Giant Polyp of the Cervix - A Case Report

Polyps arising from the uterine cervix are common, but they are usually small. Giant polyps, defined as more than 4cms in size, are rare, with only about 20 cases reported in the literature (overview of reports in Table 1). In this case history a giant cervical polyp measuring 12cms in length and 4cms in width is presented.

Table 1: Overview of published reports.

The patient was a 45-year-old Caucasian woman. She had experienced a painless lump protruding outside the vagina for more than a year. She was para 2, her menstrual periods were regular and there had had been no irregular bleeding. She had no other health issues.

On gynecological examination a lobulated pink polyp measuring at least 12cms in length and 4 cm in width was found. The consistency was soft to firm. There was no ulceration. The polyp arose from inside the cervical canal 2cms above the external os and reached 4-5cms outside the vulva (Figures 1&2). Gynecological examination including sonography was otherwise unremarkable.

The polyp was excised under general anesthesia with a diathermy knife without any bleeding or other complications. Suturing was not necessary. The postoperative course was uneventful, and the histological report confirmed a benign cervical polyp. At 4 years there has been no recurrence.

Polyps of the cervix are common. They are usually small (<2cm) and are often asymptomatic and thus found during routine gynecological examination [1]. Polyps can appear at any age but are generally found in parous women during the fourth to sixth decades of life [2,3]. Most cervical polyps are benign, but malignancy does occur, at a reported rate of 0.1% [4] to 1.7% [5], the risk of malignancy increasing with rising age. A recent review showed that 3.7% of removed polyps had abnormal pathology [6]. It is recommended that all polyps be removed and examined histologically [7].

Because concurrent endometrial pathology occurs in around 10 % of cases, a specimen from the endometrium should also be obtained.

In contrast, giant polyps (defined as measuring > 4cms), are rare and are usually symptomatic. Presenting symptoms can be bleeding, vaginal discharge, or a palpable mass. Pain is usually not a problem [8]. Approximately 20 cases of these giant polyps have so far been reported. The polyps have been found in both parous and non-parous women of all ages, mostly in early middle age (Table 1), but also during pregnancy [9,10], in adolescents [11,12] and even in a 5-year-old girl [13]. Only 3 reported women were postmenopausal. The largest reported polyp measured 30cms [14]. Giant polyps are usually single, but multiple polyps have been described [3].

Clinically the polyps can be suspicious of a malignancy, especially if there is ulceration on the surface, or they may be mistaken for a prolapsed uterus [15,16] or imminent miscarriage [7]. Due to the rarity of giant polyps and their unknown prevalence it is not possible to give an estimate of malignancy risk.

Differential diagnoses include the large variety of cervical tumors that can present clinically as a polyp: cervical cancer, fibromyoma, angioleiomyoma, leiomyoblastoma, endocervical or endometrial adenosarcoma, cervical embryonal rhabdomyosarcoma, müllerian adenosarcoma, cervical lymphoma, endometrial polyp protruding through the cervix, endometriosis. After adequate diagnostic procedures have been done the polyp can be excised. Simple excision of cervical polyps is usually sufficient, and recurrence is rare [17-20]. As mentioned, the endometrium should also be sampled.

Giant polyps of the cervix are rare, usually symptomatic, and usually benign. Simple excision represents adequate treatment in most cases. All polyps should be sent for histological examination after removal and concurrent sampling of the endometrium is recommended [21-28].

None

The author declares no conflict of interest. The patient has given written permission for her case to be presented.

1. Gothwal M, Singh P, Bharti JN, Yadav G, Solanki V (2019) Giant cervical angiomyomatous polyp masquerading third-degree uterine prolapse: A rare case with review of literature. Int J Appl Basic Med Res 9(4): 256-258.
2. Bucella D, Frédéric B, Noël J-C (2008) Giant cervical polyp: a case report and review of a rare entity. Arch Gynecol Obstet 278(3): 295-298.
3. Yadav BS, Nandedkar SS, Malukani K, Agrawal P (2015) Multiple giant cervical polyps: a case report with literature review. Int J Biol Med Res 6(1): 4741-4745.
4. Buyukbayrak EE, Karsidag YK, Kars B, Sakin O, Alper AGO, et al. (2011) Cervical polyps: evaluation of routine removal and need for accompanying D&C. Arch Gynecol Obstet 283(3): 581-584.
5. Levy RA, Kumarapeli AR, Spencer HJ, Quick CM (2016) Cervical polyps: Is histologic evaluation necessary? Pathol Res Pract 212(9): 800-803.
6. Adinma JIB (1989) Cervical polyp presenting as inevitable abortion. Trop Doct 19(4): 181.
7. Hamadeh S, Addas B, Hamadeh N, Rahman J (2018) Conservative management of huge symptomatic endocervical polyp in pregnancy: A case report. Afr J Reprod Health 22(2): 88-90.
8. Amesse LA, Taneja A, Broxton E, Pfaff-Amesse T (2002) Protruding giant cervical polyp in a young adolescent with a previous rhabdomyosarcoma. J Pediatr Adolesc Gynecol 15(5): 271-277.
9. Soyer T, Demirdağ G, Güçer S, Orhan D, Karnak I (2014) Giant cervical polyp with mesonephric duct remnants: unusual cause of vaginal bleeding in an adolescent girl. Fetal Pediatr Pathol 33(3): 176-181.
10. Gögöüs S, Senocak ME, Arda IS, Büyükpamukçu N, Akçören Z (1993) Multilocular endocervical polyp in a five-year-old girl. Pediatr Pathol 13(4): 415-419.
11. Abdul MA, Afolabi KK, Madugu N (2012) Giant cervical polyp complicating uterine fibroid and masquerading as cervical malignancy. Arch Int Sur 2(1): 39-41.
12. Harrison AO (2014) Prolapsed giant cervical fibroid polyp mimicking procidentia – aftermath of traditional therapy for fibroids –a case report and review of the literature (2014). Open Science J Clin Med 2(1): 15-18.
13. Saier FL, Hovadhanakul P, Ostapowicz F (1973) Giant cervical polyp. Obstet Gynecol 41(1): 94-96.
14. Lippert LJ, Richart RM, Ferenczy A (1974) Giant benign endocervical polyp: report of a case. Am J Obstet Gynecol 118(8): 1140-1141.
15. Duckman S, Suarez JR, Sese LQ (1988) Giant cervical polyp. Am J Obstet Gynecol 159(4): 852-854.
16. Aridogan N, Cetin MT, Kadayifci O, Atay Y, Bisak U (1988) Giant cervical polyp due to a foreign body in a 'virgin'. Aust N Z J Obstet Gynaecol 28(2): 146-147.
17. Branger C, Dreher E, Burkhardt A, Schmuckle U (1991) Giant polyp of the cervix (in German). Geburtshilfe Frauenheilkd 51(2): 148-149.
18. Khalil AM, Azar GB, Kaspar HG, Abu-Musa AA, Chararah IR, Seoud MA (1996) Giant cervical polyp. A case report. J Reprod Med 41(8): 619-621.
19. Wu W-Y, Sheu B-C, Lin H-S (2005) Giant cervical polyps: Report of two cases and literature review. Taiwan J Obstet Gynecol 44(1): 65-68.
20. Yi KW, Song S-H, Kim KA, Jung WY, Lee JK, Hur J-Y (2009) Giant endocervical polyp mimicking cervical malignancy: primary excision and hysteroscopic resection. J Minim Invasive Gynecol 16(4): 498-500.
21. Massinde AN, Mpogoro F, Rumanyika RN, Magoma M (2012) Uterine prolapse complicated with a giant cervical polyp. J Low Genit Tract Dis 16(1): 64-65.
22. Simavli S, Kinay T (2013) Giant Cervical Polyp: A case report and review of the literature. Turkiye Klinikleri J Gynecol Obst 23(2): 119-122.
24. Ota K, Sato Y, Shiraishi S (2017) Giant polyp of uterine cervix: A case report and brief literature review. Gynecol Obstet Case Rep 3(2): 1-4.
25. Nair V, Nigam J S, BhartiJ N, Dey B, Singh A (2021) Giant endometrial polyp in a postmenopausal woman. Cureus 13(1): e12789.
26. Rexhepi M, Trajkovska E, Koprivnjak K (2019) An unusually large fibroepithelial polyp of uterine cervix: case report and review of literature. Open Access Maced J Med Sci 7(12): 1998-2001.
27. Rexhepi M, Trajkovska E, Koprivnjak K (2019) An unusually large fibroepithelial polyp of uterine cervix: case report and review of literature. Open Access Maced J Med Sci 7(12): 1998-2001.
28. Israel SL (1940) A study of cervical polyps. Am J Obstet Gynecol 39(1): 45-50.