25 November 2008 Case of the Week #135
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We thank Dr. Suma B. Pillai, PSG Institute of Medical Science and Research, Peelamedu, Coimbatore, Tamil Nadu (India) for contributing this case. To contribute a Case of the Week, email NatPernick@Hotmail.com with the clinical history, your diagnosis and diagnostic microscopic images in JPG, GIF or TIFF format (send as attachments, we will shrink if necessary). Please include any other images (gross, immunostains, etc.) that may be helpful or interesting. We will write the discussion (unless you want to), list you as the contributor, and send you $35 (US dollars) by check or PayPal for your time after we send out the case. Please only send cases with high quality images and a diagnosis that is somewhat unusual (or a case with unusual features).
Case of the Week #135
A 50 year old woman presented with vaginal bleeding for 25 days. She had two children with a normal full term vaginal delivery. There was no history of abortion or curettage. Vaginal examination showed an elongated cervix and a small polyp in the anterior lip. The uterus was bulky and retroverted. Fornices were unremarkable. Abdominal ultrasound was normal. A polypectomy was performed, and produced grey white tissue measuring 0.5 x 0.3 x 0.2 cm.
What is your diagnosis?
Glial polyp of cervix
These features are classic for a glial polyp of the cervix. The polyp was covered by stratified squamous epithelium, and was composed of mature glial tissue with moderate cellularity. The glial cells were bland with round/oval nuclei in a fibrillary background. There was no atypia or mitotic figures. GFAP stained the glial cells and stroma (image). The fibrillary processes are typically immunoreactive for PTAH (not performed in this case). In some cases, bone and cartilage have been found.
Cervical glial polyps are rare, with less than 100 cases reported. Generally they are endocervical, but ectocervical polyps have been reported (Obstet Gynecol 1983;61:261).
How does glial tissue appear in the cervix? The most widely accepted theory is implantation of fetal brain tissue during abortion or curettage, as illustrated in an 18 year old woman post curettage for spontaneous abortion (Am J Clin Pathol 1980;73:718). Other possible mechanisms include development of a teratoma, ectopic glial tissue or neoplasia of Müllerian origin.
Cervical glial polyps are benign, and excision is generally curative, although it may recur. No cases of malignant behavior have been reported.
Additional references: Cervix chapter at PathologyOutlines.com
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