Wednesday, November 17, 2010

Pedunculated cervical polyp- Ultrasound videos:

Polyps (small outgrowths) are known to occur in the cervical canal (the lumen of the lower third of the uterus), anytime from puberty to menopause. However, they are rare in menopausal women and even rarer in puberty. They are common in women over the age of 20 years and who have had children.
What is the cause of cervical polyps? It is believed that cervical polyps are the result of long term insult or inflammation of the lining (mucosa) of the cervical canal. Also, changes in estrogen levels can also cause polypoid growths to form in the cervical canal (endo-cervix).
What are the main symptoms of a polyp in the cervix? The common presenting symptoms are pain in the lower pelvis, vagina, discharge from the vagina- mucous or blood, irregular and painful menses etc.
What are the types of cervical polyps? The common types of polyps of the cervix are the sessile polyps (which have no stalk are seen as small projections from the endo-cervical lining). The rarer type is the pedunculated polyp of the cervix. This type of pedunculated cervical polyp has a long stalk connecting the growth to the lining  of the cervix. It may project into the vagina, and be confused with a endometrial polyp (a polyp of the body of the uterus) or small fibroid.
One the methods of diagnosing a cervical polyp is by ultrasound and color Doppler imaging of the uterus, best seen on transvaginal ultrasound (inserting the ultrasound probe via the vagina).
Present case (pedunculated polyp of the cervix):
This woman is an unusual case in that she is in the perimenopausal age (47 years) and has severe pain  in the lower pelvis with irregular menses.
This is what we saw on transvaginal ultrasound imaging (see sagittal section ultrasound video clip below):
 There is an elongated hyperechoic (bright) mass within the cervical canal (arrows).
 Power Doppler ultrasound video shows large feeder blood vessels supplying the mass (growth). This is a typical appearance. (See sagittal section Power Doppler video clip above).
Color Doppler ultrasound video clip (below) further confirms the highly vascular nature of the growth in the cervical lumen. It is elongated and fills the length of the cervix.
We performed a transverse section ultrasound imaging of the cervix, and this is what we saw (see the color Doppler video clip below):

The feeder vessels are seen entering and coursing through the entire polyp within the cervix.
Can such growths of the cervical lumen be cancerous? Generally, cervical polyps are benign (almost 99 % of polyps of the cervix are non cancerous). However, the highly vascular nature of the growth in this case, warrants further examination, at least a PAP smear and a study of the specimen after surgery is also advisable. 
 For further reading on this topic see this article on: Ultrasound imaging of Cervical polyps
For more ultrasound images of this case and more on imaging of the uterus, see:

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