Clinicopathological evaluation of cervical polyps

Yıl 2015, Cilt: 46 Sayı: 4, 98 - 101, 02.01.2016

Mehmet Şentürk , Mehmet Budak Birol Durukan , Yusuf Çakmak , Ayhan Yıldırım Mesut Polat

https://doi.org/10.16948/zktb.68746

Öz

Objective: Management of uterine cervical polyps is a common debate in clinical practice. Ethical concerns complicate decision making as well as designing randomized or prospective studies. Thus, clinical evidence can be gathered from retrospective studies. Possibility of malignant transformation is also a concern in assessment and management of pre- and post-menopausal patients. In this study we aimed to identify if a difference exist in between these groups, and discuss our results with the previously reported.

Material and Method: We evaluated results of 245 patients retrospectively. Totally 270 polyps were detected. Pathological results of polyps were compared according to menopausal status and symptoms. Fisher’s Exact Test and Fisher-Freeman-Halton Test were used in statistical analysis. Statistical significance is considered where p<0.05 and p<0.01.

Results: There was no invasive disease. Cervical intraepithelial neoplasia type 1 was seen in one postmenopausal patient. Polyps were asymptomatic in 39.6% (n=97) of the cases and coincide with abnormal uterine bleeding (AUB) in 53.9% (n=132), and missed abortus in 6.5% (n=16). Patients with polyps significantly tend to have complaint of abnormal uterine bleeding compared to other symptoms.

Conclusion: Routine cervical polypectomy is not necessary. Cytology and utilization of colposcopy should be considered prior to polypectomy, as well as assessment of clinical and menopausal status.

Anahtar Kelimeler

Menopause, Uterine Cervi, Polyp

Serviks poliplerinin klinikopatolojik değerlendirmesi

Öz

Amaç: Klinik pratikte servikal poliplerin nasıl yönetileceği yaygın bir tartışma konusudur. Randomize kontrollü prospektif çalışmalar etik olarak doğru bulunmadığından bu konudaki çalışmalar retrospektif olmaktadır. Malin transformasyon potansiyeli pre ve postmenapozal hastalarda endişe oluşturmaktadır. Bu çalışmada, servikal polip görülen hastalarda, semptom ve menopoz durumuna göre polipektomi piyeslerinin patoloji sonuçlarının karşılaştırılması amaçlanmıştır.

Gereç ve Yöntem: Servikal polip tanısı konulan 245 hasta retrospektif olarak incelendi. Total olarak 270 polip incelendi. Patoloji sonuçları menopoz durumu ve semptomlara göre Fisher’s Exact Test ve Fisher-Freeman-Halton Test ile karşılaştırıldı. İstatistiksel anlamlılık p<0.05 ve p<0.01 olarak kabul edildi.

Bulgular: Olgularda invazif hastalık görülmedi. Sadece postmenapozal bir hastada servikal intraepitelyal neoplazi (CIN 1) görüldü. Poliplerin %39,6’sı (n=97) asemptomatik hastalarda, %53,9’u (n=132) anormal uterin kanaması olan hastalarda ve % 6,5’i (n=16) missed abortus ile başvuran hastalarda görüldü. Anormal uterin kanaması olan olgularda servikal polip belirgin olarak fazla idi.

Sonuç: Rutin servikal polipektomi gereksizdir. Kolposkopi kullanımı ve sitoloji klinik ve menopozal durumun değerlendirilmesiyle beraber polipektomiden önce dikkate alınmalıdır.

Anahtar Kelimeler

Uterin serviks, Menopoz, Po- lip

Kaynakça

• Tıraş MB. Current Diagnosis and Treatment: Obstetric and Gynecology. 11th ed. New York, NY: Lange (McGraw-Hill);Chapter 40. Bening Disorders of The Uterine Cervix;2014.p.657-59
• Cotran RS, Kumar V, Collins T. Robbins Pathologic Basis of Disease. 6th ed. Philadelphia, PA; Elsevier;1992:1042,1048-53. Chanpter 24. The Female Genital Tract.
• Berzolla CE, Schnatz PF, O'Sullivan DM, Bansal R, Mandavilli S, Sorosky JI.
• Dysplasia and malignancy in endocervical polyps. J Womens Health (Larchmt). 2007;16(9):1317-21.
• Abramovici H, Bornstein J, Pascal B. Ambulatory removal of cervical polyps under colposcopy.Int J Gynaecol Obstet. 1984;22(1):47-50.
• Golan A1, Ber A, Wolman I, David MP. Cervical polyp: evaluation of current treatment.
• Gynecol Obstet Invest. 1994;37(1):56-8.
• MacKenzie IZ1, Naish C, Rees CM, Manek S. Why remove all cervical polyps and examine them histologically? BJOG. 2009;116(8):1127-9.
• Selim MA, Shalodi AD. Benign diseases of the uterine cervix. Ruling out neoplasia a diagnostic priority. Postgrad Med 1985;78:141–3. 6–7, 50.
• Fauth C1, Franko A, Duan Q, Wood S, Duggan MA. Clinicopathological determinants of vaginal and premalignant-malignant cervico-vaginal polyps of the lower female genital tract.
• J Low Genit Tract Dis. 2011;15(3):210-8.
• Long ME1, Dwarica DS, Kastner TM, Gallenberg MM, Chantigian PD, Marnach ML, et all. Comparison of dysplastic and benign endocervical polyps. J Low Genit Tract Dis. 2013;17(2):142-6.
• Mehmet Aytaç YÜKSEL, Serdar ÇELİK, Remzi ABALI, İlkbal TEMEL, Ahmet Birtan BORAN, Sevim PURİSA. Clinicopathological Evaluation of Cervical Polyps İstanbul Tıp Derg - Istanbul Med J 2011;12(3):131-134
• Schnatz PF1, Ricci S, O'Sullivan DM. Cervical polyps in postmenopausal women: is there a difference in risk? Menopause. 2009;16(3):524-8.
• Younis MT1, Iram S, Anwar B, Ewies AA. Women with asymptomatic cervical polyps may not need to see a gynaecologist or have them removed: an observational retrospective study of 1126 cases. Eur J Obstet Gynecol Reprod Biol. 2010;150(2):190-4.
• Ebru ÇELİK, Zeynep DOĞAN ARTAŞ, Salih Burçin KAVAK. [Investigation of Endometrial Pathologies in Patients with Cervical Polyp] Fırat Üniversitesi Sağlık Bililmleri Tıp Derg. 2012; 26 (3): 103 - 106
• Stenchever MA, Droegemueller W, Herbst AL, Mishell D Compherencive gynecology, 4th edn. Mosby, St. Louis.2001;492-493.
• Hill EC, Pernoll ML (eds). Current obstetric & gynecologic diagnosis & treatment, 8th end. Appleton & Lange, Noralk. 2002; 726-727
• Coeman D1, Van Belle Y, Vanderick G, De Muylder X, De Muylder E, Campo R.
• Hysteroscopic findings in patients with a cervical polyp. Am J Obstet Gynecol. 1993;169(6):1563-5.
• Neri A1, Kaplan B, Rabinerson D, Ovadia J, Braslavsky D. Cervical polyp in the menopause and the need for fractional dilatation and curettage. Eur J Obstet Gynecol Reprod Biol. 1995;62(1):53-5.
• Esim Buyukbayrak E1, Karageyim Karsidag AY, Kars B, Sakin O, Ozyapi Alper AG, Pirimoglu M, et all. Cervical polyps: evaluation of routine removal and need for accompanying D&C. Arch Gynecol Obstet. 2011;283(3):581-4.