Goubaa Mohamed MD Djerba Tunisia

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A 45-year-old multiparous woman is seen with pelvic pressure and painful intercourse. Vaginal sonography detects an enlarged cervix with abnormal doppler vascularisation and a 4-cm intravaginal mass. Femme âgée de 45 ans, multipare, consulte pour une pesanteur pelvienne et des rapports douloureux. L'échographie endovaginale montre un col un peu élargie et une vascularisation anormale au Doppler et une masse intra-vaginale de 4 centimètres.


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Pedunculated polyp prolapses from the cervix. Polype pédiculé sortant du col utérin
Polyp prolapse from the cervix Prolapsus d'un polype à travers le col utérin


Endocervical polyps

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Endocervical polyps are the most common benign neoplasm of the cervix. They are focal hyperplasic protrusions of the endocervical folds, including the epithelium and substantia propria. They are most common in the fourth to sixth decades of life and usually are asymptomatic but may cause profuse leucorrhoea or post-coital spotting. Grossly, they appear as typical polypoid structures protruding from the cervical os. At times, endometrial polyps protrude through the cervical os and are difficult to remove with endometrial curettage because they tend to move away from the curette.

Sonography :
Polyps appear sonographically as hyperechoic endometrial foci. The hyperechoic area can be a well-defined, or an ill-defined global thickening of the endometrium. How-ever, endovaginal sonography may miss focal endometrial polyps because the walls of the endometrial cavity compress the polyps, making discrimination of a polyp from a globally thickened endometrium difficult. For intrauterine contrast to better visualize endometrial cavity lesions, clinicians began using saline-infusion sonography, often called Sonohysterography. Sonohysterography has become a valuable method for diagnosis of endometrial polyps and other endometrial lesions.

Differential diagnosis of vaginal polyp :
Cystic vaginal masses :
* Haematocolpos
* Gartner's duct Cysts (the most common cystic vaginal masses).
* Vaginal inclusion Cysts Mucinous cysts
* Endometriosis
* Urétral diverticule
* Ureterocoeles
* Cystocels
Solid vaginal masses :
* Foreign body
* Leiomyoma
Leiomyoma of the urethra
* Vaginal Neoplasms and Malignant vaginal masses (Carcinoma in situ. , epidermoid carcinoma, Fibrosarcoma, Melanoma, Leiomyosarcoma, Sarcoma botyroides, Metastatic carcinoma).

Treatment :
Treatment is removal, which can usually be accomplished by twisting the polyp with a dressing forceps if the pedicle is slender. Smaller polyps may be removed with punch biopsy forceps. Polyps with a thick stalk may require surgical removal.