Cervical Polyp
Cervical Polyp
CASE
PRESENTATION
vaginal bleeding
HISTORY OF PRESENT
ILLNESS
2 weeks prior to admission, noted
vaginal bleeding
Sudden onset
Intermittent
Scanty – consuming 1 thinly-soaked
sanitary pad per episode
No clots
Red
Non-foul
Not exacerbated by physical activity nor
intake of drugs
Not relieved by rest
Non-foul
Whitish
Not associated with abdominal or
hypogastric pain nor dyspareunia
No medications taken
No consult done
2 hours prior to admission,
recurrence of vaginal bleeding
Nohistory of
contraceptive use
SEXUAL HISTORY
First coitus at 23 y.o.
Husband as the only sexual partner
3-4 times a week
Last sexual contact was around 55-
57 y.o.
Not associated with dyspareunia nor
postcoital bleeding.
PAST ILLNESSES &
OPERATIONS
M – HTN, had cervical polyp, had arthritis,
no DM, no asthma, no heart and
kidney diseases, no CA
M – took Diovan OD for HTN, Colchicine for
arthritis
A – no food and drug allergies
S – 1952, had CS 2° to CPD
2002, Polypectomy done at Los
Angeles, U.S.A.
H – previous surgery
FAMILY HISTORY
Breast CA on the maternal side
HTN on paternal side
No heredofamilial diseases like DM,
TB, asthma, kidney and heart
diseases
SOCIAL HISTORY
Marital – married; living with husband
and family of her youngest daughter
Stress level – no significant recent
life events; unemployed
Life history information – had history
of travel to Bohol, Manila, and Los
Angeles
Habits – does not smoke nor drink
alcoholic beverages, occasional
coffee drinker, no history of illicit
drug use
Education – secondary education
Husband – 84 y.o., businessman,
non-promiscuous
NUTRITIONAL HISTORY
Meals for the past 24 hours
Aug.6,2006 – Dinner:
2 cups rice, 1 medium-sized fish, 1 glass
of water
Aug.7,2006 – Breakfast:
2 pcs stuffed bread, 1 glass of milk
Aug.7,2006 – Lunch:
2 cups rice, 1 medium-sized fish, 1
serving vegetables, 1 glass of juice
No change of appetite
With dentures
No allergy to foods, not choosy with
foods
Budget for food varies with
availability with money
Ideal Body Weight (IBW)
IBW = ht (cm) – 100 – 5%
= 5’(12’)(2.54cm) – 100 – 5%
= 152.4 – 100 – 5%
= 52.4 – (2.62)
= 49.78 kg ~ 50 kg
Actual wt = 74 kg
Total Energy Requirement (TER)
TER = IBW (30) + 300
= 50 (30) + 300
= 1500 + 300
= 1800 cal/day
Basal Metabolic Rate (BMR)
BMR = weight (kg)
height (m)2
= 74 kg
(1.52)2
= 74 kg
2.31 m2
= 32.0 kg/m2 ~ obese
SYSTEMS REVIEW
General. on walker, no easy
fatigability, had occasional
headache, no fever, no dizziness, (+)
blurring of vision
Respiratory. No cough, no dyspnea
Cardiovascular. No chest pain, no
tightness, no palpitations
Gastrointestinal. No dysphagia, no
weight loss
Urinary. No urgency, no frequency,
no dysuria
Reproductive. (+) vaginal bleeding,
(+) abnormal discharge, no pruritus
nor pain
PHYSICAL EXAMINATION
General. Patient was conscious,
coherent, cooperative, afebrile, not
in respiratory distress with the
following vital signs:
BP = 130/80 mmHg
HR = 74 bpm Ht = 5’
RR = 18 cpm Wt = 74kg
Temp.= 36.6ºC
Skin. Warm, senile turgor
HEENT.
Head: symmetric, no scars, no fractures,
thin grayish hairs
Eyes: no ptosis, pink palpebral
conjunctivae, anicteric sclerae, clear
cornea
Ears: no discharge, no foreign body, no
tenderness,
Nose: no discharge, no foreign
body
Mouth and Throat: lips pink, moist
oral mucosa and tongue
Neck. No venous engorgement, no
tenderness, no rigidity, no
lymphadenopathy
Breast.
I - symmetrical, no skin
retraction or dimpling,
no swelling or
discoloration, no discharge,
brown areola with everted
nipple
P – no tenderness, no mass,
Chest and Lungs.
I – No gross deformities, equal
chest expansion
P – equal tactile fremitus, no
tenderness
P – resonant
A – clear breath sounds, no rales,
no wheeze
Heart.
I – no bulging of precordium
P – PMI at 5th L ICS midclavicular
line, no heave, no thrill
P – dullness within normal limits
A – distinct heart sounds, normal
rate and rhythm, no murmur,
no pericardial friction rub
Abdomen.
I – flat, silvery striae, midline CS
scar
P – soft, no tenderness, no mass,
no organomegaly
P – tympanitic
A – normoactive bowel sounds
Genitalia.
Speculum exam
cervix: pinkish, smooth, no ulcerations
scanty, reddish, non-foul bleeding
no mass, no tenderness
A – no mass, no tenderness
Extremities. (+) bipedal non-pitting
edema, strong pulses
LABORATORY TESTS
Urinalysis
Color – yellow
Transparency – hazy
Albumin – trace
Blood - ++
Bacteria – rare
Complete Blood Count (CBC)
WBC – 6.56 K/uL
Neutrophils – 3.86
Lymphocytes – 1.77
Monocytes – 0.632
Eosinophils – 0.203
Basophils – 0.107
RBC – 4.57 M/uL
HgB – 12.7 g/dL
Hct – 39.8%
Atrophic vaginitis
Endometrial polyp
Endometrial carcinoma
ATROPHIC VAGINITIS
Senile vaginitis
Inflammation of the vaginal
epithelium due to atrophy secondary
to decreased levels of circulating
estrogens
Most common in postmenopausal
women
Pathophysiology
Decreased estrogen
production
Atrophy of vaginal
epithelium
discomfort
itching
burning dyspareunia
Vaginal bleeding
Decreased estrogen production
Dyspareunia
Discomfort
Vaginal bleeding
Urinary symptoms
Urinary urge incontinence
Urinary frequency
Dysuria
Nocturia
Others
Cystocele, rectocele, enterocele
Basis for Inclusion
82 y.o.
Postmenopausal bleeding
Vaginal discharge
Basis for Exclusion
(-) Itching
(-) Vulvar burning
(-) Urinary symptoms
(-) Cystocele, rectocele, enterocele
Mass at the external os
ENDOMETRIAL POLYP
Are localized overgrowths of
endometrial glands and stroma that
project beyond the surface of the
endometrium
They are soft, pliable, and may be
single or multiple.
Most polyps arise from the fundus of
the uterus
They may have a broad base
(sessile) or be attached by a slender
pedicle (pedunculated).
The growths were discovered in all
age groups, with peak incidence
between the ages of 40 and 49.
Clinical manifestations
Majority are asymptomatic
Associated with wide range of
abnormal bleeding patterns
Occasionally, a pedunculated
endometrial polyp with a long pedicle
may protrude from the external
cervical os
Polyps are succulent and velvety,
with a large central vascular core
The color is usually gray or tan but
may occasionally be red or brown
The tip of a prolapsed polyp often
undergoes squamous metaplasia,
infection, or ulceration
The clinician cannot distinguish
whether the abnormal bleeding
originates from the polyp or is
secondary to the frequently
coexisting endometrial hyperplasia.
Basis for Inclusion
82 y.o.
Abnormal bleeding
1x1cm, single, soft, mobile, non-
tender, well-delineated, grayish-
white polypoid mass at the external
os
Basis for Exclusion
(-) ulcerations at the tip of polypoid
mass
UTZ findings of endocervical polyp
Diagnostic Procedures
Because most endometrial are
asymptomatic,the diagnosis is not usually
established until the uterus is opened
following hysterectomy for other reasons.
Are often discovered by vaginal
hydrosonoraphy, hysteroscopy, and/or
hysterosalphingography during the
diagnostic workup of a woman with a
refractory case of abnormal uterine
bleeding.
ENDOMETRIAL CANCER
most common gynecologic CA
Phil: 3rd most common gynecologic
CA
Occurs primarily in postmenopausal
women
Increasingly virulent with advancing
age
Any factor that increases exposure to
unopposed estrogen increases risk of
endometrial cancer (ovary, breast,
Increased Risk
Variants of normal anatomy and
physiology
obesity
21-50 lbs = 3x
>50 lbs = 10x
nulliparity = 2x
early menarche and late menopause
>52 years = 2.5x
Tamoxifen use = 2.5 – 9x
Atypical hyperplasia = 29%
Frank abnormality and disease
DM = 3x
HTN = 1.5x
Cervical Polyp
CERVICAL POLYP
Most common benign neoplastic
growths of the cervix
Most common in multiparous
women in their 40s and 50s
Usually present as a single polyp,
but multiple polyps do occur
occasionally
Majority are smooth,soft, reddish-
purple to cherry red, and fragile
They easily bleed when touched
Polyps may arise from either:
Endocervical canal – endocervical polyp
Usually have a narrow long pedicle
Occur during reproductive years
Grayish-white in color
Etiology
Usually secondary to inflammation or
abnormal local responsiveness to
hormonal stimulation
Focal hyperplasia and localized
proliferation are the response of the
cervix to local inflammation.
Clinical Manifestation
Intermenstrual bleeding, especially
following contact such as coitus or
pelvic exam
Sometimes associated leukorrhea
emanates from the infected cervix
Many are asymptomatic and
recognized for the first time during a
routine speculum exam
Often the polyp seen on inspection is
difficult to palpate because of its soft
consistency
Basis for inclusion
82 y.o., multiparous
Postmenopausal bleeding
Leukorrhea
Previous history of polypectomy
1x1 cm, grayish-white, well-delineated
mass at the external os
Ultrasound findings - polypoid mass within
the mid-cervical canal approximately 1.3 x
1.3 x 1.1cm in size, suggestive of
endocervical polyp versus cervical
pathology
Management
Most endocervical polyps may be
managed in the office by grasping
the base of the polyp with an
appropriately sized clamp
Polyp is avulsed with a twisting
motion and sent to the pathology
laboratory for microscopic evaluation
The polyp is usually friable. If the
base is broad or bleeding ensues, the
base may be treated with chemical
cautery, electrocautery, or
cryocautery
After polyp is removed, endometrial
sampling should be performed to
diagnose a coexisting endometrial
hyperplasia or carcinoma in both
symptomatic and asymptomatic
COURSE IN THE WARD
On admission, patient was referred
to IM Department for evaluation due
to old age. She was diagnosed to
have Essential HTN. She was given
Co-Diovan 80mg 1tab OD.
Patient was operated on her first
hospital day through fractional
curettage with cervical punch biopsy
and polypectomy under intravenous
sedation. Pre-operative and post-
operative diagnosis was cervical
polyp.
Fractional curettage obtained a
minimal amount of endometrial and
endocervical tissue. Uterine depth
was 8cm. EBL was 50cc.
Specimen were sent for biopsy and
findings showed Endometrial polyps,
Chronic endocervitis and no
diagnostic abnormality in the
ectocervix.
Patient was discharged on her first
post-operative day with improved
condition – no complaints of vaginal
bleeding or abnormal vaginal
discharge.
. . . . . . . . . . . . . . .Thank
you