Cervical endometriosis: a diagnostic and management dilemma

Abstract

Cervical endometriosis is usually a retrospective finding on histology. We describe the diverse symptomatology of the disease, wherein a suspicion of diagnosis may be raised. A series of five patients with cervical endometriosis confirmed on histology was identified. One patient was asymptomatic but examination revealed a mass arising from the cervix. Two patients presented with persistent postcoital bleeding, one patient with intermenstrual bleeding and one patient with both intermenstrual and postcoital bleeding. All patients were followed up with colposcopy and cervical biopsy. Persistence of symptoms determined the mode of treatment which included surgical management in the form of large loop excision of the transformation zone (LLETZ) biopsy in four patients. Cervical endometriosis is a benign condition which may present with symptoms such as persistent post-coital bleeding or intermenstrual bleeding. Colposcopy and cervical biopsy are pivotal to the diagnosis. This condition can be managed expectantly in asymptomatic patients and persistent symptoms may warrant surgery.

Endometriosis mimicking glandular atypia in a cervical cytology

“…[1] The differential diagnosis of atypical glandular cells apart from endometriosis includes benign conditions such as tubal metaplasia and lower uterine segment sampling and malignant conditions as adenocarcinoma in situ of the endocervix, and endometrial adenocarcinoma. [19]…”

Postcoital bleeding due to cervical endometriosis

“…Thus, cervical biopsy and histopathological evaluation is the best way for the definitive diagnosis of cervical endometriosis. Cervical endometriosis has been defined in two histopathological forms, superficial and deep 13. Superficial cervical endometriosis involves the cervical stroma subjacent to the epithelium.…”

Sonographic diagnosis of a large and deep endometrioma of the uterine cervix

“…7 The deep form is localized in the outer 3rd of the cervical wall and is usually associated with the involvement of the rectovaginal septum or serosal surface of the supravaginal portion of the cervix. 8 Colposcopy and directed cervical biopsy can provide an accurate diagnosis of superficial cervical endometriosis. We believe that in case of an abnormal cervical morphology, the TVUS examination has become necessary to suspect ''endometrioma'' of the cervix.…”