Endocervical Polyp Research Articles

Giant Endocervical Polyp with Malignant Characteristics in an Adolescent

Introduction: A cervical polyp is a flexible, friable, pedunculated neoplasm, mostly originating from the endocervical area. It is considered giant when it is >4 cm. Most are benign but they must be removed and subjected to histopathologic examination because they may present malignancy. Clinical Case: A 13-year-old female patient, with no personal pathological personal or familiar history, was referred from another health center due to a 1-year history of a vaginal tumor with apparently no underlying cause. Physical examination showed a red, multilobulated, vaginal tumor of approximately 10 cm long, with mucus around it, foul-smelling, easy bleeding, painful on palpation, protruding from vaginal introitus with a deep pedicle. The patient underwent surgery where the excision of the vaginal tumor extending to the exocervix was performed. Conclusion: In this case, due to the initial clinical characteristics, a malignant pathology (such as rhabdomyosarcoma) may be suspected, thus, complementary imaging and laboratory studies need to be performed, to rule out this diagnosis and offer an adequate and well oriented surgical treatment; a subsequent definitive histopathological study needs to be conducted to confirm that the lesion is compatible with an endocervical polyp, determining the patients prognosis and follow-up requirements.

Napsin A Immunoreactivity in "Hobnail" Epithelium in Benign Endometrial and Endocervical Polyps.

Endometrial and endocervical polyps not uncommonly exhibit focal benign "hobnail" change/metaplasia within the glandular epithelium, sometimes in association with inflammation or infarction. In most cases, this is readily recognized as benign but occasionally, especially in endometrial polyps, this change prompts consideration of a premalignant or malignant lesion, including early serous or clear cell carcinoma. Herein we highlight the previously unreported phenomenon of positive staining of this hobnail epithelium with Napsin A which has the potential to exacerbate concern for clear cell carcinoma. Endometrial (n = 22) and endocervical (n = 17) polyps showing hobnail change were stained with Napsin A. Six cases were positive (4 of 22 endometrial and 2 of 17 endocervical polyps). In all cases, Napsin A positivity was confined to the hobnail epithelium. The hobnail epithelium was positive with estrogen receptor and hepatocyte nuclear factor 1- beta and exhibited wild-type immunoreactivity with p53 in all cases where these markers were performed. In addition, in 2 of 3 uterine adenosarcomas with focal hobnail change the epithelium was Napsin A positive. Pathologists should be aware that Napsin A may be expressed in benign/reactive hobnail epithelium in endometrial and endocervical polyps and should not consider positivity with this marker as a diagnostic of clear cell carcinoma.

Intestinal adenocarcinoma of the uterine cervix with gastrointestinal metastasis

Introduction: Endocervical adenocarcinomas represent a very heterogeneous group of tumors. Mucinous adenocarcinoma of the intestinal type is a rare histologic variant. Clinical case: 38-year-old female patient, who consulted for abnormal uterine bleeding, as well as more frequent cycles accompanied by dysmenorrhea, denying any other added symptomatology. She also underwent speculoscopy where a verrucous lesion was found, hypervascularized at that time, a biopsy which reported endocervical mucosa with moderate chronic inflammation and papillary, mild vascular congestion, compatible with endocervical polyp and MRI with enlarged uterus with thickened endometrium myometrium and nodular endometriotic implant of cystic appearance in the cervical isthmus junction. Due to the persistence of the symptoms it was decided to perform a total hysterectomy by laparoscopy, intraoperatively moderately differentiated adenocarcinoma implants were observed, compatible with endocervical primary. It was decided not to continue with the surgical time for neoadjuvant chemotherapy management. Conclusion: Establishing the preoperative anatomopathologic diagnosis is decisive to improve the treatment to reduce morbidity and mortality of the patient.

Borderline Brenner Tumor of the Ovary in a Postmenopausal Woman: A Rare Case with Concomitant Endometrial Hyperplasia and Endocervical Polyp

Introduction:: Bordeline Brenner tumors of the ovary are rare tumors accounting for 2% of all ovarian tumors and are characterized by the presence of papillary structures covered with transitional epithelium without or minimal stromal invasion. Case Presentation:: In the present case report a 60-year-old postmenopausal woman presented with complaints of lower abdominal pain and a right ovarian mass of 4x5cm, which was diagnosed on histopathological examination as borderline Brenner tumor of the ovary. There were coexisting nonatypical endometrial hyperplasia and endocervical polyps of 1.2x0.9x0.6cm, indicating endometrial hyperstimulation as a result of estrogen secreted by the tumor. The patient was managed successfully with staging laparotomy and was diagnosed with stage I borderline Brenner tumor with non-atypical endometrial hyperplasia and benign endocervical polyp. Conclusion:: Borderline Brenner tumors are rare tumors of ovaries with uncertain malignant potential. They have no precise predictive markers but are known to produce estrogen. Surgery remains the mainstay of treatment for these tumors.

Histopathologic patterns and factors associated with cervical lesions at Jimma Medical Center, Jimma, Southwest Ethiopia: A two-year cross-sectional study.

The cervix is the lower portion of the uterus, which connects this organ to the vagina through the endocervical canal. This study aimed to determine the histopathologic patterns and factors associated with cervical lesions at Jimma Medical Center from September 12, 2017, to September 12, 2019. A 2-year facility-based cross-sectional study was conducted from May 1 to June 30, 2020. In this study, cervical cancer was the most common (71%) cause of cervical lesions. Squamous cell carcinoma was the most frequent cervical cancer diagnosed during the study, accounting for 96.4% of 331 cancerous cases, followed by adenocarcinoma (3.3%). High-grade squamous intraepithelial lesions were the most frequently diagnosed precancerous lesions, accounting for 68.4% of cases. Endocervical polyps were the most commonly diagnosed benign lesions, accounting for 59.3% of cases. The maximum age distribution of cervical lesions was in the 41-50-year age range. Squamous cell carcinoma was the most frequent type of cervical cancer. High-grade squamous intraepithelial lesions were the most frequently diagnosed precancerous cervical lesions. The most common benign cervical lesions were endocervical polyps. We recommend educating the community to improve health-seeking behavior and on possible preventive strategies for cervical cancer.

Histological changes of endocervical polypoid lesions in women at reproductive age

Abstract Background: Endocervical polyps (ECP) are fragile benign protrusions commonly affecting 2%–5% of women during the reproductive age. Aim: This study aimed to identify the histopathological changes of clinically identified endocervical polypoid lesions during the reproductive age to detect any premalignant or malignant transformation if present. The objective is to assist the clinicians to decide whether the cervical polyps should be excised or not. Materials and Methods: Sixty specimens of the resected cervical polyps were obtained from Al-Salaam Teaching Hospital in Mosul city during the period from June 2021 to February 2022, women diagnosed to have cervical polyps on per speculum examination were given a time to be operated on with exclusion of pregnant, postmenopausal women, those on hormone replacement therapy, and those below 20 years. After polypectomy, fixation of biopsies in 10% buffered formalin was done followed by processing and staining with hematoxylin and eosin for histological examination. Chi-square test was used for interpretation of the histological findings. Results: The study revealed that 52% of the enrolled women were in the range of 40–49 years of age. Squamous metaplasia and benign microglandular hyperplasia were detected equally in 25% of the study group. Nabothian cyst was observed in 8%, whereas leiomyoma presenting as cervical polyp in 6%. Fortunately, no malignant changes were reported in the examined 60 cases and the only serious lesion was cervical intraepithelial neoplasia (CIN) observed in 2% of the examined polyps. Conclusion: we conclude as the incidence of malignant transformation of endocervical polyp is low in women in reproductive age and the only critical lesion is in situ intraepithelial neoplasia (CIN), it is proposed to follow an expectant management without interference and those patients can be only followed up to improve their health.

INTRAOPERATIVE FROZEN SECTION ANALYSIS OF ENDOMETRIOID OVARIAN BORDERLINE TUMOR: A DIFFICULT DIAGNOSIS

Abstract Introduction/Objective Borderline ovarian tumors (BOT) comprise approximately 15% of all primary ovarian neoplasms; of these endometroid borderline ovarian tumors (EBOT) are much rarer (2-3%). BOT is often potentially misdiagnosed as a malignant tumor based on its challenging histomorphological features and thus, treated aggressively. Herein, we present an unusual case of EBOT with adenofibromatous pattern in a 50-year-old gravida 3, para 2 female diagnosed on intraoperative frozen sections (IOFS). Methods/Case Report Patient with history of endometriosis presented with left lower quadrant abdominal pain. MRI revealed complex bilateral ovarian masses with solid and cystic components measuring 5 cm and 6.7 cm in right and left ovary, respectively. An ovarian malignancy was suspected. Patient underwent exploratory laparotomy, total abdominal hysterectomy with bilateral salpingo-opherectomy, and omentectomy. Grossly, bilateral ovaries (BO) showed intact capsule with solid and cystic components. On IOFS, the solid areas demonstrated endometrioid glands arranged in a lobular fashion with squamous morules. The cystic component demonstrated papillary projections with squamous differentiation. Cytology is mildly atypical at best. Based on these findings, a diagnosis of EBOT was made, necessitating staging. Differential diagnoses include atypical endometriosis, endometrioid adenofibroma (EAF) and endometrioid adenocarcinoma (EA). Lack of endometrial stroma surrounding the glands ruled out endometriosis. Presence of CC with papillary architecture ruled out EAF and lack of destructive stromal invasion with desmoplasia, confluence of glands and significant cytologic atypia ruled out EA. Final histopathological diagnosis of formalin-fixed paraffin-embedded specimen revealed EBOT, pT1bN0M0. Uterus and cervix revealed endometrial hyperplasia with atypia, adenomyosis, leiomyomas, and endocervical polyp. Results (if a Case Study enter NA) NA Conclusion The accurate diagnosis of BOT during IOFS is critical as it directs surgeons towards staging studies and in choosing conservative surgical treatment over aggressive treatment especially in cases of young women who desire future childbearing. As this is a rare entity, it serves the pathologist well to keep all relevant differential diagnoses in mind.

The Autogenous Coelenterate-Endocervical Polyp Uterine Cervix

Endocervical polyp represents as a benign, exophytic lesion constituted of variable admixture of proliferating endocervical glandular epithelium and metaplastic squamous epithelium permeated with a fibro-vascular core. The commonly encountered endocervical polyp is frequently accompanied by chronic inflammation, erosion of superficial epithelial surface and reactive alterations of layering epithelium.

Evaluation of Causes of Post-Menopausal Bleeding: A Hospital-Based Study

Midline cerebral congenital malformations, despite their relative rarity in the general population, with their high rate of Introduction: Postmenopausal bleeding is frequent in gynecology and occurs approximately in 5% to 10% of postmenopausal women. But most of the causes of post-menopausal bleeding are benign and treated conservatively. Women with postmenopausal bleeding have a primary or secondary malignancy of about 10%. So before starting treatment malignancy must be excluded. Common malignancies among them are endometrial or cervical carcinoma and rarely, ovarian cancer. The incidence of malignancy in the postmenopausal period remains sufficiently high, so it requires immediate investigations for early diagnosis, prompt treatment, and vigilant follow-up. The objective of the study is to evaluate the causes of postmenopausal bleeding in tertiary care hospitals in Dhaka city. Methods: This retrospective study was conducted at the Department of Obstetrics and Gynecology in Delta Medical College and Hospital, Dhaka, Bangladesh. The study duration spanned 12 months from July 2022 to June 2023. The study population consisted of 72 patients who presented with postmenopausal bleeding. The sampling for this study was conducted using a consecutive sampling method. Ethical approval was obtained from the ethical review committee of the study hospital. Descriptive statistics were used to summarize the demographic and clinical characteristics of the study participants. For the statistical analysis, the Statistical Package for the Social Sciences (SPSS). Results: Among 72 cases of postmenopausal bleeding, we found 9 cases of cancer (12.50%). Among them, 2 cases were cancer of the uterine cervix and 7 cases were cancer of the uterine corpus. Benign pathology was more frequent (63 cases: 87.50%), essentially presented atrophic endometritis 15 cases(20.83%), endometrial hyperplasia without atypia27.78% cases, endometrial polyp 16.67% cases, endocervical polyp 5.56% cases, cervical polyp 8.33%, leiomyoma found in 5.53% cases and preinvasive disease about 2.78% cases. Histopathological findings in 2 cases of carcinoma cervix were invasive squamous cell carcinoma and 7cases of endometrial cancer were endometrial adenocarcinoma. Cancer increased with advanced age while the incidence of bleeding decreased with age. Within 45 to 65 years of age is more frequent to develop post-menopausal bleeding. Conclusion: Even though causes of post-menopausal bleeding are mostly benign and treated conservatively but malignancy must be ruled out by endometrial and cervical biopsy.

Histo-pathological patterns in hysterectomy specimens at a tertiary care centre in India.

It is of interest to document histo-pathological patterns in hysterectomy specimens at tertiary care centre in India. This study included 442 cases. In this study, leiomyoma (9.17 %) was the most common preoperatively clinical diagnosis made in hysterectomy specimen. In this study, uterine fibroid showed a 90.47% correlation between pre-operative and histological findings. There was a 50 % correlation noted between adenomyosis and endocervical polyp.

MORPHOMETRIC ANALYSIS OF PAP SMEARS AND CERVICAL BIOPSIES.

Background: In women malignant lesions of the cervix are the most frequent cause of mortality and morbidity and cervical cancer is the third most common cause of cancer deaths worldwide.Cervical cancer incidence is progressively reducing due to the routine use of Pap smears and cervical biopsy. Aim of the study is to use Image Morphometric Software in order to create macro-images to analyze a large number of cells at a given time. A one Methods: year retrospective study was conducted in the Department of Pathology, Dr PSIMS & RF and data pertaining to all pap smears and their corresponding biopsies were reviewed. Each case was analysed with respect to age, and symptoms of the patient. A total of 30 patients aged bet Results: ween 35 and 70 years for whom both cervical biopsy and pap smears were done were studied over a period of 1 year. Based on Age, Symptoms, both pap smears and cervical biopsies were taken and studied . Among the biopsies studied 60% were diagnosed as Chronic Cervicitis aged between 35 to 45 years, distribution of lesions include : Endocervical Polyp (20%) aged between 45 to 50 years, Moderate Dysplasia (10%) aged between 55 to 60 years, Moderately differentiated Squamous Cell Carcinoma (10%) aged between 60 to 70 years. Among pap smears 60% inammatory smears, 20% polypoidal endocervicitis, 10% ASCUS, 10% LSIL. Testing cervical epithelium by Pap smear is a very si Conclusion: mple useful, economical and safe tool for early detection of premalignant and malignant cervical lesions. Gold standard is histopathological examination. The correlation studies are very important tools that can be used in the quality assurance of cytology laboratories.

ULTRASONOGRAPHIC ASPECTS OF THE CERVIX IN CHRONIC CERVICITIS

The aim of this study was to evaluate the structural changes of the cervix using the ultrasound examination. The studied group consisted of women aged between 21 and 75 years. 30,43% of the structural changes were represented by glandular dilatation. Other aspects observed were microcalfications (9,75%), and one endocervical polyp. All these changes are characteristic of chronic inflammation called cervicitis. The distribution of cases by age group showed that 41,46% belonged to the 41-50 age group and 36,58% to the 31-40 age group. The fewest cases (9,76%) were in the 21-30 age group. Regarding the medical history 80,49% of the patients had births or abortion in the past.

Arias-Stella reaction and frightening cytological changes in endocervical polyp: a rare case report

The Arias-Stella (AS) reaction is hormone-dependent atypical endometrial changes characterized by hyperplasia, hypertrophy, vacuolization, pronounced nuclear atypia, pronounced nuclear pleomorphism, and prominent nuclear hyperchromasia in glandular epithelial cells. It is very rare to see AS-related changes in extra uterine areas, especially in an endocervical polyp. Since this benign lesion is very similar to misdiagnoses such as adenocarcinoma, it is very critical to recognize AS reaction in extrauterine areas. The interpretation of pathological findings involves many difficulties, for example, due to the generally small size and fragmentation. Considering the clinical history and good interpretation of the nuclear details are extremely important for correct diagnosis. Here, we present the frightening cellular changes associated with AS observed in an endocervical polyp encountered after abortion in a middle-aged pregnant woman, together with the literature findings.

Endometrioid Carcinomas of the Ovaries and Endometrium Involving Endocervical Polyps: Comprehensive Clinicopathological Analyses.

While synchronous ovarian and endometrial endometrioid carcinomas (ECs) have long been described in the literature, ovarian or endometrial EC involving concomitant endocervical polyp (ECP) has not yet been reported. This study aimed to investigate the histological types and prevalence of gynecological tumors co-existing with ECP and to comprehensively analyze the clinicopathological characteristics of ovarian and endometrial ECs involving ECPs. We searched for ECP cases associated with premalignant lesions or malignancies of the female genital tract occurring between March 2019 and February 2022. We then investigated the histological types and prevalence of gynecological tumors co-existing with ECP. In addition, we reviewed electronic medical records and pathology slides to collect the clinicopathological features of four patients with ovarian or endometrial EC involving ECP. We found 429 ECPs over the three-year study period. Of these, 68 (15.9%) were associated with premalignant or malignant lesions occurring in the uterine cervix, endometrium, and ovaries. Four of these cases, including two (0.5%) ovarian grade 3 ECs and two (0.5%) endometrial grade 1 ECs, involved ECPs. In the former cases (cases 1 and 2), ECs involving ECPs exhibited similar morphology and immunohistochemical staining results to those of advanced-stage ovarian EC. In the latter cases (cases 3 and 4), the histological and immunophenotypical features of EC involving ECP were identical to those of primary endometrial EC, despite the lack of tumor involvement in the myometrium, lower uterine segment, and cervical stroma as well as the absence of lymphovascular invasion and lymph node metastasis. In all cases, no evidence of benign endometriosis, endometrial hyperplasia without atypia, or atypical hyperplasia/endometrial intraepithelial neoplasm within ECP or the adjacent endocervical tissue was noted. Considering our results, the involvement of ECP by EC may have been caused by an implantation metastasis from the ovarian (cases 1 and 2) or endometrial (cases 3 and 4) EC. To the best of our knowledge, this is the first exploration of the synchronous occurrence of endometrial or ovarian EC and ECP involvement. Implantation metastasis via transtubal and trans-endometrial cavity migration may have been the pathogenic mechanism of ECP involvement.

Analysis on pregnancy outcomes and risk factors of cervical polypectomy during the first and second trimester pregnancy

To evaluate the risk factors of miscarriage in patients attempted cervical polypectomy during the first and second trimester pregnancy. Pregnant women with singleton infants who underwent cervical polypectomy during the first and second trimester between January 2013 and May 2019 were investigated. The study retrospectively reviewed the clinical features and pregnancy outcomes after cervical polypectomy. A multivariable regression was performed to predict the risk factors of miscarriage. A total of 307 pregnant females were eventually included in our study. Twenty-seven patients (8.8%, 27/307) had a miscarriage before 28 weeks, 37 patients (12.1%, 37/307) had a preterm delivery. After univariate analysis, we found that the presence of decidual polyps and vaginal bleeding after polypectomy were the risk factors for miscarriage. Moreover, the incidence of miscarriage was significantly higher in the patients with decidual polyps than in those with endocervical polyps (14.9% vs. 5.6%, p=0.010). The most suitable hemostasis method should be taken in the cervical polypectomy during pregnancy. The risk of miscarriage associated with polypectomy during pregnancy is higher in females with decidual polyps. If decidual polyps are highly suspected and they do not cause excessive vaginal bleeding and can be ruled out the possibility of malignancy, conservative treatment may lead to a better outcome.

CLINICO-HISTOPATHOLOGICAL STUDY OF ENDOMETRIUM WITH AND WITHOUT HORMONE THERAPY IN PATIENTS WITHABNORMAL UTERINE BLEEDING

Background: Abnormal uterine bleeding (AUB) is one of the most common problem for the patients and the gynecologists. Histological characteristics of endometrial biopsy material as assessed by light microscopy remains the diagnostic standard for the diagnosis of endometrial pathology. Material and Methods: In our prospective study of 100 patients of the age between 24-75 years, clinical characteristics and the pattern of endometrial histopathology and their association with hormone therapy administration were studied. Results: Total of 100 patients were divided into two subgroups one that received hormone therapy prior to endometrial biopsy and Group II in which hormone therapy was not administered prior to the said procedure. In both groups proliferative phase was the commonest followed by secretory endometrium in both groups. Pill change, Arias Stella reaction, tubercular endometritis, endometrial carcinoma was exclusively noted in the group in hormone therapy was administered prior to endometrial biopsy. Pill change endometrium was only significantly correlated with Group I (p=0.05). Simple hyperplasia, endometrial polyp, chronic endometritis, endocervical polyp, atrophic endometrium was noted in Group II of which simple hyperplasia (p=0.10) was not found to be clinically significant. Conclusions: The study of the endometrium in AUB revealed many structural and non-structural causes manifest in the form of different endometrial histopathological patterns in two groups with or without hormone therapy. Endometrial study gives significant etiological information in AUB when interpreted with relevance to age and other clinical data, thus guiding the appropriate management.

Histopathological profile of cervical biopsies in northern Malawi: a retrospective cross-sectional study

ObjectivesAccording to the WHO (2014), cervical cancer is the second most common cancer in women globally. More than 85% of the global cervical cancer morbidity and mortality occur in low-income...

Endocervical polyps in high risk human papillomavirus infections.

Human papillomavirus (HPV) positive patients with and without endocervical polyps is compared with respect to HPV genotypes and presence of pre-invasive diseases. To our knowledge, this is the first and largest report in the literature examining the endocervical polyps in HPV positive cases. Clinicopathological data for the first one million screening patients (n = 1060 992) from around the entire country during 2015 and 2016 were targeted for this research. Colposcopy, colposcopic surgical diagnostic procedures and final pathology results of 3499 patients with high-risk (HR) HPV-positive were obtained from reference colposcopy centers. Patients with endocervical polyps (n = 243 [6.9 %]) were accepted as experimental arm while patients without any endocervical polyp (n = 3256 [93.1%]) were regarded as the control group. Age, HPV genotype, Pap smear abnormality, and final pathological results were compared between two groups using Student's t-test and cross-tabulation chi-square test. The incidence of endocervical polyp was found to be 6.9 % in HR HPV-positive women. The most common HPV genotypes observed in both groups were HPV 16 or 18. Abnormal cytology reports (≥ ASC-US) were not significantly different between both groups. However, with respect to final pathological diagnosis, patients with endocervical polyp had significantly lower numbers of pre-invasive diseases (31.3% vs 44.2%; p < 0.10). Endocervical polyps may be more common in patients with HR HPV infections. HPV 18 is observed significantly more, in the HR HPV positive endocervical polyp group. Patients with endocervical polyps do not have increased risk for preinvasive cervical diseases.

Laparoscopic Resection of Large Endo-Cervical Polyp Through Posterior Colpotomy as an Alternative Access to Vagina in Virgin Patients

Endometrial polyps have been involved in about 50% of patients with abnormal uterine bleeding and 35% of infertile patients. Management of pedunculated endocervical myoma or polyp normally requires intervention via the vaginal route. Laparoscopy provides safe alternative in patients demanding hymenal integrity. A 28-year-old, nulliparous virgin woman who presented with anemia secondary to heavy menstrual bleeding for five years. Pelvic ultrasound and MRI showed a 3.2 x 2.4 cm mass at the upper vagina it concluded that the mass likely to be pedunculated uterine fibroid, other differential diagnosis including endometrial polyp. Due to the patient’s consistent desire for preserving hymenal integrity, laparoscopic posterior colpotomy was performed and the mass was removed successfully.

Diagnosis of non-neoplastic endocervical diseases

Endocervical pathology is commonly encountered in daily outpatient gynecological practice and is apparently simple to diagnose. Remote resonance of untreated endocervical pathologies, however, indicates difficulties in detection and perhaps even in treatment. The role of the endocervix is that of boundary between the lower genital tract and the upper genital tract, that is between an environment rich in microorganisms and the almost sterile endometrium and endosalpinx. The major barrier role belongs to the cervical mucus. Non-neoplastic pathology of the endocervix is systematically discussed, as follows: endocervicitis, Naboth cysts, endocervical polyps, cervical endometriosis, cervical fibroids, cervical stenoses, glandular preneoplastic lesions and adenocarcinoma in situ. Some notions of anatomy and histology are briefly reviewed. Endocervical pathology is varied. It can be correctly diagnosed starting from the clinical picture, completed with laboratory investigations, bacteriological examinations, exfoliative cytology, molecular tests for the diagnosis of HPV infection, colposcopy, but also by thorough ultrasound examinations. Ultrasound examination of the cervix should be part of the routine examination, because its systematic evaluation can make a significant contribution to refining the diagnosis.