|Year : 2022 | Volume
| Issue : 4 | Page : 386-388
Invasive squamous cell carcinoma on the mucosal surface of the leiomyomatous polyp, cervix - Report of an extremely rare occurrence
Hariharanadha Sarma Nandyala1, Chaitanya Balekuduru1, Jyothi Suchitra Mekala2
1 Department of Pathology, RDT Hospital, Bathalapalli, Andhra Pradesh, India
2 Department of Gynecology and Obstetrics, RDT Hospital, Bathalapalli, Andhra Pradesh, India
|Date of Submission||09-Apr-2021|
|Date of Decision||20-Mar-2022|
|Date of Acceptance||26-Mar-2022|
|Date of Web Publication||17-Mar-2023|
Dr. Hariharanadha Sarma Nandyala
Department of Pathology, RDT Hospital, Bathalapalli - 515 661, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
Endocervical polyps constitute the most common new growths of the uterine cervix. They are most often found during the fourth to sixth decades and in multigravidas. The paucity of smooth muscles in the cervical stroma makes the leiomyomas uncommon in the cervix and accounts for less than 1% of all fibroids. Cervical leiomyomas or fibroids usually arise from the supravaginal portion of the cervix. Studies indicate that the prevalence of atypia, dysplasia, and malignancy in cervical polyps is none to very low. The occurrence of neoplastic change in the overlying mucosa of the leiomyomatous cervical polyp is extremely rare. There has been only a single case of squamous cell carcinoma (SCC) arising on the mucosal surface of a cervical leiomyomatous polyp. We are presenting a case of SCC arising from the mucosal surface of the cervical leiomyomatous polyp.
Keywords: Endocervical polyp, leiomyoma, squamous cell carcinoma
|How to cite this article:|
Nandyala HS, Balekuduru C, Mekala JS. Invasive squamous cell carcinoma on the mucosal surface of the leiomyomatous polyp, cervix - Report of an extremely rare occurrence. J NTR Univ Health Sci 2022;11:386-8
|How to cite this URL:|
Nandyala HS, Balekuduru C, Mekala JS. Invasive squamous cell carcinoma on the mucosal surface of the leiomyomatous polyp, cervix - Report of an extremely rare occurrence. J NTR Univ Health Sci [serial online] 2022 [cited 2023 Apr 1];11:386-8. Available from: https://www.jdrntruhs.org/text.asp?2022/11/4/386/371760
| Introduction|| |
Endocervical polyps constitute the most common new growths of the uterine cervix. They are most often found during the fourth to sixth decades and in multigravidas. The polyps typically arise within or above the cervical Os and range from a few millimeters to 4 cm in size with an average of 1 cm. Endocervical polyps are clinically relevant because approximately 40% are symptomatic and often present with bleeding. Cervical leiomyomas usually occur singly and arise from the supravaginal portion of the cervix. They produce unilateral enlargement of the cervical portion depending on the location. Leiomyoma of the cervix can present as a mass per vagina with ulceration and superficial necrosis.
The occurrence of neoplastic change on the mucosal surface of an endocervical polyp is extremely rare. Only one such case of squamous cell carcinoma (SCC) arising from the mucosal surface of a leiomyomatous polyp is on the record in the world literature. We present the second case of invasive SCC arising from the mucosal surface of a leiomyomatous endocervical polyp.
A 56-year-old lady presented to the gynecology outpatient clinic with the complaint of bleeding per vagina of 2 months duration. Physical examination in general did not reveal any significant findings. Gynecological examination revealed a small polypoidal lesion on the posterior lip of the cervix near the OS. No other significant findings were noted. A polypectomy was done and the tissue was sent for a histopathological examination.
Grossly, the polyp measured 1 × 2 × 2.5 cm with a focal brownish rough surface of size 0.5 × 0.5 cm. The cut surface revealed grayish-white firm tissue. Microscopic examination revealed a poorly circumscribed spindle cell tumor partly replacing the stroma. The tumor cells are spindle-shaped, elongate with blunt ends, and have a round to oval nucleus. The cells are arranged in sweeping fascicles, sheets, and interlacing bundles. There was no pleomorphism, no atypia, or no increase in the mitoses. The mucosa overlying the tumorous area showed neoplastic change ranging from high-grade squamous intraepithelial neoplasia (H-SIL) to frank microinvasive SCC. The invasive areas of the neoplastic squamous epithelium are surrounded by extensive infiltration of lymphocytes, eosinophils, and occasional plasma cells [Figure 1] and [Figure 2].
|Figure 1: Plump spindle shaped cells arranged in sheets and interlacing fascicles. The overlying squamous epithelium shows high grade squamous intraepithelial lesion (H&E × 10)|
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|Figure 2: The squamous epithelium overlying the spindle cell growth shows pleomorphic cells with hyperchromatic nucleus. The neoplastic cells are invading the stroma. Moderate collection of lymphocytes and eosinophils are seen around the advancing tumor edges. Blue arrow squamous cell carcinoma and red arrows leiomyoma (H&E × 20)|
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A diagnosis of microinvasive non-keratinizing SCC over a leiomyomatous polyp of the cervix is made. Subsequent to the histopathology report, the patient underwent a total hysterectomy with bilateral salpingo-oophorectomy and regional lymphadenectomy.
This specimen was sent to the pathology department and the microscopic examination revealed a tiny remnant focus of leiomyoma with a small area of SCC overlying it [Figure 3]. Lymph nodes did not reveal any metastatic deposits.
|Figure 3: Part of remnant spindle cell growth and invasive squamous cell carcinoma in the overlying mucosa (H&E × 20)|
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| Discussion|| |
Endocervical polyps are common and occur over a wide age range with a mean in the fifth decade. Cervical leiomyomatous polyp usually arises from the posterior lip of the ectocervix. The focal proliferation of endocervical stroma leads to polyp formation. Depending upon their stromal content, they may be either fibrous, angiomatous, edematous, or cellular. When these polyps protrude through the external OS, the external surface epithelium may be replaced by reserve cell hyperplasia, which can differentiate into squamous metaplasia and finally mature stratified squamous epithelium.
Although most cervical polyps are benign, several studies indicate that the prevalence of dysplasia and malignancy in the symptomatic cervical polyps is none to extremely low [Table 1].
|Table 1: Prevalence of Dysplasia and Malignancy Changes in Polypectomy Specimens|
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The occurrence of neoplastic change in the overlying squamous epithelium of a cervical polyp is extremely rare. Neno Chin et al. reported nine cases of squamous intraepithelial lesions (SIL) and two cases of SCC in 1500 cases of endocervical polyps. Women in the perimenopausal to postmenopausal years have a slightly higher likelihood of a malignancy associated with cervical polyps. Neoplastic change in the overlying mucosa of a cervical leiomyomatous polyp is much rarer with only one case reported in the world literature so far.
We have reported a second such case of invasive SCC developing in the overlying mucosa of the leiomyomatous polyp. We want to emphasize the importance of histopathological examination of all the cervical polyps, so that we may not miss any important pathology underlying these polyps, which can radically change the management protocols.
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Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]