Cervical polyp

Cervical polyps are polypoid growths projecting into the cervical canal. They can be one of the most common causes of intermenstrual vaginal bleeding. 

Epidemiology

Most patients are perimenopausal at the time of presentation, especially in the 5^th decade of life. They are the most common mass lesion of the cervix, with a reported prevalence of 1.5-10% 

Clinical presentation

More than half of cases are asymptomatic. Symptoms can include menorrhagia, postmenopausal bleeding, contact bleeding, and vaginal discharge. The diagnosis is made primarily with hysteroscopy.

Pathology

Histologically, cervical polypoid lesions encompass a spectrum of pathologic entities which include endocervical or endometrial tissue with metaplasia.

The polyps are usually pedunculated, often with a slender pedicle of varying length, but some can be sessile.

Associations

Approximately 25% of patients may also have a co-existing endometrial polyp ².

Radiographic features

Ultrasound

• sessile or pedunculated well-circumscribed masses within the endocervical canal

• may be hypoechoic or echogenic 

• identifying the stalk attaching to the cervical wall helps differentiate it from an endometrial polyp

Complications

Can progress into carcinoma of the cervix in ~0.1% of cases.

Treatment and prognosis

Surgical removal is often the treatment of choice although some suggest initial monitoring for small polyps ⁷. Recurrence is rare.

Differential diagnosis

For a polypoid lesion within the cervical canal consider:

• pedunculated uterine leiomyoma protruding through the cervical canal

• endometrial polyp protruding through the cervical canal

• cervical cancer ⁸

• endometriosis

• intrauterine blood clot  

See also

• WHO histological classification of tumors of the uterine cervix