Cervical Polyps: Is Histologic Evaluation Necessary?
Rebecca A Levy, Charles Quick. UAMS, Little Rock, AR
Background: Multiple clinical studies have shown that cervical polyps are essentially benign, with a prevalence of malignancy of 0.1%; for this reason, several studies have recommended that polypectomy is not indicated in all cases. However, histologically examined cervical polyps may contain unexpected cervical intraepithelial neoplasia (CIN), endometriosis, metaplasia and primary malignancies. The purpose of this study was to examine a consecutive series of clinically identified polyps, determine the incidence of clinically significant pathologic findings, and correlate them with atypical pap test results if available.
Design: 369 consecutive endocervical polyps (identified by clinical terminology of “cervical polyp” in pathology reports) from the past 12 years were reviewed. A histologic evaluation of the polyps was performed, followed by a chart review to identify clinical presentation and the immediately prior or concurrent pap test results.
Results: Our dysplastic/malignant findings and benign/reactive findings are listed in tables below. The incidence of each finding is the number of involved cases compared to all of the polyps evaluated (369 cases), except for the pap test percentages, which are compared to the patients with pap tests (228 cases).
|Dysplastic \ Malignant Findings||Incidence|
|CIN 1||6 (1.6%)|
|CIN 2/3||2 (0.5%)|
|Atypical Polyp / Possible Adenosarcoma||2 (0.5%)|
|Endometrioid Adenocarcinoma||1 (0.3%)|
|Adenocarcinoma in-situ||1 (0.3%)|
|Benign \ Reactive Findings||Incidence|
|Thick walled vessels||361 (97.8%)|
|Reactive epithelium||336 (91.1%)|
|Squamous metaplasia||145 (39.3%)|
|Tubal\endometrioid metaplasia||79 (21.4%)|
|Microglandular hyperplasia||67 (18.2%)|
|Atypical Stromal cells||29 (7.9%)|
|Stromal Mitoses||5 (1.3%)|