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Ultrasound shows complex cervical mass. Normal PAP smear. Have smelly vaginal discharge. Any information?

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51 year old female. Ultrasound shows 2.6x2.3x1.8 cm well circumscribed heterogenous mass in the cervix demonstrates some vascular flow in a stalk-like configuration. The uterus is anteverted. The myometrium is heterogenous. The endometrial stripe measures 2mm. Impression of radiologist:

Impression of radiologist: complex cervical mass as described. Differential includes a pedunculated polyp, pedunculated submucosal fibroid, or neoplasm.

I have a pap smear and exam every year and paps always normal. Is it possible to miss a 2 cm mass by clinical examination? The ultrasound was ordered by my gynocologist after I went in with smelly vaginal discharge - gynecologist prescribed antibiotics and no more discharge, but now I am worried about the mass they found on ultrasound. I can't see my gynecologist until next week. Can you offer any information, please?

I know you can't say without exam but if my pap was normal in october 2012, could a cancerous mass 2cm in size grow in 5 months? Could a 2cm cervical growth (poly or submucosal fibroid or neoplasm) escape detection by clinical examination? The radiologist recommends sonohysterography, hysterography, and/or biopsy.

Complex vertical mass as described above. Differential includes a pendunculated polyp, pedunculated submucosal fibroid, or neoplasm.

Have had pap smears every year and all normal (last pap was Oct 2012). Had the ultrasound because I had smelly vaginal discharge for the least 2 months which is now gone after taking antibiotics. Ultrasound was ordered by the gynecologist who prescribed antibiotics just to check out status of my pelvic region.

Can you advise, please. Got these results back but don't see Dr until next week. Thank you!
Posted Thu, 11 Apr 2013 in Vaginal and Uterus Health
Answered by Dr. Timothy Raichle 1 hour later
Hello, I would be happy to help you with your question.

Do not panic! This is a relatively simple problem. You presented with an abnormal discharge, and they found what sounds like an endocervical polyp. The lining of the uterus is normal, so the chance of uterine cancer is very low. Cervical cancer is also an extremely low probability given the normal pap smears and no abnormal bleeding. The proper evaluation includes:

1. A sonohysterogram - to further characterize the cervical mass / polyp
2. Ask for an 'endometrial biopsy' to make absolutely certain that this is not a uterine issue
3. You are likely facing a hysteroscopy with endocervical polypectomy to remove this mass and at that time you will know for sure that it is benign

Yes, endocervical polyps can be associated with an abnormal discharge. Yes, you will likely need a version of a D&C (using a camera = hysteroscopy) to evaluate and remove the abnormality. And yes, with removal of this abnormality you will likely be treating the reason for which you originally presented - the abnormal discharge. It will all turn out okay and I believe that you are getting treated correctly!!

I hope that this helps and good luck!
Above answer was peer-reviewed by
Follow-up: Ultrasound shows complex cervical mass. Normal PAP smear. Have smelly vaginal discharge. Any information? 1 hour later
Thank you so much for the quick reply - I will sleep much better tonight and face my 24 4th graders tomorrow with a more honest smile (I teach elementary school)
Answered by Dr. Timothy Raichle 10 hours later
Yes, you should try not to stress too much about this. Make sure that they follow the plan I laid out, and if they stray from what I listed, then ask questions..."I read that you might want to....".

You are always welcome to direct a question directly to me - just start out "This is a question for Dr. Raichle...."
Above answer was peer-reviewed by
Follow-up: Ultrasound shows complex cervical mass. Normal PAP smear. Have smelly vaginal discharge. Any information? 12 hours later
Hi this is is a question for Dr Raichle... My gynecologist got back the results of the endometrial biopsy and said it isnt good news (i did not know that she requested this test)... She now thinks I need to see a gynecological oncologist. This is what the the endometrial biopsy surgical pathology report says...

Fragments of cervical squamous epithelium without diagnostic abnormality.
Atypical mucinous glandular groups. The differential diagnosis for these atypical glands includes a low grade mucinous endometroid adenocarcinoma, florid benign microglandular hyperplasia of the cervix, or a cervical tumor with mucinous differentiation. Unfortunately, immunohistochemical staining gives a muixed expression pattern that does not allo determining the site of the glands or the nature (benign or malignant). Further sampling of the endometrium and cervix is recommended if clinically feasible and indicated.

Microscopic description: specimen features numerous atypical mucinous cells arrayed in papilay fronds or back to back glands. Intense acute inflammation is also present with a background that consist of sheets of neutrophils suggestive of pus. Some of the atypical glands appear to merge with squamos cells. However, rare small glands immediately adjacent to the atypical glands have the features of endometrium including vimentin reactivity and ER expression with no CEA expression. The atypical glands express CEA variability, show proliferation index of ~15% (by MIB-1

Thanks for your help, XXXXXXX
Answered by Dr. Timothy Raichle 22 minutes later

This is a very concerning, but confusing, pathology report. It seems to me that your doctor probably did a biopsy of the cervix (which was benign) and a curretting of the inside of the cervix. There is obviously a concerning tumor or growth within the cervix which will require a more definitive surgery to figure out what is going on. I would definitely see a GYN/ONC specialist to get this sorted out. Do not assume the worst until they have seen you and give you a better idea of what is going on. The only good news is that they could not say for certain that it was cancer. Please keep me updated and ask if you would like me to do more research for you or if you have more questions. At the very least you must consider that this is likely a curable problem. Good luck!!
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