Cervical polyp and ectropion

Definition

Cervical polyp

• Typical presentation: contact bleeding and spotting, often an incidental finding.
• Important: histology is mandatory — and the polyp does not exclude a coexisting carcinoma, the Pap is still needed.

Ectopy

• Definition: columnar epithelium lies on the portio surface, i.e. outside the cervical canal.

• Cervical polyps are common benign growths of the cervix and endocervix; they usually originate in the endocervical canal and are mostly attached by a slender stalk.
• In ectropion (ectopy), endocervical columnar epithelium lies on the surface of the ectocervix owing to eversion of the endocervical canal.

Classification

Three types

• Type 1: TZ entirely ectocervical and fully visible.
• Type 2: TZ extends endocervically but is fully visible with instruments.
• Type 3: TZ endocervical and not fully visible — colposcopy inadequate.

Occurrence & epidemiology

Epidemiology

• Cervical polyps occur in about 2–5 % of women; women over 20 with several previous pregnancies are affected more often.
• Endocervical polyps occur mainly before the menopause, ectocervical polyps mainly after it.
• Malignant change is rare.

Aetiopathogenesis

What the transformation zone is

• The TZ is the area between the original and the current squamocolumnar junction — through squamous metaplasia virtually every dysplasia arises there.

Aetiology and risk factors

• They arise from focal hyperplasia of the endocervical columnar epithelium; chronic inflammation, cervical infection, congestion and raised oestrogen levels are regarded as contributing factors.
• Ectropion is a common, usually physiological finding in women of reproductive age and is strongly influenced by hormonal status, particularly oestrogen.

Clinical features

• About two thirds of women with cervical polyps are asymptomatic; intermenstrual bleeding, bleeding after intercourse and, if the polyp becomes infected, purulent discharge may occur.
• Ectropion remains asymptomatic in many women; increased discharge, postcoital bleeding and dyspareunia may occur.

Histology

• Histologically, cervical polyps consist of a vascular stroma covered by squamous or columnar epithelium.

Diagnosis

Typical imaging findings

• Colposcopy: A rounded, dark-red glossy protrusion with a smooth surface emerges from the os. It sits on a narrow stalk, can be moved sideways and bleeds easily on contact; the surrounding cervix is calm.
• Colposcopy: Around the os there is a sharply demarcated, velvety red grape-like area: columnar epithelium displaced onto the ectocervix. The border with the pale squamous epithelium is smooth with a regular vascular pattern; no atypical vessels.
• Colposcopy: Several tense, yellowish dome-shaped cysts a few millimetres across lie beneath intact epithelium, with delicate, regularly branching vessels running over them. Beside them are flat whitish plaques without sharp margins.

• Diagnosis is made on speculum examination: endocervical polyps are usually reddish pink, glistening and smaller than 1 cm, and may bleed easily.
• In ectropion, columnar epithelium is visible on speculum examination as an area extending beyond the external cervical os.

Keep learning in the app

Further reading (selection)

1. MSD Manual Professional: Cervical Polyps
2. DocCheck Flexikon, Ektopie & Kondylome
3. DocCheck Flexikon, Transformationszone

Cross-references