Table 18.1 Nomenclature of bone tumors
Cervical polyps
BASIC INFORMATION
DEFINITION
A cervical polyp is a growth protruding from the cervix or endocervical canal. Polyps that arise from the endocervical canal are called endocervical polyps. If they arise from the ectocervix, they are called cervical polyps.
EPIDEMIOLOGY & DEMOGRAPHICS
Cervical polyps are common. Found in approximately 4-6% of all gynecologic patients. Most commonly present in perimenopausal and multigravid women between the ages of 30 and 50 years. Endocervical polyps are more common than cervical polyps and are almost always benign (Fig. 85). Malignant degeneration is extremely rare.
PHYSICAL FINDINGS & CLINICAL PRESENTATION
Polyps may be single or multiple and vary in size from being extremely small (a few mm) to large (4-5 cm). They are soft, smooth, reddish-purple to cherry-red in color. They bleed easily when touched. Very large polyps can cause some cervical dilation. There may be vaginal discharge associated with cervical polyps if the polyp has become infected.
Figure 85 A, Fibroid polyp protruding through the external cervical os. B, Small endocervical polyp.
ETIOLOGY
• Most unknown
• Inflammatory
• Traumatic
• Pregnancy
DIAGNOSIS
DIFFERENTIAL DIAGNOSIS
• Endometrial polyp
• Prolapsed myoma
• Retained products of conception
• Squamous papilloma
• Sarcoma
• Cervical malignancy
WORKUP
Polyps are most commonly asymptomatic and are usually found at the time of annual gynecologic pelvic examination. Polyps are also found in women who present for evaluation of intermenstrual or postcoital bleeding and for profuse vaginal discharge. Polyps are painless. Unless a patient has a bleeding abnormality that necessitates her being evaluated by a physician, polyps would go undiagnosed until her next Pap smear was obtained.
TREATMENT
NONPHARMACOLOGIC THERAPY
Simple surgical excision can be done in the office. The physician should be prepared for bleeding, which can easily be controlled with silver nitrate or Monsel’s solution. Most commonly, a polyp is excised by grasping it at the stalk and twisting it off. Polyps can also be excised by electrocautery or, in the case of very large polyps, in an outpatient surgical suite. Sexual intercourse and tampon usage are to be avoided until the patient’s follow-up visit. Also, douching is not to be performed.
ACUTE GENERAL Rx
Generally, no medication is needed.
CHRONIC Rx
Patient is followed up in 2 weeks for recheck of the surgical excision site unless there is active bleeding, in which case she would be seen immediately. The cervix should be checked at the patient’s routine gynecologic visits.
• Most unknown
• Inflammatory
• Traumatic
• Pregnancy
DIAGNOSIS
DIFFERENTIAL DIAGNOSIS
• Endometrial polyp
• Prolapsed myoma
• Retained products of conception
• Squamous papilloma
• Sarcoma
• Cervical malignancy
WORKUP
Polyps are most commonly asymptomatic and are usually found at the time of annual gynecologic pelvic examination. Polyps are also found in women who present for evaluation of intermenstrual or postcoital bleeding and for profuse vaginal discharge. Polyps are painless. Unless a patient has a bleeding abnormality that necessitates her being evaluated by a physician, polyps would go undiagnosed until her next Pap smear was obtained.
TREATMENT
NONPHARMACOLOGIC THERAPY
Simple surgical excision can be done in the office. The physician should be prepared for bleeding, which can easily be controlled with silver nitrate or Monsel’s solution. Most commonly, a polyp is excised by grasping it at the stalk and twisting it off. Polyps can also be excised by electrocautery or, in the case of very large polyps, in an outpatient surgical suite. Sexual intercourse and tampon usage are to be avoided until the patient’s follow-up visit. Also, douching is not to be performed.
ACUTE GENERAL Rx
Generally, no medication is needed.
CHRONIC Rx
Patient is followed up in 2 weeks for recheck of the surgical excision site unless there is active bleeding, in which case she would be seen immediately. The cervix should be checked at the patient’s routine gynecologic visits.
Huge cervical fibromatous polyp
DISPOSITION
Since these are almost always benign, usually no further treatment is needed. Annual gynecologic examinations should be performed to check for any regrowths.
REFERRAL
To a gynecologist for removal of polyps
PEARLS & CONSIDERATIONS
COMMENTS
A Pap smear should be obtained before removing the polyp. If an abnormal Pap smear is obtained, more than likely the cause will be secondary to the polyp. If a colposcopic evaluation is needed, this should also be performed. During pregnancy, the cervix is highly vascularized. If the polyps are stable and benign-appearing, they should just be observed during the pregnancy and removed only if they are causing bleeding.
Since these are almost always benign, usually no further treatment is needed. Annual gynecologic examinations should be performed to check for any regrowths.
REFERRAL
To a gynecologist for removal of polyps
PEARLS & CONSIDERATIONS
COMMENTS
A Pap smear should be obtained before removing the polyp. If an abnormal Pap smear is obtained, more than likely the cause will be secondary to the polyp. If a colposcopic evaluation is needed, this should also be performed. During pregnancy, the cervix is highly vascularized. If the polyps are stable and benign-appearing, they should just be observed during the pregnancy and removed only if they are causing bleeding.
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