Benign / nonneoplastic epithelial lesions

Endocervical polyp

Editor-in-Chief: Debra L. Zynger, M.D.
Natalia Buza, M.D.

Topic Completed: 12 August 2019

Minor changes: 3 September 2021

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PubMed Search: Endocervical polyp[TIAB]

Natalia Buza, M.D.
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Cite this page: Buza N. Endocervical polyp. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/cervixendocervpolyp.html. Accessed November 27th, 2021.
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
  • 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)
  • Cervix / endocervix
  • Most likely nonneoplastic in nature
  • 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)
Case reports
Clinical images

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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
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


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
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?

  1. Presence of any mitotic activity indicates malignancy
  2. Presence of heterologous mesenchymal elements indicates malignancy
  3. Rarely, such lesions may harbor in situ or invasive malignancy
  4. Such lesions are most common in children and adolescents
Board review style answer #1
C. Rarely, such lesions may harbor in situ or invasive malignancy

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Reference: Endocervical polyp
Board review style question #2
Which of the following morphological features are characteristic of benign endocervical polyps?

  1. Bland endocervical glandular proliferation with squamous metaplasia
  2. Marked nuclear atypia of surface epithelium with strong diffuse p16 immunoreactivity
  3. Periglandular stromal condensation
  4. Prominent leaf-like glandular architecture with intraglandular projections
Board review style answer #2
A. Bland endocervical glandular proliferation with squamous metaplasia

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Reference: Endocervical polyp
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