Cervical polyp are tumor–like formations emanating from the cylindrical epithelium of the endocervix and growing into the lumen of the cervix. Polyps of the cervical canal usually manifest themselves as whites, contact bleeding, pulling pains. Diagnosis of cervical polyp includes vaginal examination, colposcopy, cervicoscopy, histological analysis of cervical scraping. Removal of the cervical canal polyp is performed by unscrewing its legs and cauterizing the bed, followed by curettage of the cervical mucosa.
N84.1 Cervical polyp
Cervical polyp are formed as a result of focal proliferation of endocervix cells and are tree-like connective tissue outgrowths on a thin or wide leg. The polyps of the cervical canal can grow into the lumen of the cervical canal or protrude beyond it. Polyps grow in any part of the cervix, but are more often localized in the area of changing epithelial zones or external pharynx. In the case of multiple growths, they talk about polyposis of the cervical canal.
In the structure of benign pathology of the cervix, polyps account for about 20-25%. Along with cervical leukoplakia, erythroplakia, genital warts, epidermoid papillomas, erosions and pseudoerosions, cervical polyp are classified as background processes that increase the risk of cervical cancer and require constant supervision by a gynecologist.
Clinical gynecology uses several classifications of cervical polyp. According to the histological type, depending on the ratio of the glandular, stromal and vascular components, there are glandular, glandular-fibrous, fibrous, adenomatous, angiomatous polyps.
According to the differences in the structure of the epithelial cover, polyps covered with cylindrical, flat multilayer, as well as high cylindrical or immature epithelium with metaplastic changes are distinguished. Taking into account the predominance of proliferation and epidermization processes, simple, proliferating and epidermizing polyps of the cervical canal are differentiated.
Along with the true polyps of the cervical canal, decidual polyps, or pseudopolypes, are isolated, the occurrence of which is associated with pregnancy. Pseudopolypes lack a vascular pedicle and are represented by decidual tissue – transformed endometrium. If the presence of decidual polyps of the cervical canal is associated with the threat of termination of pregnancy, then they are removed during gestation.
Macroscopically, true cervical polyps are structures with a diameter of 2 to 40 mm, having an oval or rounded shape, smooth surface. The intensity of vascularization and the vessels shining through the integumentary epithelium determine the color of polyps from pale pink to burgundy. The consistency of the cervical polyp can be soft or dense, depending on the content of fibrous tissue in them.
Microscopically, the polyps of the endocervix are similar to the mucous membrane of the cervical canal. At the base or central part of the true polyps of the cervical canal, blood vessels feeding the tumor pass through.
The genesis of cervical polyp is not clear enough. Endocervix polyps are more often diagnosed in patients older than 40 years. It is believed that the development of cervical polyps may be based on hormonal disorders, age-related changes in the female body, immune disorders, stress factors. A favorable background for the occurrence of cervical polyp is mechanical injury to the cervix during abortions, childbirth, diagnostic curettage, hysteroscopy, as well as chronic endocercivitis – inflammation of the cervical canal mucosa.
In 70-75% of cases, cervical polyp are combined with erosion or pseudoerosion of the cervix, uterine fibroids, ovarian cysts, endometriosis, ovarian dysfunction, endometrial polyps, atrophic colpitis. There is also a correlation between the frequency of occurrence of cervical polyps with violation of vaginal microbiocenosis and STIs: candidiasis, gardnerellosis, papillomavirus infection, genital herpes, ureaplasmosis, mycoplasmosis, chlamydia, trichomoniasis, mixed infections.
Symptoms of cervical polyp
Small and single polyps of the cervical canal often do not cause symptoms and are detected by chance. Usually, the manifestation of clinical manifestations is associated with secondary changes in polyps – injuries, infection, inflammation, ulceration. In this case, there is the appearance of uncomfortable and pulling pain in the lower abdomen, pathological serous or serous-purulent whites. When the polyp of the cervical canal is traumatized, there are secretions of a blood-like nature or contact bleeding.
Menstrual cycle disorders and infertility with cervical polyp are usually associated with concomitant pathology or the causes that caused the formation of polyps. In relatively rare cases, malignancy of cervical polyps is noted.
In pregnant women, cervical polyp due to reflex irritation of the cervix may pose a threat of spontaneous termination of pregnancy from an early stage. Other gestational complications may include a low placenta location, cervical insufficiency.
The main principles of diagnosis of cervical polyp are their visual detection, examination by colposcopy or cervicoscopy, ultrasound, knife biopsy of the cervix with curettage of the cervical canal.
During gynecological examination, thickening and hypertrophy of the cervix and bright pink polypoid formations of rounded or cluster-shaped protruding from the cervical canal are visualized in mirrors. Polyps covered with multilayered epithelium with keratinization processes have a whitish color; if blood circulation in the polyp is impaired, it acquires a dark bardic or purple color. In polyps prolapsing into the lumen of the vagina, depending on the number of stromal elements, a soft or hard-elastic consistency is determined.
Colposcopy and cervicoscopy allow you to see small polyps of the cervical canal, to examine in more detail their structure, the presence of inflammation, necrosis, ulceration of the surface, as well as other existing changes in the cervix. Gynecological ultrasound is performed to exclude endometrial polyps in the uterine cavity.
After visual examination, a biopsy is performed with fractional scraping of the walls of the cervix and histological examination of the material. Before surgical removal of cervical polyps, smears for infection are examined by bakposev and PCR methods. In case of detection of STDs, their preliminary course therapy with the control of cure is indicated.
Treatment of cervical polyp
Any polyps of the cervical canal are an indication for removal. Under aseptic conditions, after exposing the cervix with mirrors, the polyp of the cervical canal is captured with a compressed clamp and removed, producing unscrewing movements. Then the cervical canal is scraped with a curette, achieving thorough removal of the polyp leg. The polyp bed is additionally treated by cryogenic or radiofrequency method. With echographic signs of endometrial changes, hysteroscopy is performed with diagnostic curettage of the uterine cavity.
Polyps located close to the external pharynx are wedge-shaped excised with the imposition of a catgut suture. Polyps localized in the upper parts of the cervical canal require targeted removal under hysteroscopic control. The removed material is sent for histological examination to study the goodness of the cervical canal polyp. In the future, depending on laboratory data, anti-inflammatory or hormonal therapy may be prescribed.
Recurrent polyposis of the cervical canal serves as an indication for cone-shaped amputation of the cervix. Removal of cervical polyp during pregnancy is performed if the size of the formation exceeds 10 mm, its rapid growth, bleeding, signs of necrosis or initial malignancy (discariasis) of the polyp is noted.
Recurrences of cervical polyp develop with incomplete removal of the leg of the neoplasm. In rare cases, thermal burns are noted due to cauterization of the polyp bed, strictures and stenosis of the cervix. Non-removed cervical polyp can provoke bleeding, support genital tract infections, cause cervical factor infertility, malignancy. Pregnancy management in patients with cervical polyp requires the prevention of spontaneous miscarriage, cervical insufficiency, premature birth, cervical dystocia.
Conditions for the prevention of cervical canal polyps are: the passage of a regular medical examination, prevention and timely therapy of gynecological and endocrine pathology, the exclusion of traumatic effects on the cervix. If suspicious symptoms appear, you should immediately be examined by a gynecologist.