Protruding giant cervical polyp in a young adolescent with a previous rhabdomyosarcoma

Giant cervical polyps are rare entities, with only 8 reported cases in the international literature (MEDLINE 1966-2002). Of these cases, only one has been described in the pediatric population. There has been no report of a giant cervical polyp occurring in the older, although early, adolescent period. The discovery of a giant cervical polyp in a young adolescent is a gynecological oddity. The immense size of giant cervical polyps, together with their menacing appearance and unusual presentation, can simulate a malignant neoplasm. Care must be taken in their diagnosis and management so that the patient's fertility is not compromised. We report on a young adolescent girl with a previous history of a rhabdomyosarcoma (RMS), who presented with a giant cervical polyp protruding from the vaginal introitus. The literature on this entity is reviewed.     

Lung cancer metastatic to a cervical polyp

BACKGROUND: We describe an unusual finding of a lung cancer metastatic to a cervical polyp. CASE: A 69-year-old female with metastatic lung cancer was referred for evaluation of an asymptomatic cervical polyp. The polyp was removed and pathologic examination revealed a focus of invasive adenocarcinoma with signet ring features within a polypoid fragment of squamous mucosa. All studies suggest a primary pulmonary origin. CONCLUSION: Cervical polyps occur in up to 5% of women and 1.7% contain carcinomatous changes. Most malignant polyps result from the progression of localized dysplasia, but distant metastases have been reported. We were unable to find any prior report of a primary lung cancer metastatic to a cervical polyp. Although removal or biopsy of asymptomatic polyps is reasonable, further studies need to be done.     

Hysteroscopic cervical polypectomy with a polyp snare

The cervical canal is difficult to visualize during hysteroscopy, making hysteroscopic maneuvers difficult. In our patient, after traditional surgical approaches failed, we used a polyp snare and closed the outflow channel of the hysteroscope, which allowed rapid removal of a cervical polyp in its entirety. This is an effective technique for excising intracervical lesions. (J Am Assoc Gynecol Laparosc 6(2):201-203, 1999)     

Giant cervical polyp: a case report and review of a rare entity

BACKGROUND: If cervical polyps are a common pathology in the female adult population, 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. CASE REPORT: We report the case of a giant cervical polyp of 5.5 cm occurring in a multiparous 47-year-old woman who clinically presented vaginal bleeding. The lesion was resected by electrosurgery with no recurrence 7 months after surgery. CONCLUSION: The diagnosis, management and outcome of this rare entity had been reviewed according to the literature.     

The role of hysteroscopy in the current management of the cervical polyps

The current management of patients with cervical polyps may include different approaches and protocols, such as a simply removal of the polyp in most cases at an office setting, surgical dilatation and curettage, electrosurgical excision or hysteroscopic polypectomy. Exploration of the cervical canal and uterine cavity by hysteroscopy determines the exact origin of the polyp pedicle (cervical or endometrial) and if there is any concurrent endometrial pathology. The majority of cervical polyps are asymptomatic, and their incidence is increasing with age. Symptomatic cervical polyps may cause intermenstrual bleeding, postcoital bleeding, heavy menses, postmenopausal bleeding and vaginal discharge. Cervical polyps may be detected by routine gynaecological examination, colposcopy, filling defects on hysterosalpingogram, gynaecological ultrasound (abdominal, transvaginal or sonohysterography) or endometrial biopsy. The location, number, and size of cervical polyps are best determined with diagnostic hysteroscopy. In the past, simple twisting or avulsion of the polyp or blind curettage was the standard surgical treatment of choice. However, this treatment often leaves residual polyp fragments in the cervical canal. Difficulty may also occur in differentiating endocervical from endometrial lesions. In addition, up to 25% of patients who have cervical polyp, have also a coexisting endometrial polyp, so there is a need for evaluation of the endometrial cavity. It is important to note the usefulness of hysteroscopy to manage a patient with a cervical polyp, especially when she presents abnormal uterine bleeding, in order to make an accurate diagnosis and offer appropriate treatment.     

The relation between granulocyte elastase activity in cervical mucus and gestational cervical polyp

Granulocyte elastase activity in cervical mucus (elastase activity) was measured in pregnant women (10-20 gestational weeks) with cervical polyp and controls (gravida with no cervical polyp). Elastase activity in the cervical polyp group was 86 +/- 44 U/l, and that in the control group was 22 +/- 13 (p less than 0.01). Elastase activity after polypectomy was 44 +/- 24. It decreased significantly compared with prepolypectomy (p less than 0.05). A high level of elastase activity continued in cases without polypectomy. Immunohistochemical staining of elastase for cervical polyps was also performed. In the low elastase staining group there was low elastase activity (46 +/- 26 U/l). Elastase activity in the moderate staining group was 89 +/- 31, and that in the intense staining group was 114 +/- 31. As for the prognosis of patients with cervical polyps, the occurrence rate of chorioamnionitis is 9% in the control group, 14% in the polyp with polypectomy group and 40% in the polyp without polypectomy group. There was a significant difference between the polyp without polypectomy group and other groups (p less than 0.01). These data suggest that cervical polyp is a focus of inflammation and that it may cause chorioamnionitis. We conclude that cervical polyp during pregnancy should be removed. If polypectomy could not be performed, local anti-inflammatory and anti-infectious therapy would be needed.     

Primary diffuse large B-cell lymphoma of the uterus presenting solely as an endometrial polyp.

We report a primary diffuse large B-cell lymphoma of endometrial polyp in a 44-year-old woman who presented with irregular vaginal spotting and was found to have a polyp protruding from the cervical os. Histology of the polyp showed an atypical diffuse infiltration by large, mononuclear cells within the stroma and between endometrial glands in one of the polypoid fragments. Immunohistochemistry and testing for immunoglobulin heavy chain gene rearrangement showed a B-cell lineage, consistent with diffuse large B-cell lymphoma. Staging procedures including detailed gynecology examination, body computed tomography scan, and bone marrow examination, as well as total hysterectomy, showed no evidence of lymphoma outside of the polyp. To our knowledge, this represents the first well-documented instance of primary lymphoma of the uterus presenting as an endometrial polyp. The differential diagnosis of endometrial biopsies containing an atypical lymphoid infiltrate should include the rather rare possibility of primary uterine lymphoma arising in an endometrial polyp. Immunohistochemistry and/or molecular analysis for antigen receptor gene rearrangements are critical in arriving at the correct diagnosis.     

A rare case of a variant cervical polyp in adolescence

The authors, stress on the importance of the examination of the vagina and the cervix in case of a mucous bleeding at adolescent girls. The following case is being introduced: after examination of a 16-year-old patient who had undergone a two-year treatment for a vaginal discharge, a bleeding polyp, the size of an egg and attached to a leg was found and extirpated. The histological examination read as "a myomatous polyp of the cervical canal with hemorrhagic necrosis". This case has been compared with the already published classes. The authors discuss some possibilities for differential diagnosis of the subjective symptoms and biopsy in adolescence. The conclusion is that gynecologists should use vaginoscopy as additional diagnostic method.     

Hysteroscopy in cases of cervical polyps

To assess the usefulness of hysteroscopy in cases of cervical polyps, we studied 78 patients with a lesion found during a routine gynecological examination. All women were referred for diagnostic hysteroscopy followed by endoscopic polypectomy. In 83.3% of the cases intrauterine investigation confirmed primary diagnosis - a polyp peduncle in the cervical canal. Sixty-five of those lesions were the only pathologic condition, and six (7.7%) were associated with an endometrial polyp. In the remaining 16.7% of examined patients, primary polyps identified as cervical polyps appeared to be endometrial. All women admitted to the study were successfully treated by hysteroscopy. Our results suggest that endoscopic evaluation of the uterine cavity in women with cervical polyps can clarify the initial diagnosis. Hysteroscopy allows not only a precise visualisation of the polyp peduncle but also gives the possibility to identify and treat concurrent asymptomatic intrauterine pathological conditions.     

Polypoid endometriosis of the cervix: a case report and review of the literature

Background

Giant and multilobular endocervical polyps are rare and need to be differentiated from cervical neoplastic lesions.

Case report

The authors report a 29-year-old sexually inactive woman presenting with a prolapsed giant endocervical polyp, associated with malodorous discharge and menorrhagia. The wide-based polyp originated in part from the posterior lip of the exocervix and in part from the endocervix. This trilobular pedunculated mass (90 × 50 × 35 mm) had small cysts on the surface and focal areas of haemorrhage. Microscopic examination revealed areas with classic endocervical mucosal polyp histology intimately mixed with expanses of endometrial stroma and occasional endometrial glands. Immunohistochemically the endometrial stroma showed strong CD10 positivity, glands were oestrogen and progesterone receptor positive and Ki-67 proliferation index was low.

Conclusion

Polypoid endometriosis of the cervix is a distinct form of endometriosis that may be mistaken for a neoplasm. Five earlier reports of this entity have not described a prolapsed polyp assuming gigantic proportions. We conclude that this condition be considered in the differential diagnosis of polypoid lesions of the cervix.     

Tamoxifen and giant endometrial polyp

We present the case of a woman with a giant endometrial polyp of uncommon dimension who was receiving adjuvant tamoxifen for breast cancer. In her gynecologic examination, she had a mass measuring 3 x 4 x 4 cm protruding from the cervical os. The mass was extirpated under general anesthesia. The mass originated from the endometrial cavity. The endometrial polyp measured 10 x 6 x 3 cm macroscopically and was found to be benign under microscopic examination. We conclude that physicians should be aware of the confounding effects of tamoxifen on the histological and ultrasonographic appearance of the endometrium.     

Polypoid cystic adenomyosis of the uterus: report of a case.

A case of focal adenomyosis of the uterus with unusual gross features is presented. The patient, a 43-year-old woman, had experienced abnormal vaginal bleeding for 8 years. Hysteroscopy revealed a polypoid mass compatible with a submucosal leiomyoma, and a hysterectomy was performed. The uterus showed a 7 x 5 x 3-cm firm polypoid mass attached to the anterior wall that occupied most of the uterine cavity and protruded through the cervical os. It contained a large, central, cystic cavity filled with bloody fluid that communicated with the endometrial cavity through a fistula-like tract. Both the surface of the mass and the inside of the cystic cavity were covered by endometrial mucosa, and there were endometrial islands in the intervening wall. The differential diagnosis of this unique form of adenomyosis included polypoid submucosal leiomyoma with invagination of endometrium, endometrial polyp, submucosal leiomyoma with invagination of endometrium, endometrial polyp, and uterine diverticulum.     

Adenosarcoma mülleriano de útero: un tumor infrecuente de difícil diagnóstico

Uterine adenosarcoma is a rare neoplasm constituting only around 8% of all uterine sarcomas. This tumor is associated with tamoxifen therapy and pelvic radiation. The most characteristic clinical feature is a recurrent cervical polypoid lesion. Patients have often had previous biopsies for the same reason, but without an accurate diagnosis. Furthermore, a mistaken diagnosis may have been made, the most common being cervical polyp. Uterine adenosarcoma consists of neoplastic glands with a benign appearance and a sarcomatous stroma.     

Giant cervical polyp

A giant cervical polyp occurring in a 56-year-old multiparous woman is described. Although the polyp was benign, total hysterectomy and bilateral salpingo-oophorectomy were carried out because of incidental cystic and adenomatous hyperplasia of the endometrium.     

Placental site trophoblastic tumor of the uterine cervix occurring from undetermined antecedent pregnancy

A cervical polyp complicated by severe hemorrhage was removed from a 43-year-old Japanese woman (gravida 0), who had undergone tubectomy on the right side 10 years previously. The polyp was diagnosed by immunohistochemical studies as placental site trophoblastic tumor of the cervix, but no metastatic foci were found in any other uterine site. The tumor was further demonstrated by PCR polymorphisms to possess two genomic DNA of the patient and her husband. Serum beta-hCG and urinary hCG titers were both low, which rapidly fell to 0.8 mIU/mL after a total hysterectomy and remained 0.2 mIU/mL after dismission. She has been uneventful for 3 years.     

Long retained intravaginal foreign body: a case report

Recurrent vaginal discharge in children may be due to variety of causes. Intravaginal foreign body retained for long duration can be a diagnostic dilemma. This report presents the case of a girl who had an intravaginal foreign body for over four years duration. Recurrent, unremitting, foul-smelling, bloody vaginal discharge in a child should alert the clinician to the possibility of a retained vaginal foreign body.     

南京城区宫颈疾病女性性功能障碍调查研究

目的:了解宫颈疾病女性性功能障碍(female sexual dysfunction,FSD)患病率及危险因素。方法:采用回顾性调查方法,对在南京医科大学附属南京妇幼保健院宫颈科门诊就诊的18-55岁有正常性生活女性进行问卷调查。取宫颈脱落细胞,采用PCR和膜杂交方法,检测出21种常见人乳头瘤病毒(human papillomavirus,HPV)中任何一种HPV亚型即为HPV阳性。通过宫颈专科医生常规妇科检查获知女性所患宫颈疾病。应用女性性功能指数(female sexual function index,FSFI)问卷对受访者近1个月的性生活状况进行调查,采用多因素非条件Logistic回归分析影响FSD的宫颈疾病。结果:发放调查问卷共2 045份,472例拒绝,1 573例接受问卷调查,去除不合格问卷458份,有效问卷1 115份,有效率71%。1 115例女性研究对象中宫颈疾病患者占43.6%(486/1 115)。486例宫颈疾病患者中,性功能障碍者占52.3%(254/486)。在FSD组中,患有宫颈疾病者显著多于宫颈正常者,差异有统计学意义(P<0.01)。宫颈疾病组的性欲、性唤起、阴道润滑、性高潮、性满意、性疼痛等各项性功能评分值均低于宫颈正常组(P<0.05)。多因素非条件Logistic回归分析表明:宫颈息肉(OR=1.57,95%CI=1.01-2.45)、宫颈糜烂(OR=1.74,95%CI=1.23-2.45)、宫颈肥大(OR=2.26,95%CI=1.33-3.84)、宫颈上皮内瘤变(cervicalintraepithelialneoplasia,CIN)(OR=2.95,95%CI=2.13-4.08)是FSD的独立危险因素。危险度大小依次是:CIN>宫颈肥大>宫颈糜烂>宫颈息肉。结论:南京城区FSD在宫颈疾病专科门诊中发病率颇高,有必要加强性保健宣传,促使有宫颈疾病者定期进行生殖系统健康体检,形成良好的性生活方式,从而降低FSD发病率。     

Uterine metastases from breast cancer in a patient under tamoxifen therapy. Case report

The authors report a case of metastases of breast cancer confined to the uterus and cervical subserous leiomyoma in a postmenopausal woman under tamoxifen therapy for two years. After abnormal uterine bleeding, pathologic examination on biopsy of a cervical polyp revealed cervical involvement secondary to lobular breast cancer. The patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy. Pathologic examination of the surgical specimen revealed both invasion of breast origin and of the cervix until the isthmus, endometrium and cervical subserous leiomyoma. The adnexa uteri were not affected. The possibility of uterine metastases in patients suffering from breast cancer, either undergoing tamoxifen therapy or not, always has to be considered.     

Endocervical stromal sarcoma--a case report

A case of a stromal sarcoma in a cervical polyp is presented. The tumor was confined to the polyp as evidenced by the histological examination of the uterus and cervix after surgery. In spite of that the patient died of widespread abdominal metastasis 1 year after the initial diagnosis.     

Cervical and duodenal polyps and their malignant alterations--case report

During routine examination of a 32-year-old patient, a cervical polyp was found and CIN III was confirmed by biopsy. After performing colposcopy, biopsy and establishing CIN III as well as performing gastroscopy where a duodenal polyp was found, thorough diagnostic exams and therapy were carried out. Complete duodenal resection and conization were performed. The medical board decided that neither further radiation nor chemotherapy was needed.