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CASE REPORT
Year : 2012  |  Volume : 2  |  Issue : 1  |  Page : 39-41

Giant cervical polyp complicating uterine fibroid and masquerading as cervical malignancy


Department of Obstetrics and Gynecology, Reproductive Health Unit, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria

Date of Web Publication22-Sep-2012

Correspondence Address:
Muhammad A Abdul
Department of Obstetrics and Gynecology, Reproductive Health Unit, Ahmadu Bello University Teaching Hospital, Zaria
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2278-9596.101273

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  Abstract 

Introduction: Huge cervical polyp causing diagnostic dilemma is rarely encountered in gynecologic practice. The objective of this study is to document a case of huge cervical polyp masquerading as cervical cancer seen and managed in Ahmadu Bello University Teaching Hospital, Zaria, Nigeria.
Case Report: A 39-year-old trader para 5 + 0 who presented at the gynecologic unit with a 7-year history of fleshy mass protruding from the vagina which had been progressively increasing in size but was reducible. Physical examination revealed severe pallor, 16-week sized abdomino-pelvic firm irregular mass, and a huge firm mass protruding through the vagina, measuring 30 cm by 20 cm. The vaginal mass was irregular in shape and occupied the whole of the vagina. The cervix was not reachable. Pelvic ultrasonography revealed features of multiple intramural and subserous fibroids and a right simple cystic adneaxeal mass about 6 cm in diameter. Anemia was corrected, and at examination under anesthesia, a diagnosis of huge cervical polyp (arising from the posterior cervix) with multiple uterine fibroids was made. She had vaginal polypectomy, total abdominal hysterectomy, and bilateral salpingo-ophorectomy using an abdomino-perineal approach. She did well postoperatively and subsequently on follow-up. Histology confirmed cervical fibroid polyp and uterine leiomyoma.
Conclusion: Although giant cervical fibroid is rare, it may masquerade as cervical malignancy or uterine inversion. Proper evaluation is needed to make an accurate diagnosis.

Keywords: Cervical malignancy, cervical polyp, polypectomy, uterine fibroids


How to cite this article:
Abdul MA, Koledade AK, Madugu N. Giant cervical polyp complicating uterine fibroid and masquerading as cervical malignancy. Arch Int Surg 2012;2:39-41

How to cite this URL:
Abdul MA, Koledade AK, Madugu N. Giant cervical polyp complicating uterine fibroid and masquerading as cervical malignancy. Arch Int Surg [serial online] 2012 [cited 2019 Sep 20];2:39-41. Available from: http://www.archintsurg.org/text.asp?2012/2/1/39/101273


  Introduction Top


Giant cervical polyp is rarely encountered in gynecologic practice, and so far, only a handful of cases have been reported in the literature. [1],[2] Recently, Massinde and co-workers from Tanzania reported a case of a large cervical polyp associated with uterine prolapse in a 55-year-old grand multiparous woman. [3] Similarly Khalid and colleagues from Lebanon reported a case of giant cervical polyp in a sexually inactive nulliparous lady. [4] Occasionally, large cervical polyp may be associated with a foreign body. [5] Although giant cervical polyp is uncommon, it is not limited to adults. Amesse and colleagues reported a case of huge cervical polyp in an adolescence. [1]

In nearly all the cases of huge cervical polyp reported, vaginal bleeding is the principal symptom and the mass mimics cervical malignancy, thus underscoring the importance of histological examination of the polyp. [2],[6]

We report a case of a giant cervical polyp associated with multiple uterine fibroids in a 40-year-old multiparous woman recently managed in the gynecologic unit of Ahmadu Bello University Teaching Hospital, Zaria, Nigeria.


  Case Report Top


A 40-year-old para 5 + 0 (5 alive) whose last child birth was 9 years before she presented. She presented to the gynecological clinic following referral from the general out-patient department, with 7 years history of protrusion of a fleshy mass per vaginam and 2 months history of progressive generalized body weakness. The mass had progressively increased over the years, but was still reducible, but with difficulty and bleeding from the surface of the mass whenever she reduced it. The mass increased in size during menstruation and reduced minimally afterward. There was associated recurrent milky, non-itchy, non-offensive discharge from the surface of the mass. Also, there was associated intermittent dull lower abdominal pain radiating to the lower back over the last 1 year usually following reduction of the mass. There was no history of urinary, gastrointestinal tract or cadio-respiratory symptoms. Three years prior to presentation, she was counseled for vaginal hysterectomy in another hospital on account of suspected utero-vaginal prolapse, but she declined.

She attained menarche at 12 years and her menstrual flow was regular for 6 days with no menorrhagia. She had dysmenorrhea, dyspaurenia, and coital bleeds, which made her stop coitus 2 years prior to presentation. She had never used modern contraceptive methods.

All her pregnancies were supervised, term, and spontaneous vertex deliveries with no peripartum problems and she had no co-morbidity. She is the only wife of her husband, a 49-year-old businessman, with no family history of breast or genital tract malignancy.

When she was examined, she was found to be ill looking, afebrile, and moderately pale. The chest was clinically clear. The pulse rate was 100 beats per minute; the blood pressure was 100/60 mmHg, while the heart sounds were I and II only with no murmurs.

The abdomen was flat with fullness in the suprapubic region which was mildly tender. The liver, spleen, and kidneys were all clinically within normal limits. There was a firm irregular abdomino-pelvic mass of 16 weeks size. No ascites was present. Vaginal examination revealed a huge polypoid mass outside the introitus, measuring about 30 cm by 20 cm [Figure 1], and also filled the whole of the vagina and the cervix could not be reached. The mass bled moderately on contact. Pelvic ultrasonography revealed multiple intramural fibroids on both anterior and posterior walls, the largest measuring 40 by 40 mm, and a left-sided simple ovarian cyst about 60 mm in its maximum diameter.
Figure 1: The giant cervical polyp protruding out of the vagina

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An impression of a giant cervical polyp complicating multiple uterine fibroids with moderate anemia was made to rule out cervical malignancy. An urgent packed cell volume revealed 22% and the patient was counseled on the need for admission for correction of anemia and subsequent surgery. The total white cell count was normal, but there was neutrophilia of 90%. Serum urea and electrolyte and random blood sugar were within normal limits. The swab culture of the discharge on the mass and urine yielded Candida and  Escherichia More Details coli, respectively. Anemia was corrected with two units of red cells. At examination under anesthesia, cervical polyp was confirmed arising from the whole of posterior cervix. Vaginal polypectomy and total abdominal hysterectomy with bilateral salpingo-ophorectomy was done via an abdomino-perineal approach. Operative findings [Figure 2] were that of a giant pedunculated cervical polyp and 16-week sized uterus saddled with multiple intramural fibroids. There were also bilateral peri-fimbrial and peri-ovarian adhesions and estimated blood loss was about 700 ml. She had a unit of whole blood intraoperatively.
Figure 2: The uterus with multiple fibroids and the prolapsed cervical polyp

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She had an excellent postoperative course and was discharged on the fifth postoperative day with a packed cell volume of 30%. Histopathologic examination of specimens revealed cervical fibroid polyp and uterine leiomyoma. She is currently doing well on hormonal replacement therapy.


  Discussion Top


This case was the only case of giant cervical polyp seen in our center over the last 10 years, thus reaffirming its rarity as observed by previous workers. [1],[2],[6],[7] Most of the reported cases of giant or huge cervical polyp were found in perimepausal women. This case was encountered in a 40-year-old multiparous woman. Unlike the case reported by Amesse and colleagues in which the cervical polyp was associated with utero-vaginal prolapse, ours was complicated by multiple uterine fibroids. [1]

The symptom complex presented by the patient (huge polyploid mass associated with vaginal bleeding and discharge) was consistent with the established data and this certainly mimicked cervical malignancy, thus emphasizing the importance of histological examination particularly in environments where cervical cancer is common (such as ours). [2],[4],[6] However, it has been documented that only about 2% of cervical polyps undergo malignant transformation. [4]

Vaginal polypectomy is the treatment for cervical polyp. However, in our case, it was combined with total abdominal hysterectomy for multiple uterine fibroids since the patient had completed her family size.

In conclusion, although giant cervical fibroid is rare, it may masquerade as cervical malignancy or uterine inversion. Proper evaluation is needed to make an accurate diagnosis.

 
  References Top

1.Amesse LS, Taneja A, Broxson E, Pfaff-Amesse J. Protruding giant cervical polyp in a young adolescent with a previous rhadomyosarcoma. J Pediatr Adolesc Gynecol 2002;15:271-7.  Back to cited text no. 1
    
2.Bucello D, Frederic B, Noel JC. Giant cervical polyp: A case report and review of rare entity. Arch Gynecol Obstet 2008;278:295-8.  Back to cited text no. 2
    
3.Massinde AN, Mpogoro F, Rumanyika RN, Magona M. Uterine prolapsed complicated with giant cervical polyp. J Low Genit Tract Dis 2012;16:64-5.  Back to cited text no. 3
    
4.Khalil AM, Azar GB, Kasoar HG, Abu-Musa AA, Charara IR, Seoud MA. Giant cervical polyp: A case report. J Repod Med 1996;41:619-21.  Back to cited text no. 4
    
5.Aridogan N, Cetin MT, Kadayifci O, Atay Y, Bisak U. Giant cervical polyp due to a foreign body in a 'virgin'. Aust N Z J Obstet Gynecol 1988;28:146-7.  Back to cited text no. 5
[PUBMED]    
6.Yi KW, Song SH, Kim KA, Jung WY, Lee JK, Hur JY. Giant endocervical polyp mimicking cervical malignancy: Primary excision and hysteroscopic resection. J Minim Invasive Gynecol 2009;16:498-500.  Back to cited text no. 6
[PUBMED]    
7.Duckman S, Suarez JR, Sese LQ. Giant cervical polyp. Am J Obstet Gynecol 1988;159:852-4.  Back to cited text no. 7
[PUBMED]    


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