Silent Intruders: A Case Report of Concurrent Atypical Endometrial Polyp with Cervical Intraepithelial Neoplasia

Abstract

Postmenopausal bleeding is an alarming symptom that needs careful consideration. Endometrial polyps co-existing in the background of endometrial hyperplasia/endometrial cancer is well-established. However, it has been very sparsely reported in the background of atrophic endometrium. The authors report a unique case of concurrent atypical endometrial polyp with cervical intraepithelial neoplasia (CIN) in the background of an atrophic endometrium. A 53-year-old multiparous, postmenopausal lady of Asian ethnicity presented with recurrent episodes of bleeding per vaginum. She did not give any history of exogenous estrogen intake, diabetes, hypertension, or any other surgical risk factors for endometrial malignancy. Her body mass index was 23.9 kg/m². Magnetic Resonance Imaging revealed a large cervical fibroid, endometrial thickness 8 mm (mixed with blood clots), and focal adenomyosis. Outpatient endometrial sampling was unsatisfactory. She underwent a total hysterectomy with bilateral salpingo-oophorectomy. An incidental hidden diagnosis of concurrent atypical endometrial polyp with CIN underlying the cervical leiomyoma was made. This is the first of its kind to be reported so far. It is not known whether such an association could be due to cervical leiomyoma or de novo.

Keywords: Atypical endometrial polyp; cervical intraepithelial neoplasia; concurrent cancers; endometrial intraepithelial neoplasia; postmenopausal bleeding.

Figure 1

(a) Three Tesla-magnetic resonance imaging pelvis showing a well-defined T1, T2 isotense lesion 7.7 cm × 6.5 cm × 6.6 cm arising from the posterior lip of the cervix (marked in **), an intramural fundal fibroid (marked in *), blood products (marked with arrow), (b) shows endomyometrial junction well maintained, (c) enhancing lesion under the fibroid possible adenomyotic changes (marked with arrow)

Figure 2

(a) Total abdominal hysterectomy + bilateral salpingo-oophorectomy specimen showing cervical fibroid (separated), (b) Gross finding of the cut-open specimen showing a sessile polyp near posterior fundic region

Figure 3

Histopathology showing atypical endometrial hyperplasia/endometrioid intraepithelial neoplasia, (a) Low power view of the endometrial polyp (inset) with closely packed glands and absent intervening stroma (×100; H and E stain), (b) The atypical glands are arranged back to back with nuclear stratification (×400; H and E stain)