LACERATIONS, STRICTURES, POLYPS
Parturition rarely fails to leave its mark on the external cervical os. Linear or horizontal lacerations are common, and if no infection occurs, they may heal satisfactorily without specific surgical or postpartum care. More complex lacerations penetrating deeply into the gland- bearing portion of endocervical stroma or extending into the lateral fornix permit eversion of the lining of the endocervical canal. Infection frequently, if not always, results from such severe lacerations unless it is treated promptly and effectively. Lacerations of the cervix may even extend into the lower uterine segment or the parametria. Such lacerations are uncommon in spontaneous deliveries.
Stricture of the internal cervical os is seen after post-traumatic or
postinfectious cicatrization as well as in the rare cases of partial or
complete congenital atresia. If obstruction at the internal or external os is
complete or if a narrowing (stenosis) of the cervical canal is present, the
menstrual flow and endometrial debris are dammed up within the uterine cavity,
producing hematometra. This type of stenosis is found after the application of
radium to the cervix or uterine cavity. The presence of a large uterus
distended with blood after the menopause should strongly suggest a diagnosis of
carcinoma of the uterine body or cervix. During the childbearing age, of
course, the possibility of a pregnant uterus must always be considered before
exploring with an instrument an assumed stricture of the cervical canal.
The uterine mucosa may give rise to the formation of polyps. These are
fleshy tumors that arise as local overgrowths of endometrial glands and stroma
and project beyond the surface of the endometrium. These are most common in the
fundus of the uterus but may occur anywhere in the endometrial cavity. They are
generally small (a few millimeters) but may enlarge to fill the entire cavity.
Endometrial and endocervical polyps have, etiologically and clinically, a quite
different significance. The etiology of cervical polyps remains unknown,
although inflammation has been implicated. They arise from the mucous membrane
of the cervix and histologically contain all the elements (columnar epithelium,
fibrous stroma and glands) of the endocervix. In the early stages, they cause no
symptoms and remain undiagnosed, provided they are not detected by chance on
the occasion of an examination prompted by other indications. As a rule, they
are observed only when they extrude from the external os as soft, red, granular
tabs, either single or multiple. Bleeding that is never profuse and often is
only a slight staining or spot-ting induces the patient to call on the
physician. The polyps tend to bleed readily on manipulation, particularly when
the extruding parts of the polyp are ulcerated, which is frequently the case.
The bleeding, when not caused by manipulation, is frequently, in character and extent, the same as that which may occur in cancer of the cervix, and
it therefore is important not only that the polyps be removed completely at
their bases to prevent recurrence but also that a careful histologic
examination of the obtained specimen(s) be made by an experienced pathologist.
Cervical polyps may spring also from the vaginal surface of the cervix
(not illustrated). These far less frequently encountered polyps are gray rather
than red, much firmer, and, in some
instances reach the size of several centimeters in diameter and pedicle length.
These are often difficult to distinguish from prolapsing fibromas or uterine
fibroids (leiomyomata).
Although the polyps are, as a rule, benign tumors, it should be kept in mind that carcinoma originating in a polyp has been infrequently reported. In all cases, one may expect recurrences if the polyps are not wholly removed at the base of their pedicles.
