Huge cervical fibroid-polyp mimicking cervical cancer: a case report

doi:10.15406/ogij.2025.16.00778

eISSN: 2377-4304

Obstetrics & Gynecology International Journal

Case Report Volume 16 Issue 1

Huge cervical fibroid-polyp mimicking cervical cancer: a case report

Ezenwaeze MN,¹

Verify Captcha

Regret for the inconvenience: we are taking measures to prevent fraudulent form submissions by extractors and page crawlers. Please type the correct Captcha word to see email ID.

Nweze SO,¹ Onah LN,¹ Ugwu IA,¹ Nevo CO,¹ Odugu BU,¹ Dinwoke VO,¹ Mba SG,¹ Ortuanya KE,¹ Awkadigwe FJ,¹ Nwankwo BC,² Nwankwo CN,³ Umezulike HE,⁴ Eze OE,⁵ Enyinna P,¹ Omeke CA,¹ Chukwma ST,⁶ Ngozi IO⁷

¹Department of Obstetrics and Gynaecology, Enugu State University Teaching Hospital, Enugu, Nigeria
²Department of Community Medicine, Enugu State University Teaching Hospital, Enugu, Nigeria
³Department of Paediatrics, University Teaching Hospital, Enugu, Nigeria
⁴Newpath Specialist Hospital, New Haven, Enugu, Nigeria
⁵Department of Haematology, Enugu State University of Science and Technology College of Medicine, Enugu, Nigeria
⁶Department of Medical Microbiology, College of Medicine Enugu State University of Science and Technology, Enugu, Nigeria
⁷Department of Chemical Pathology, Enugu State University of Science and Technology College of Medicine, Enugu, Nigeria

Correspondence: Ezenwaeze Malachy Nwaeze, Department of Obstetrics and Gynaecology, Enugu State University of Science and Technology Teaching Hospital, Enugu, Nigeria

Received: December 23, 2024 | Published: January 3, 2025

Citation: Ezenwaeze MN, Nweze SO, Onah LN, et al. Huge cervical fibroid-polyp mimicking cervical cancer: a case report. Obstet Gynecol Int J. 2025;16(1):1-3. DOI: 10.15406/ogij.2025.16.00778

Download PDF

Abstract

Huge cervical polyps are rarely encountered in gynaecological practice and often pose a diagnostic dilemma. They usually mimic cervical malignancy, uterine inversion or prolapse in their presentation. We report a case of a huge cervical fibroid-polyp masquerading as cervical cancer. The patient was a 30-year-old nulliparous lady who presented with abnormal vaginal bleeding which was sometimes postcoital, a fleshy and partly necrotic vaginal mass with offensive vaginal discharge for about one year. These clinical features heightened the suspicion of a possible cancer of the cervix. Following basic laboratory investigations, the patient had a thorough examination under anesthesia with subsequent polypectomy (excision biopsy). She had a complete resolution of her symptoms and an uneventful postoperative recovery. Histopathological study of the excised tissue confirmed a leiomyomatous polyp. A high index of suspicion with proper patient evaluation are key in making accurate diagnosis and treatment.

Keywords: cervical fibroid-polyp, polypectomy, cervical cancer

Introduction

Cervical polyps are usually small benign growths of the endocervical canal, commonly encountered in middle-aged women.¹ Huge or giant cervical polyps are defined as polyps with a size greater than 4cm. They are rarely encountered in gynaecological practice and can pose a diagnostic dilemma.² Very few cases of huge cervical polyps have been reported.³ Cervical polyps are relatively common pathology in adult females with size usually less than 2cm and mostly incidental findings at routine vaginal examination.⁴ Cervical fibroids are usually single and may be either interstitial or subserous. They are rarely submucous or polypoidal as in the index case. Giant cervical polyps can be confused with more serious pathology due to their size and clinical presentation.^5,6 They have also been noted in literature to have been frequently mistaken for malignant neoplasm at the time of presentation.⁷ Commonly reported symptoms of cervical polyps include abnormal vaginal bleeding and discharge.⁸

This case report aims to highlight yet a rare presentation of a huge cervical fibroid-polyp with the attendant diagnostic dilemma of excluding cervical cancer.

Case report

A 30-year old married nulliparous woman presented with abnormal vaginal bleeding which was sometimes postcoital, a fleshy and partly necrotic vaginal mass with offensive vaginal discharge for about one year. She had normal menstrual history prior to onset of symptoms. The patient was noted to be pale on general examination with packed cell volume of 22%. Other general and systemic examination findings were normal. Vaginal examination revealed a large irregular mass in the introitus with offensive necrotic distal area that bled profusely on mild touch. This ominous finding heightened the suspicion of cancer of the cervix and precluded further examination in the gynaecological outpatient clinic. The patient was worked up and booked for examination under anesthesia (EUA), staging and biopsy. The findings of the procedure included a bulky uterus of about 9 weeks’ gestational size with a huge, partly necrotic mass of about 10cm x 8cm and weighing 1.10kg extruding through a healthy ring of cervix into the vagina and out of the introitus. A clinical diagnosis of cervical fibroid-polyp to rule out cancer of the cervix was entertained. The histology of cervical biopsy showed just inflammatory cells with no malignant changes or atypia. The patient was transfused with three units of sedimented red blood cells and subsequently had polypectomy with postoperative antibiotics and analgesics. Her postoperative recovery was uneventful. Histopathological study of the excised mass confirmed leiomyomatous polyp of the cervix with abundant endometrial glands and no signs of dysplasia or malignancy (Figure 1) (Figure 2).

Figure 1 Huge irregular cervical fibroid-polyp with a necrotic distal part.

Figure 2 The stalk of the huge irregular cervical fibroid-polyp with a necrotic distal part.

Discussion

Cervical polyps account for 23% of polyps located on the uterus.⁹ They originate from a localized increase in endometrial tissue, varying from single to multiple occurrences, and may attach to the uterus in different ways.⁹ It is usually an asymptomatic common gynecological condition and often found during unrelated pelvic imaging. However, they may cause abnormal uterine bleeding, pelvic discomfort or infertility when large. Even though as low as 2% of cervical polyps have been reported to undergo malignant transformation, current studies suggest removing those that are symptomatic or show abnormal cells.¹⁰ Commonly reported symptoms of cervical polyps include abnormal vaginal bleeding and discharge.⁸However, our patient presented with abnormal vaginal bleeding which was sometimes postcoital, with a partly necrotic vaginal mass and offensive discharge which heightened the suspicion of cervical cancer.

Incidence tends to increase with age. Large cervical fibroids have been reported most frequently in adult nulliparous women as in the index case.^9,10 Their sizes range from 5 to 17cm and can be found intravaginally or may extrude beyond the vaginal introitus spontaneously or during a Valsalva maneuver.¹¹

Although the gold standard for histologic assessment of endometrial polyps is hysteroscopic-guided biopsy,¹² which enables simultaneous visualization and removal of the lesion, Pelvic ultrasonography is often the initial step, which typically depicts a lesion that is hyperechoic with well-defined margins situated within the uterine cavity, demarcating the endometrial walls, and surrounded by a thin hyperechoic halo. Doppler ultrasound can be beneficial, particularly when it successfully delineates the vascular supply to the polyp.¹³

Majority of cases of cervical polyps are treated by polypectomy. However, instances necessitating abdominal or vaginal hysterectomy have been documented.¹⁴ Our patient had polypectomy with resolution of symptoms.

Despite the benign nature of giant cervical polyps, as documented in several studies, their significant sizes and ominous clinical presentation can mimic malignant pathology. Therefore, rigorous clinical examination and relevant laboratory investigations are imperative to exclude neoplastic disease. Surgical excision (polypectomy) remains the primary treatment modality, with histopathological examination providing the definitive diagnosis.¹⁵

Conclusion

Huge cervical fibroid polyp is rare and can pose a diagnostic dilemma, especially when they present with clinical features mimicking cervical cancer as reported in this case. High index of suspicion and proper patient evaluation are key in making accurate diagnosis and giving appropriate treatment.