Benign Tumor of The Cervix

BENIGN TUMORS OF THE
CERVICS
PRESENTER : DR MAZENGO
SUPERVISOR : DR FURAHA
10/Jan/2020.
•
BENIGN TUMORS OF
THE CERVICS
CONTENTS
1.Introduction
2.Anatomy of the cervix
3.Cervical polyps
4.Cervical erosion(ectopy)
5.Cervical eversion(ectropion)
6.Nabothian cyst
7.Endometrial cyst
8.Mammary
introduction
Definition
Benign cervical lesions are non cancerous
cervical tumors that does not metastasize or
invade the surrounding tissues and not life
threatening condictions
Examples of benign cervical lesions are
- cervical polyp, cervical ectropion,cervical
fibroids,cervical stenosis,and nabothian
follicles etc
Anatomy of the cervix
The cervix is the lower portion of the uterus,

is usualy 2 to 3 cm long, It connects the
vagina with the main body of the uterus
acting as a gateway between them.
The opening into the uterus is called internal
os and the opening to the vagina is called
the external os
• Anatomically and histologically, the cervix
is distinct from the uterus and hence it is
considered as a separate anatomical
structure.
• The function of the cervix is to allow flow
of the menstrual blood from the uterus into
the vagina and direct the sperm into the
uterus during intercourse. The opening of
the cervical canal is normally very narrow.
• The mucosa lining the cervical canal is
known as endocervix, and the mucosa
covering the ectocervix is known as
exocervix
• The junction between endocervix and
ectocervix is known as squamous
columnar junction
BENIGN CERVICAL POLYP
• Usually occurs during reproductive age
especially after 40 years
• They are benign tumors arising from the
endocervical epithelium and may be seen
as smooth reddish protrusions
• Endometrial hyperplasia and cervical
polyps co exist more frequent than would
expect.
Pathogenesis of cervical polyp
• Increased level of estrogen which results
to focal hyperplasia of the columnar
epithelium of the endocervix,(progesterone
may serve as antiproliferetive function)
• Chronic inflammation of the cervix ,
vagina,or uterus(Infections like HPV, yeast
infections or herpes)
• Clogged blood vessels
RISK FACTORS
• Tamoxifen use( estrogen)
• Obesity
Other risk factors includes post menopausal
hormones therapy is associated with
endometrial polyps, particularly regimens
with high dose of estrogen and or progestin
with low ant estrogenic activities
TYPES OF CERVICAL POLYP
There are two types of endocervical polyps,
this is according to the area of origin
- endocervical polyp, it originate from the
endocervix( from inside the cervical os)
- Ectocervical polyp,it originate from out
side the cervival os.
CLINICAL PRESENTATION
• Abnormal uterine bleeding
• Intermenstral bleeding(most prequent

symptoms in premenopausal women with
endometrial polyp)
• Asympomatic
INVESTIGATIONS
In absence of a prolapsed polyp there is no
physical examination finding associated with
endometrial polyps. A prolapsed polyp can
be visualized during speculum examination
typically as a globular friable , pedunculated
lesion protruding from the external cervical
os
TREATMENT(POLYPECTOMY)
ECTROPION
ETIOLOGY
• 1.congenital
at birth in about one-third of cases , the
columnar epithelium of the endocervix
extend beyond the external os.
This condition persists only for a few days
until the level of estrogen derived from the
mother falls thus congenital etropy heals
spontaneously
• Real congenital ectopy appears at or soon
after puberty under the influence of
estrogen in about one third of cases
2. Aquired
a) Hormonal -: The squamous columnar
junction is not a static and its movement ,
either inwards or outwards is dependent on
estrogen .
• when the estrogen level is high, it moves
out so the columnar epithelium extends
onto the vaginal portion of the cervix
replacing the squamous epithelium .
• This state is observed during pregnancy
and amongst pills users .
• The squamous columnar junction returns
to its normal position after 3 months
following delivery and little earlier following
withdraw of the pill
• B) infection -: chronic infection produces
denuded area around the external os.
columnar epithelium grows from the cervical
canal to cover the denuded area.
Infection may supervene on an ectopy
because of the delicate columnar epithelium
which is more vulnerable to trauma and
infection.
pathogenesis
• In the active phase of of ectopy , the
squamous columnar junction moves out
from the os.
• The squamous epithelium of the
ectocervix is replaced by columnar
epithelium of the endocervix.
• The replaced epithelium is usually
arranged in a single layer(flat type)
Pathophysiology ct
• Or may be hyperplastic as to ford in ward
to accommodate in the increased area(a
follicular ectopy)
• At a time it becomes heaped up to ford
inward and outwards (a papillary ectopy)
• Columnar epithelium is less resistance to
infection rather than squamous epithelium
• During the process, the squamous
epithelium may obstruct the mouth of the
glands normally not present into ecto
cervix leading to retention of secretion
which results to formation of nabothian
follicle.
• nb. Ectopy is not considered as pre
cancerous but the squamous columnar
junction is vulnerable to malignant change.
Clinical features
• The lesion may be asymptomatic . How
ever the following symptoms may be
present
a) Vaginal discharge -:
the discharge may be excessively mucoid
from the overgrowth or over active cervical
crypts. It may be mucopurulent , offensive
and irritants in presence of infection.
Cf ct……..
• The mucoid discharge can some times be
even blood stained due to premenstrual
congestion
b)Contact bleeding specifically during
pregnancy and pill use either following
coitus or defecation may associated
feature .
c)Associated cervicitis may produce
backache ,pelvic pain and at a time infertility.
sign
• Cervical examination reveals the following:
speculum examination shows bright red
area surrounding and extending beyond the
external os in the ectocervix.
It is neither tender nor bleeds to touch but
on rubbing with a gauze there may be
multiple oozing spots
other investigations which cab be done to
diagnose ectopy includes-:
colposcopy
cervical smear
biopsy
Differential diagnosis of ectopy
a) ectropion : this is happens when the lip of

the cervix are curled back to expose the
endocervix .this may happen when the lip of
the cervix are stretched by the bivalve
speculum
b) Early carcinoma.
it is indurated friable and usually ulcerated
which bleeds to touch.
c) Primary sore
there is denudation of the epithelium
without excavation of of cervical tissue, the
ulcer has punched up appearance.
d) Tubercular ulcer(biopsy confirm
diagnosis)
management
• All cases should be subjected to

cytological examination from cervical
smear to exclude dysplasia or
malignancy .
• On doubtful smear colposcopy and
cervical biopsy should be done
ASYMPTOMATIC CASES
In asymptomatic cases discovered on
routine examination ,active treatment should
withheld.
SYMPTOMATIC CASES
a) Detected during pregnancy and early
puerperium , the treatment should be
withheld for at least 12 wks postpartum.
• In pill users the pills should be stopped
and the barrier method is advised
• b)persisted ectopy with troublesome
discharge should be treated surgically by ;
thermal cauterization
cryosurgery or
leservaporization
NB :All the methods employed are based
on the principle of destruction of the
columnar epithelium to be followed by its
healing by the squamous epithelium.
CERVICAL CYST
These are usually multiple , they are formed
due to blocking of the cervical gland duct
usually as results of ectopy.
The cleft of columnar epithelium become
covered with squamous cell and columnar
cell continue to secrete mucoid materials
The mucous secretions of the cervical
glands are accumulated and results in the
formation of cysts of varying sizes from
microscopic to macroscopic(pea size)
DIAGNOSIS
• Can be diagnosed during pelvic
examination and by speculum examination
or by colposcopy.
• But sometimes can be diagnosed by
ultrasound ,MRI,or CT scan.
Management and treatment of
Nabothian cyst
• Nabothia cyst are benign and usually don’t
require treatment.
• The treatment is directed towards chronic
cervicitis
• In rare cases cyst may become more large
and distort the shape and size of the
uterus the excision is indicated.
ENDOMETRIOTIC CYST
• These are situated in the portio vaginalis
part of the cervix , the cyst is small and
reddish of is less than 1cm in diameter.
• It is more explained by implantation theory.
• The implantation of the endometrium
occurs during delivery or surgery.
• The lining epithelium shows endometrial
glands and stroma
• Superficial endometriosis of the cervix has
been confused with endocervical glandular
dysplasia and adenocarcinoma,
• Which can only be excluded by biopsy
• Differential diagnosis also include cervical
gestational trophoblastic disease and
normal hyperemia related to pregnancy,
both of which can be excluded by
negative testing.
Symptoms:
includes intermenstrual or postcoital
bleeding ,deep dyspareunia and
dysmenorrhea.
Speculum: examination reveals a small
reddish cyst.
Treatment: is destruction by cauterization
and rarely by excision.
summary
• Benign cervical lesions are common
problems encountered in gynaecological
clinc.
• Cervical ectopy may be congenital or
acquired due to hormonal effect as
observed in pregnancy and pill users
• All cases of ectopy should be subjects to
cytological examination to exclude
dysplasia and malignancy
• Ectopy detected during pregnancy
treatment should be withheld for at least
12 wks postpartum
• Cervical cyst may be nabothian,
endometrial, or mesonephric should be
confirmed by biopsy.
reference
• D .C DUTTA TEXT BOOK OF
GYNAECOLGY
• UPTODATE.
THE END
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BENIGN TUMORS OF THE

The cervix is the lower portion of the uterus,

• Intermenstral bleeding(most prequent

a) ectropion : this is happens when the lip of

• All cases should be subjected to

THANK YOU FOR LISTENING

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