Giant Polyp of the Cervix - A Case Report
Abstract
A 45-year old woman was diagnosed with a giant polyp arising from the cervix of the uterus and reaching out 4-5cms beyond the vulva. The polyp was excised with diathermy knife without complications and was benign on histological examination. At four years there has been no recurrence. Giant cervical polyps are rare, with only about 20 cases reported in the international literature. The field of giant cervical polyps is discussed.
Keywords: Cervix; Giant; Polyp
Introduction
Polyps arising from the uterine cervix are common, but they are usually small. Giant polyps, defined as more than 4cms in size, are rare, with only about 20 cases reported in the literature (overview of reports in Table 1). In this case history a giant cervical polyp measuring 12cms in length and 4cms in width is presented.
Case Presentation
The patient was a 45-year-old Caucasian woman. She had experienced a painless lump protruding outside the vagina for more than a year. She was para 2, her menstrual periods were regular and there had had been no irregular bleeding. She had no other health issues.
On gynecological examination a lobulated pink polyp measuring at least 12cms in length and 4 cm in width was found. The consistency was soft to firm. There was no ulceration. The polyp arose from inside the cervical canal 2cms above the external os and reached 4-5cms outside the vulva (Figures 1&2). Gynecological examination including sonography was otherwise unremarkable.
The polyp was excised under general anesthesia with a diathermy knife without any bleeding or other complications. Suturing was not necessary. The postoperative course was uneventful, and the histological report confirmed a benign cervical polyp. At 4 years there has been no recurrence.
Discussion
Polyps of the cervix are common. They are usually small (<2cm) and are often asymptomatic and thus found during routine gynecological examination [1]. Polyps can appear at any age but are generally found in parous women during the fourth to sixth decades of life [2,3]. Most cervical polyps are benign, but malignancy does occur, at a reported rate of 0.1% [4] to 1.7% [5], the risk of malignancy increasing with rising age. A recent review showed that 3.7% of removed polyps had abnormal pathology [6]. It is recommended that all polyps be removed and examined histologically [7].
Because concurrent endometrial pathology occurs in around 10 % of cases, a specimen from the endometrium should also be obtained.
In contrast, giant polyps (defined as measuring > 4cms), are rare and are usually symptomatic. Presenting symptoms can be bleeding, vaginal discharge, or a palpable mass. Pain is usually not a problem [8]. Approximately 20 cases of these giant polyps have so far been reported. The polyps have been found in both parous and non-parous women of all ages, mostly in early middle age (Table 1), but also during pregnancy [9,10], in adolescents [11,12] and even in a 5-year-old girl [13]. Only 3 reported women were postmenopausal. The largest reported polyp measured 30cms [14]. Giant polyps are usually single, but multiple polyps have been described [3].
Clinically the polyps can be suspicious of a malignancy, especially if there is ulceration on the surface, or they may be mistaken for a prolapsed uterus [15,16] or imminent miscarriage [7]. Due to the rarity of giant polyps and their unknown prevalence it is not possible to give an estimate of malignancy risk.
Differential diagnoses include the large variety of cervical tumors that can present clinically as a polyp: cervical cancer, fibromyoma, angioleiomyoma, leiomyoblastoma, endocervical or endometrial adenosarcoma, cervical embryonal rhabdomyosarcoma, müllerian adenosarcoma, cervical lymphoma, endometrial polyp protruding through the cervix, endometriosis. After adequate diagnostic procedures have been done the polyp can be excised. Simple excision of cervical polyps is usually sufficient, and recurrence is rare [17-20]. As mentioned, the endometrium should also be sampled.
Conclusion
Giant polyps of the cervix are rare, usually symptomatic, and usually benign. Simple excision represents adequate treatment in most cases. All polyps should be sent for histological examination after removal and concurrent sampling of the endometrium is recommended [21-28].
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