a key diagnostic skill. A comprehensive history and use of the PALM-COEIN classification system will provide clear guidelines for clinical management, evidence-based treatment, and an individualized plan of care. The purpose of this Clinical Bulletin is to define and describe classifications of abnormal uterine bleeding, review updated terminology, and identify methods of assessment and treatment using a woman-centered approach.

Cervical polyps: Is histologic evaluation necessary?

ObjectiveThe aim of this study was to examine a series of clinically identified cervical polyps and determine the incidence of significant histologic and concurrent cytologic findings. MethodsConsecutive cervical polyps from January 2000 through September 2012 were retrieved from the hospital laboratory information system. Histologic evaluation of these polyps was performed, followed by a chart review of clinical findings and correlation with the immediately prior or concurrently collected cervical Papanicolaou (Pap) test results, when available. ResultsA total of 369 cervical polyps were identified and reviewed. The patient ages ranged from 18 to 87 years (mean 46.5years). Eight polyps demonstrated squamous dysplasia (6 Cervical Intraepithelial Neoplasia/CIN I, and 2 CIN II/III), while 6 had malignant or atypical/potentially malignant features (2 adenosarcoma, 2 atypical polyps concerning for Mullerian adenosarcoma, 1 endometrioid endometrial adenocarcinoma and 1 adenocarcinoma in-situ). An increased incidence of atypical squamous cells of undetermined significance (ASCUS) and atypical glandular cells not otherwise specified (AGC NOS) Pap diagnoses (12.7% and 6.1%, respectively) was found in women with benign polyps on biopsy. DiscussionWe demonstrated a higher rate of clinically significant histologic findings in cervical polyps (14 of 369 cases, 3.7%) compared to previously reported studies. The increase in ASCUS and AGC Pap results was most likely related to reactive and inflammatory changes present in benign polyps. Our results suggest that removal of all cervical polyps with subsequent histologic review is warranted.

Should we be bothered with asymptomatic endocervical polyps in perimenopausal women

Cervical polyps are defined as focal hyperplastic protrusions of endocervical folds with an incidence of 1%-10%. The majority of endocervical polyps are benign and the incidence of high-grade squamous intraepithelial lesion (HSIL) or carcinoma is relatively rare (1: 1000). Endocervical polyps are mostly incidentally discovered, however the most frequent symptoms are post-coital, postmenopausal or intermenstrual bleeding and/or profuse discharge. Here, we present a perimenopausal women with an asymptomatic polyp, later to be diagnosed with cervical carcinoma. A 46-year-old woman applied to our outpatient clinic without any complaint. The examination revealed a 2.3x2 cm cervical polyp with a slim pedincule. An immediate cervical polypectomy was performed and histopathological examination was resulted as HSIL. The patient then underwent cold-knife conization and endocervical curettage (ECC). The excized cone material’s histopathology was consistent with the polyp and the cervical lesion was continous at the surgical borders. ECC was positive for cervical intraepithelial changes. A type 1 hysterectomy was carried out. The definitive pathological diagnosis was microinvasive squamous carcinoma. Accummulating literature advises against routine polypectomy, despite the possibility of displasia in cervical polyps. Various clinical aspects, such as symptoms, age, menopausal status, cytological and colposcopic findings have been evaluated in conjunction with this common entity. In conclusion, the gen- eral notion that symptomatic polyps over 5 mm should be evaluated may be cost-effective, but will not discern cases of polyp associated operable microin-vasive /invasive cervical carcinomas.