Cervical polyp is a benign focal mucosal proliferation originating from the endocervical canal. It is most common in women aged 40-60 and frequently presents with abnormal uterine bleeding (intermenstrual bleeding, postcoital bleeding). Cervical polyps are usually solitary, pedunculated and 1-3 cm in size. Malignant transformation risk is very low (0.2-1.7%). On imaging, it appears as a well-defined, homogeneous, polypoid lesion containing a feeder vessel in the endocervical canal. US and MRI are the primary modalities for diagnosis. Polypectomy is both diagnostic and therapeutic.
Age Range
30-60
Peak Age
45
Gender
Female predominant
Prevalence
Common
Cervical polyps originate from the columnar epithelium and underlying stromal tissue of the endocervical canal. Chronic inflammation, hormonal stimulation (especially estrogen) and local vascular congestion play roles in etiology. Histopathologically, the polyp center contains a fibrovascular core (feeder vessel and stroma) covered by columnar or squamous metaplastic epithelium. This fibrovascular core is identified on imaging as a feeder vessel on Doppler — a critical finding supporting polyp diagnosis. The pedunculated structure results from focal growth forming a stalk under the effects of gravity and intracavitary pressure. Polyps are generally benign with rare malignant transformation; however, adenocarcinoma or dysplasia may be found within a polyp — therefore histopathological examination of all removed polyps is recommended.
Single arterial feeder vessel demonstration in polyp stalk on Doppler US — pathognomonic finding supporting cervical polyp diagnosis. Reflects the vascular component of the fibrovascular core. Regular arterial waveform and moderate resistance index support benign nature. This finding is critical in distinguishing polyp from endometrial thickening/hyperplasia or blood clot.
Well-defined, polypoid lesion with homogeneous or mildly heterogeneous echogenicity in the endocervical canal on transvaginal US. Generally isoechoic or slightly hyperechoic to surrounding endocervical mucosa. Pedunculated structure may be visible. May contain small cystic areas (dilated glands). Size is usually 1-3 cm. SIS (saline infusion sonography) can better visualize the polyp as a free-floating mass within the cavity.
Report Sentence
Well-defined polypoid lesion measuring ... mm with homogeneous echogenicity in the endocervical canal, consistent with cervical polyp.
Single arterial feeder vessel demonstration in polyp stalk on Doppler US — critical finding supporting polyp diagnosis. The feeder vessel extends from the cervix toward the center of the polyp showing regular arterial waveform. Resistance index is generally moderate (RI 0.5-0.7). Multiple irregular vessels or very low RI suggest malignant polyp or carcinoma.
Report Sentence
Single arterial feeder vessel identified in the polyp stalk on Doppler US, consistent with benign cervical polyp.
Well-defined polypoid lesion with intermediate-high signal intensity in the endocervical canal on T2-weighted images. Glandular/mucosal component shows high signal, fibrovascular stroma shows intermediate signal on T2. Pedunculated structure can be clearly assessed on T2. Cervical stroma is low signal on T2 creating contrast with the polyp. Intact cervical stroma indicates no invasion.
Report Sentence
Well-defined polypoid lesion with intermediate-high signal intensity in the endocervical canal on T2-weighted images, consistent with cervical polyp.
Diffuse homogeneous enhancement of the polyp on contrast-enhanced MRI — reflecting vascular structure of the fibrovascular core. Enhancement is smooth and uniform without necrosis or areas of irregular enhancement. Polyp stalk shows enhancement along the feeder vessel on contrast phase. Homogeneous enhancement pattern supports benign nature.
Report Sentence
Diffuse homogeneous enhancement of the endocervical polypoid lesion on contrast-enhanced MRI, consistent with benign cervical polyp.
Appears as a low-contrast soft tissue lesion in the endocervical canal on contrast-enhanced CT. Due to CT's lower soft tissue contrast resolution compared to MRI, small polyps may not be detected on CT. In larger polyps, a homogeneously enhancing soft tissue mass is observed in the endocervical canal. CT usually detects this as an incidental finding when performed for other indications.
Report Sentence
Mildly enhancing soft tissue lesion in the endocervical canal on contrast-enhanced CT suggesting possible cervical polyp; further evaluation with MRI is recommended.
Criteria
Polyp originating from portio (ectocervix) surface — covered by squamous epithelium. Less common. May have a broader base than endocervical polyp. Can be directly visualized by colposcopy.
Distinct Features
On portio surface, squamous epithelium, broad-based, visible by colposcopy
Criteria
Polyp originating from columnar epithelium of the endocervical canal — most common type. Pedunculated structure is typical. May prolapse through external os. Contains mucus-secreting glands.
Distinct Features
Endocervical canal origin, columnar epithelium, pedunculated, mucus-secreting glands, most common type
Criteria
Cervical polyp >4 cm in size — rare. May be clinically confused with cervical carcinoma. May prolapse into vagina due to large size. Histopathological examination is mandatory as it may contain focal dysplasia or carcinoma.
Distinct Features
>4 cm, rare, may mimic cervical carcinoma, vaginal prolapse, histopathology mandatory
Distinguishing Feature
Endometrial polyp originates from the endometrial cavity and is seen within the endometrial cavity. Cervical polyp originates from the endocervical canal. SIS clearly shows the localization and stalk structure of both polyp types. Feeder vessel is seen in both but location is distinguishing.
Distinguishing Feature
Cervical carcinoma is a mass infiltrating cervical stroma showing heterogeneous enhancement and diffusion restriction. Cervical polyp is a well-defined lesion with homogeneous enhancement not invading cervical stroma. On MRI, carcinoma disrupts cervical stromal hyperintensity on T2 while polyp remains external to the stroma.
Distinguishing Feature
Nabothian cyst is a simple cystic lesion within cervical stroma not showing polypoid appearance in endocervical canal. Cervical polyp is a solid polypoid mass within endocervical canal. On US, nabothian cyst is anechoic and avascular while cervical polyp is echogenic with feeder vessel.
Urgency
routineManagement
surgicalBiopsy
NeededFollow-up
no-follow-upCervical polyp is a benign lesion and polypectomy is both diagnostic and therapeutic. Polypectomy can be performed in clinic setting or with hysteroscopic guidance. Histopathological examination of all removed polyps is recommended — although rare, malignant transformation (0.2-1.7%), dysplasia or adenocarcinoma in situ may be detected. Observation is acceptable in asymptomatic small polyps but polypectomy is recommended in postmenopausal women or presence of abnormal bleeding. Recurrence rate is low and routine follow-up is generally not required.
Cervical polyps are almost always benign. Polypectomy is sufficient for symptomatic polyps. Malignancy risk is less than 1% but histological evaluation is recommended. Recurrence may occur.