Endocervical polyp

Cervix
Benign / nonneoplastic lesions
Endocervical polyp

Author: Natalia Buza, M.D.

Editor-in-Chief: Debra Zynger, M.D.

Topic Completed: 12 August 2019

Revised: 9 March 2020

Copyright: 2007-2020, PathologyOutlines.com, Inc.

PubMed Search: Endocervical polyp[TIAB]

Page views in 2019: 27,897

Page views in 2020 to date: 8,102

Table of Contents

Cite this page: Buza N. Endocervical polyp. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/cervixendocervpolyp.html. Accessed March 29th, 2020.

Definition / general

Benign exophytic proliferation composed of variable admixture of endocervical glandular and metaplastic squamous epithelium with a fibrovascular core

Essential features

Endocervical polyps are common benign proliferations composed of a fibrovascular core and endocervical glandular or metaplastic squamous epithelium
Chronic inflammation, surface erosion and reactive epithelial changes are common
Rare cases may harbor in situ or invasive squamous or glandular lesions
Lack of leaf-like architecture and periglandular stromal condensation, which are key features of Müllerian adenosarcoma (Am J Surg Pathol 2009;33:278)

ICD coding

ICD-10: N84.1 - polyp of cervix uteri

Epidemiology

Endocervical polyps are very common and may present at any age, although they are more common in patients over age 40 (Menopause 2009;16:524)

Sites

Cervix / endocervix

Pathophysiology

Most likely nonneoplastic in nature

Etiology

No definite known etiologic factors, although the role of chronic inflammation has been hypothesized
Endocervical polyps with microglandular hyperplasia / polypoid cervical microglandular hyperplasia may be associated with pregnancy or exogenous progestin effect (Int J Gynecol Pathol 1995;14:50)

Clinical features

Most are found incidentally during a routine gynecological exam
May also present with abnormal vaginal spotting or bleeding (postcoital or contact) or abnormal vaginal discharge (Obstet Gynecol 1963;21:659)

Diagnosis

Endocervical polyps often protrude through the cervical os and can be detected during routine gynecologic examination or colposcopy (Arch Gynecol Obstet 2007;276:299)
Cervical Pap smear may show atypical cells due to reactive surface epithelial changes (Obstet Gynecol 2006;107:701)

Case reports

36 year old woman with endocervical polyp with an unusual cytology finding (Cytopathology 2007;18:316)
57 year old woman with large endocervical polyp with cartilaginous and osseous metaplasia (Int J Gynecol Pathol 2009;28:98)
Endocervical polyp with florid epidermal metaplasia (Int J Gynecol Pathol 2016;35:478)

Treatment

Polypectomy is recommended for symptomatic and large (> 3 cm) endocervical polyps (Arch Gynecol Obstet 2007;276:299)

Clinical images

Images hosted on other servers:

Colposcopy

Polyp

Gross description

Usually single, most often measures < 1 cm

Gross images

Contributed by Natalia Buza, M.D.

Small polyp

Frozen section description

Microscopic features of endocervical polyp on frozen sections are similar to those seen on permanent sections
The most important differential diagnosis on frozen section is adenosarcoma
Unlike adenosarcoma, endocervical polyps lack periglandular stromal condensation, papillary intraglandular projections and no significant stromal or epithelial cell atypia is identified (Am J Surg Pathol 2015;39:116)

Frozen section images

Contributed by Natalia Buza, M.D.

Glands within uniform stroma

Microscopic (histologic) description

Fibrovascular core with variably sized vasculature (often including thick walled arteries)
Variable stromal cellularity often with mixed chronic inflammation
Surface epithelium is endocervical glandular type and may show squamous metaplasia, erosion and reactive / reparative changes
Proliferation of endocervical glands, which may be cystic or may show benign microglandular hyperplasia
Mitotic activity may be noticeable, especially in cases with marked inflammation or florid microglandular hyperplasia (Int J Gynecol Pathol 2014;33:524)
"Epidermal" metaplasia may be seen with skin appendage structures (Int J Gynecol Pathol 2016;35:478)
Stromal cells may be multinucleated, may show decidual change or may contain heterologous elements (fat, cartilage, bone, glial tissue), which could represent retained fetal tissues from a previous gestation (Int J Gynecol Pathol 2010;29:394)
Endocervical polyps may rarely harbor in situ or invasive squamous and glandular lesions, i.e. high grade squamous intraepithelial lesion, adenocarcinoma in situ, squamous carcinoma and adenocarcinoma (J Womens Health (Larchmt) 2007;16:1317, Int J Gynecol Pathol 2009;28:567)

Microscopic (histologic) images

Contributed by Natalia Buza, M.D. and Andrey Bychkov, M.D., Ph.D.

Thick walled arteries

Microglandular hyperplasia

Squamous metaplasia

Chronic inflammation

Mitoses

Cystically dilated glands

Positive stains

Immunohistochemical stains are typically not necessary to make the diagnosis
Epithelial elements stain with various epithelial markers (cytokeratins, EMA) and the stromal component stains with vimentin and smooth muscle markers

Negative stains

p16 is negative or only patchy weak positive, which helps rule out high grade squamous intraepithelial lesion / adenocarcinoma in situ

Sample pathology report

Cervix, polypectomy:
- Benign endocervical polyp with chronic inflammation and reactive changes

Differential diagnosis

Adenosarcoma:
- Leaf-like glandular architecture, resembling phyllodes tumor of the breast, with intraglandular papillary projections and prominent periglandular stromal condensation
- Stromal cell atypia and stromal mitotic figures are also present
Endometrial polyp:
- Proliferation of benign endometrial stromal and glandular elements, protruding into the endometrial cavity
- Occasionally a larger polyp arising in the lower uterine segment may protrude into the endocervical canal or may be visible through the cervical os, mimicking an endocervical polyp
Polypoid adenomyoma:
- Polypoid mass composed of smooth muscle and irregular benign endocervical type glands, often showing a lobular architecture (Case Rep Pathol 2014;2014:275421)
Condyloma:
- Exophytic, warty lesion of the ectocervix with squamous epithelium showing papillomatosis and koilocytosis, commonly associated with low risk human papillomavirus infection

Board review style question #1

Which of the following statements is true about this endocervical lesion?

Presence of any mitotic activity indicates malignancy
Presence of heterologous mesenchymal elements indicates malignancy
Rarely, they may harbor in situ or invasive malignancy
They are most common in children and adolescents

Board review answer #1

C. Rarely, they may harbor in situ or invasive malignancy

Reference: Endocervical polyp

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Board review style question #2

Which of the following morphological features are characteristic of benign endocervical polyps?

Bland endocervical glandular proliferation with squamous metaplasia
Marked nuclear atypia of surface epithelium with strong diffuse p16 immunoreactivity
Periglandular stromal condensation
Prominent leaf-like glandular architecture with intraglandular projections

Board review answer #2

A. Bland endocervical glandular proliferation with squamous metaplasia

Reference: Endocervical polyp

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