Silent malignancy in plain sight: a rare case of dual carcinomatous and sarcomatous transformation in a giant cervical polyp

Abstract

Cervical polyps are common benign gynecological lesions. Although malignant transformation is exceedingly rare (occurring in <1.7% of cases), it presents a distinct clinical challenge because preoperative screening including Pap cytology and pelvic ultrasonography often yields normal findings. A 52-year-old perimenopausal woman (P2L2) presented with irregular menstrual cycles and intermenstrual spotting. Speculum examination revealed a large, pedunculated cervical polyp measuring approximately 5 cm. Both preoperative cervical cytology (NILM) and transvaginal ultrasound were reassuring. The patient underwent polypectomy, dilation and curettage (D&C), and endocervical curettage. Histopathological examination revealed sheets of highly dysplastic cells infiltrating vascular stroma with atypical mitosis. Immunohistochemistry (IHC) demonstrated carcinoma foci along with atypical stromal cell proliferation favoring a low-grade endometrial stromal sarcoma (ESS) with focal high-grade sarcomatous change. Stalk margins showed no lymphovascular invasion. Following multidisciplinary team (MDT) review and staging pelvic MRI/chest CECT showing no distant disease or residual invasion, total laparoscopic hysterectomy with bilateral salpingo-oophorectomy was performed. Final pathology showed no residual malignancy, and the patient remains disease-free under regular surveillance. Giant cervical polyps, even when presenting with benign physical characteristics and normal cytology/imaging, can harbor complex focal malignancies with mixed carcinomatous and sarcomatous components. Routine histopathological and immunohistochemical evaluation of all excised cervical lesions is essential for timely diagnosis and optimal oncologic management.