Pathology

III. Benign Conditions

Objectives:

After completing this section you will be able to:

• list common non-neoplastic disorders of the cervix
• describe their clinical features
• describe/recognize histologic features
• state clinical behavior
• state treatment

1. Squamous metaplasia

This is a process by which the columnar endocervical epithelium is replaced by stratified squamous epithelium. It is a typical response to a variety of stimuli including hormones, chronic irritation and inflammation. It is benign and has no malignant potential.

Squamous metaplasia

2. Cervical polyp

This is a small, pedunculated, often sessile mass. Most originate from the endocervix (endocervical polyps) with a few from the portio vaginalis (ectocervical polyps).

Clinical appearance

This is the most common cervical growth especially in multigravidae but rare before menarche. It is usually asymptomatic and found incidentally. Occasionally it may cause intermittent vaginal or postcoital bleeding, a discharge or, in older women, postmenopausal bleeding.

Endocervical polyps are more likely to bleed than their ectocervical counterparts. They appear as single, red, smooth or lobulated, polypoid growths projecting from the external os. They vary in size but typically are less than 1 cm.

Ectocervical polyps are pale, flesh-colored, smooth and rounded, often with a broad pedicle.

Endocervical polyp.

Histology

The lesion is characterized by overgrowth of benign stroma covered by epithelium. Endocervical polyps are covered by endocervical, squamocolumnar or metaplastic squamous epithelium while ectocervical ones are covered by stratified squamous epithelium. The stroma, which contains thick-walled blood vessels at the base and many small vessels in the center, is more fibrous in ectocervical polyps. Endocervical glands may be present within the stroma but are usually very few or absent in ectocervical polyps. The polyp may become ulcerated at the apex with extravasation of blood causing intermittent bleeding and marked stromal inflammatory cell infiltrate.

Endocervical polyp. Note covering of columnar epithelium and many congested vessels with hemorrhage into the superficial portion of the polyp (lower left).

Clinical behavior

It is benign with no malignant potential but rarely cancer can arise in it.

Question: Why must all cervical polyps be routinely examined histologically?