|
 
 |
| CASE REPORT |
|
| Year : 2020 | Volume
: 47
| Issue : 3 | Page : 192-194 |
|
Giant fibroid polyp mimicking uterine inversion
Subrata Das
Department of Obstetrics and Gynaecology, ESI PGI MSR and ESIC Medical College, Kolkata, West Bengal, India
| Date of Submission | 01-Aug-2020 |
| Date of Acceptance | 20-Oct-2020 |
| Date of Web Publication | 21-Jan-2021 |
Correspondence Address:
Dr. Subrata Das
J/6, Banerjee Para, Kamdahari, Garia, Kolkata - 700 084, West Bengal
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jss.JSS_77_20
A multiparous postmenopausal woman presented with continuous bleeding per vagina along with a large cervical polyp, protruding through introitus simulating uterine inversion. She was stabilized by five-unit packed-cell blood transfusion. After initial diagnostic confirmation, she was treated by polypectomy. Further investigations revealed it to be a giant fibroid polyp of benign nature arising from cervix. She was amenorrheic on the next 12 months of follow-up.
Keywords: Myoma, fibroid polyp, menorrhagia, uterine inversion
How to cite this article:
Das S. Giant fibroid polyp mimicking uterine inversion. J Sci Soc 2020;47:192-4 |
| Introduction | |  |
Uterine fibroid is the most common pelvic tumor of females,[1] with an 20' incidence in the reproductive age.[2] It most commonly arises from interstitial part of the uterus. In about 1'–2' of cases, it arises from cervix[1],[3] which are also from supravaginal part mostly. Some of those have a stalk with pedunculated structure, which are known as fibroid polyp and resembling finger-like projection and usually arise from the posterior lip of the ecto-cervix.[3] Cervical polyps are commonly <2 cm in length[4],[5] and discovered incidentally during pelvic examination. Length of cervical polyps with a size of > 4 cm is rare.[6] These are usually benign tumors but malignant transformation can occur in 1.7' of cases.[7] Very few of them may enlarge and fill up the vagina,[3] with variegated appearance and protrude externally through introitus and look-like uterine inversion. The principal symptoms of such fibroid polyp is vaginal bleeding.[5],[8] In the literature, due to their rarity, I am report a giant cervical polyp protrude outside of introitus resembling uterine inversion.
| Case Report | | |
A 60-year-old, postmenopausal, multiparous woman presented at our gynaecology emergency with irregular vaginal bleeding for 4 months. She complained of something coming down per vagina for a day before admission. She attained menopause at 47 years of age. On admission, she had severe pallor with blood pressure 90/60 mmHg and feeble pulse 110/min. A variegated with foul-smelling broad mass was lying outside the vulva. At initial bimanual examination, it was not possible to palpate the upper part of the large growth partially filling the vagina, and the cervical os was not delineated. On rectal examination, uterus could not be palpated. Resuscitation was initiated. Her hemoglobin (Hb) was 5.1 g/dl, and fasting and postprandial blood sugars were 139 and 237 mg/dl, respectively. Renal and liver function tests were normal. Ultrasonography revealed normal uterine shape and size, and it was low down in the pelvis. Glycemic control was achieved with human insulin, and Hb was raised to 10 g/dl by five units of packed cell transfusion before examination under anesthesia (EUA).
EUA revealed that the body of the uterus was lying just above the growth in the vagina and the large mass measuring 13 cm × 10 cm arising from right lateral and anterior lip of the cervix with left lateral margin of the cervix free from growth [Figure 1]. Uterine sounding revealed normal uterocervical length. Polypectomy was done by cutting and ligating the thick attachment with cervix followed by uterine curettage. A 13 cm × 10 cm ×5 cm polyp was sent for histopathology which showed a benign leiomyoma. After 12 months of follow-up, the patient is well without any recurrence of polyps. She was symptom-free, and had persistent amenorrhea because of menopause. | Figure 1: Photograph showing giant cervical fibroid polyp along with Hegar's dilator in situ through external cervical os during examination under anesthesia
Click here to view |
| Discussion | | |
The presence of unusually large cervical polyp in the postmenopausal age group is uncommon. They often show no symptoms but sometimes may present with intermenstrual bleeding or menorrhagia.[6]
A tiny polyp to become such a huge fibroid polyp had definitely taken long time to grow; it is a matter of concern that she was from geriatric age group and had suffered a lot by neglecting her own health for number of years. However, that may be due to poverty and inaccessibility of public healthcare that it remained untreated.
Giant cervical polyp mimicking uterine inversion is a rare entity. In our patient, a large heavy polyp had displaced and pulled the uterus down from its normal position; therefore, on rectal examination, it could not be delineated properly and the large size of polyp with friable surface did not allow bimanual vaginal examination [Figure 1]. However, sonography and EUA can help in such cases and prevent more radical surgery, especially in younger patients. As in our case, sonography showed normal uterine size which was low down in the pelvis.
Most of the giant cervical polyps described in the literature were initially suspected to be malignant, but histopathology examination (HPE) [Figure 2] revealed benign tumors,[6],[7] which is also true in the present case. Therefore, in our opinion, excision of the polyp as an initial operation (88) and HPE of the specimen may guide for further treatment or hysterectomy. Thereby, we may avoid many unnecessary hysterectomies, especially when women are at risk for major surgery because of severe anemia or other morbidities in younger and nulliparous women. The review shows that the giant cervical polyp occurs more commonly in adult nulliparous women.[6] However, our patient was postmenopausal multiparous. | Figure 2: Microscopic picture of the cervical fibroid polyp (H and E, ×40)
Click here to view |
Cervical polyp can be removed using ring forceps, laser, or cauterization, and sometimes, hysterectomy[9] may also be required. However, in case of larger polyp, with thickened pedicle, tying surgical string around the polyp and cutting it off are commonly used, which we carried out in our case.
| Conclusion | | |
Large cervical polyp may cause life-threatening bleeding. Therefore, early diagnosis and prompt treatment can avert major morbidity and occasional mortality.
Consent for publication
Patient has signed written consent form to permit publication of the individual data and pictures.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Khanam D, Hakim S, Parveen S, Ali WM. Huge anterior lip cervical Fibroma presenting as gynaecological emergency: A rare case report. Int J Med Res Rev 2015;3:115-7.  |
| 2. | Mandhane HM, Aher GS, Gavli U. A case report of enormous fibroid-polyp. J Evol Med Dent Sci 2015;4:5606-8. |
| 3. | Khanam SA. An unusually big cervical fibroid polyp: A case report. Chattagram Maa-O-Shishu Hosp Med Coll J 2016;15:65-7. |
| 4. | Inal ZH, Inal HA. Giant cervical polyp in a postmenopausal female patient. J Obstet Gynecol Neonatal Nurs 2014;11:108-9. |
| 5. | Ota K, Sato Y, Shiraishi S. Giant polyp of uterine cervix: A case report and brief literature review. Gynecol Obstet Case Rep 2017;3:1-4. |
| 6. | Bucella D, Frédéric B, Noël JC. Giant cervical polyp: A case report and review of a rare entity. Arch Gynecol Obstet 2008;278:295-8. |
| 7. | Khalil AM, Azar GB, Kaspar HG, Abu-Musa AA, Chararah IR, Seoud MA. Giant cervical polyp. A case report. J Reprod Med 1996;41:619-21. |
| 8. | Abdul MA, Koledade AK, Madugu N. Giant cervical polyp complicating uterine fibroid and masquerading as cervical malignancy. Arch Int Surg 2012;2:39-41. [Full text] |
| 9. | Duckman S, Suarez JR, Sese LQ. Giant cervical polyp. Am J Obstet Gynecol 1988;159:852-4. |
[Figure 1], [Figure 2]
|
Search Pubmed for