III. Benign Conditions
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
- 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.
- 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).
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.
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).
It is benign with no malignant potential but rarely cancer
can arise in it.
Question: Why must all cervical polyps be routinely