Benign Tumors Of The Cervix

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Endocervical polyps are the most common benign neoplasms of the cervix. Please

note that the word neoplasm refers to a cancerous growth. They are focal

hyperplastic (abnormal cell growth) protrusions of the endocervical folds,

including the epithelium and substantia propria.

They are most common in the fourth to sixth decades of life and usually are

asymptomatic but may cause profuse leukorrhea or postcoital spotting. (blood

after orgasm)

Grossly, they appear as typical polypoid structures protruding from the

cervical os. At times, endometrial polyps protrude through the cervical os. They

cannot be distinguished from endocervical polyps by gross appearance.

Microscopically, a variety of histologic patterns are observed, including (1)

typical endocervical mucosal (2) inflammatory (granulation tissue) (3) fibrous

(4) vascular (5) pseudodecidual (6) mixed endocervical and endometrial (7)

pseudosarcomatous.

Treatment is removal, which can usually be accomplished by twisting the polyp

with a dressing forceps if the pedicle is slender. Smaller polyps may be removed

with punch biopsy forceps. Polyps with a thick stalk may require surgical

removal.

Microglandular hyperplasia Microglandular hyperplasia refers to a clinically

polypoid growth measuring 1-2 cm. It occurs most often in women who are on oral

contraceptive therapy or Depo-Provera and in pregnant or postpartum women. It

reflects the influence of progesterone. Microscopically, it consists of tightly

packed glandular or tubular units, which vary in size, lined by a

flattened-to-cuboidal epithelium with eosinophilic granular cytoplasm containing

small quantities of mucin. Nuclei are uniform, and mitotic figures are rare.

Squamous metaplasia and reserve cell hyperplasia are common. An atypical form of

hyperplasia can be mistaken for clear cell carcinoma. Unlike clear cell

carcinoma, it lacks stromal invasion, has scant mitotic activity, and lacks

intracellular glycogen

Squamous papilloma Squamous papilloma is a benign solid tumor typically

located on the ectocervix. It arises most commonly as a result of inflammation

or trauma. Grossly, the tumors are usually small, measuring 2-5 mm in diameter.

Microscopically, the surface epithelium may show acanthosis, parakeratosis, and

hyperkeratosis. The stroma has increased vascularity and a chronic inflammatory

infiltrate. Treatment is removal. The squamous papilloma resembles a typical

condyloma acuminatum but lacks the koilocytes microscopically.

Smooth muscle tumors (leiomyomas) These benign neoplasms may originate in the

cervix and account for approximately 8% of all uterine smooth muscle tumors.

They are similar to tumors in the fundus. When located in the cervix, they

usually are small, ie, 5-10 mm in diameter. Symptoms depend on size and

location. Microscopically, leiomyomas resemble the typical smooth muscle tumor

found in the uterine corpus. Treatment is required only for those patients who

are symptomatic. The cervical leiomyoma is usually part of the spectrum of

uterine smooth muscle tumors.

Mesonephric duct remnants When present, mesonephric duct remnants are

typically located at the 3-o’clock and the 9-o’clock positions, deep within the

cervical stroma. They usually are incidental findings and are present in

approximately 15-20% of serially sectioned cervices. As the name implies,

mesonephric duct remnants are vestiges of the mesonephric or Wolffian duct.

Usually, they are only a few millimeters in diameter and seldom are grossly

visible. Microscopically, they consist of a proliferation of small round tubules

lined by epithelium that is cuboidal to low columnar. The tubules tend to

cluster around a central duct. The cells lining the tubules contain no glycogen

or mucin, but the center of the tubule may contain a pink material that contains

glycogen or mucin.

Endometriosis When present in the cervix, endometriosis is usually an

incidental finding. Grossly, it may appear as a bluish-red or bluish-black

lesion, typically 1-3 mm in diameter. Microscopically, the implants are typical

endometriosis, consisting of endometrial glands, endometrial stroma, and

hemosiderin-laden macrophages. The implants usually gain access to the cervix

during childbirth or previous surgery.

Papillary adenofibroma This neoplasm is uncommon. Grossly, it appears as a

polypoid structure. Microscopically, the neoplasm contains branching clefts and

papillary excrescences lined by mucinous epithelium with foci of squamous

metaplasia. A compact, cellular, fibrous tissue composed of spindle-shaped and

stellate fibroblasts supports the epithelium. The stroma is devoid of smooth

muscle, and mitoses are rare. Similar growths occur in the endometrium and the

fallopian tubes.

Heterologous tissue Heterologous tissue includes cartilage, glia, and skin

with appendages. This type of tumor rarely occurs in the cervix. While they may

arise de novo, these tumors probably represent implants of fetal tissue from a

previous aborted pregnancy. Hemangiomas Hemangiomas in the cervix are rare in

occurence and are similar to those found elsewhere in the body.

 

 

 

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