Transcript Endocervical polyps

Cervical Lesions
Maria Julieta V. Germar, FPOGS, FSGOP
Section of Gynecologic Oncology
UP College of Medicine-Philippine General Hospital
The Medical City
Ateneo School of Medicine and Public Health 16 November 2011
Lecture Outline
Review: Anatomy
 Benign Lesions of the Cervix

Clinical Presentation, Diagnosis
Management

Infectious Conditions:Cervicitis
Clinical Presentation, Diagnosis
Management

Cervical Cancer
Prevention
Diagnosishhhh
Staging
Management
2011 updates
The cervix
• corresponds to the narrow stalk
end of the pear shaped uterus
• a cylindrical-shaped muscular
structure , about 3-5cm in length
and partly lies in the upper vagina,
extending superiorly into the
retroperitoneal space behind the
bladder and in front of the rectum.
The cervix
•The length and width of the
endocervical canal varies; it is
usually 2.5 to 3 cm in length
The width of the canal varies
with the parity of the woman
and changing hormonal levels.
A single layer of columnar
epithelium lines the
endocervical canal and the
underlying glandular structures.
This specialized epithelium
secretes mucus, which
facilitates sperm transport.
An abrupt transformation usually is
seen at the junction of the columnar
epithelium of the endocervix and the
nonkeratinized stratified squamous
epithelium of the portio vaginalis The
stratified squamous epithelium of the
exocervix is identical to the lining of
the vagina.
Speculum examination of the vagina
and cervix
Benign Lesions of the Cervix
Endocervical Polyp
Nabothian Cyst
Cervical Myoma
Endocervical Polyps

Most common benign neoplasm of
the cervix

Usually found in the 4th to 6th decade
of life.

May be single or multiple and may be
pedunculated lesion on a stalk of
varying length.

May be cervical/ectocervical or
endocervical
Endocervical polyps
Polyps may arise from either the
endocervical canal (endocervical
polyp) or ectocervix (cervical
polyp).
 Endocervical polyps are more
common than are cervical polyps.
 Polyps whose base is in the
endocervix usually have a narrow,
long pedicle and occur during the
reproductive years, whereas
polyps that arise from the
ectocervix have a short, broad
base and usually occur in
postmenopausal women.

Endocervical polyps
Etiopathogenesis:
 abnormal focal responsiveness to
hormonal stimulation or local inflammation
 The color of the polyp depends in part on
its origin, with most endocervical polyps
being cherry red and most cervical polyps
grayish white.
Endocervical Polyps
CLINICAL PRESENTATION
 Polyps bleed easily to touch
 Usually asymptomatic but
may also present as
abnormal bleeding: post
coital bleeding, menorrhagia,
postmenopausal bleeding
DIAGNOSIS
• Speculum examination then
Biopsy
MANAGEMENT
 Polypectomy,
surgical dilatation and
curettage, hysteroscopic
polypectomy
Benign Lesions of the Cervix
Endocervical Polyps
Nabothian Cyst
Cervical Myoma
Nabothian Cysts



mucus-filled lesions ,multiple
translucent or opaque, white or
yellow lesion ranging from 2mm
to 10mm in size.
retention cysts of endocervical
columnar cells occurring where a
tunnel or cleft has been covered
by squamous metaplasia.
These cysts are so common that
they are considered a normal
feature of the adult cervix
Nabothian cysts


The area of the
transformation zone of the
cervix is in an almost
constant process of repair,
and squamous metaplasia
and inflammation may
block the cleft of a gland
orifice.
The endocervical columnar
cells continue to secrete,
and thus a mucous
retention cyst is formed.
Nabothian Cysts
CLINICAL PRESENTATION

asymptomatic

tend to occur following natural
tissue regrowth after minor
trauma or after childbirth.
DIAGNOSIS
◦Clinical, Speculum exam
MANAGEMENT
◦usually asymptomatic and
need no treatment.
Benign Lesions of the Cervix
Endocervical Polyps
Nabothian Cyst
Cervical Myoma
Cervical Myoma
A cervical myoma is usually a
solitary growth
 Because of the relative paucity of
smooth muscle fibers in the cervical
stroma, the majority of myomas that
appear to be cervical actually arise
from the isthmus of the uterus.


CLINICAL PRESENTATION:

Vaginal Bleeding
dysuria,urgency, obstruction and
dyspareunia

Cervical Myoma
DIAGNOSIS
 Speculum, Pelvic examination,
Biopsy
MANAGEMENT
 if reproductive age : GnRH
agonists ( to shrink myoma),
excision
 If completed family size:
Hysterectomy
Infectious Conditions of the Cervix
Condyloma
Gonococcal Cervicitis
Chlamydial cervicitis
Condyloma acuminata, cervix
CLINICAL PRESENTATION
 The warts may be raised or
flat, single or multiple, small
or large. Some may cluster
to form a cauliflower-like
shape.
 Condyloma acuminatum is
the most common viral
sexually transmitted
disease of the vulva,
vagina, rectum, and cervix
Condyloma acuminata, cervix
 Genital
warts are
caused by the human
papillomavirus (HPV).
Most commonly
HPV 6,11
 HPV is easily spread
during oral, genital, or
anal sex with an
infected partner.
Condyloma acuminata, cervix
The virus can be shed from both macroscopic and
microscopic lesions.
 It is highly contagious, with 25% to 65% of
sexual partners developing the infection.
 Studies have demonstrated condoms offer only
modest protection against HPV transmission.
 The average incubation period is 3 months, with a
wide range of 1 to 8 months.
 peak incidence occurs between the ages of 15
and 25 years.

Condyloma acuminata, cervix
DIAGNOSIS
 Speculum exam, biopsy,
colposcopy
MANAGEMENT
ablative
 Cryosurgery (freezing)
 electrocautery
 Laser treatment
PREVENTION
 Abstinence
 HPV Vaccine
Infectious Conditions of the Cervix
Condyloma
Gonococcal Cervicitis
Chlamydial cervicitis
Gonococcal Cervicitis
MICROBIOLOGY:
 Etiologic
agent: Neisseria
gonorrhoeae
 Gram-negative
intracellular
diplococcus
 Infects
mucus-secreting
epithelial cells
Gonococcal Cervicitis

CLINICAL MANIFESTATIONS:

Cervicitis – inflammation of the cervix

Non-specific symptoms: abnormal
vaginal discharge, intermenstrual
bleeding, dysuria, lower abdominal
pain, or dyspareunia
Clinical findings: mucopurulent or
purulent cervical discharge,
easily induced cervical bleeding
60% of women with clinical
cervicitis have no symptoms
symptoms may occur within 10
days of infection



Gonococcal Cervicitis
DIAGNOSIS
• Culture
• Non-culture
tests
• Polymerase chain reaction (PCR)
(Roche Amplicor)
• Gram stain
• All patients tested for gonorrhea should
be tested for other STDs, including
chlamydia, syphilis, and HIV.
MANAGEMENT

Antibiotic treatment of patient and partner
(within the past 60 days)
Treatment for Uncomplicated Infections
of the Cervix, Urethra, and Rectum
Recommended Regimens*
Ceftriaxone 250 mg IM in a single dose. If there's
an oropharyngeal component this is preferred
OR
Cefixime400 mg orally in a single dose
OR
Ciprofloxacin 500 mg orally in a single dose*
OR
Ofloxacin 400 mg orally in a single dose*
OR
Levofloxacin250 mg orally in a single dose*
PLUS
2011
updates
TREATMENT FOR CHLAMYDIA IF
*Contraindicated
CHLAMYDIAL
INFECTION
IS NOTand
RULED
OUTNot recommended for
in pregnancy
children.
infections acquired in California, Asia, or the Pacific, including Hawaii.
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Co-treatment for
Chlamydia trachomatis
Patients infected with N. gonorrhoeae frequently are
coinfected with C. trachomatis;
Azithromycin
Doxycycline
1g
100 mg
Orally
Once
Orally
Twice a day for
7 days
Sexual abstinence for 7 days
30
or