What is the cause and medical term for a brownish-colored cervical lesion?

Cervical Polyp: Diagnosis and Management

The brownish-colored, 1 cm wide and 2 cm long cervical lesion that doesn't bleed is most likely an endocervical polyp, which is the most common benign cervical lesion, but requires colposcopy with biopsy to definitively exclude premalignant or malignant pathology. 1, 2

Medical Terminology and Differential Diagnosis

The medical term for this lesion is most likely an endocervical polyp (also called cervical polyp), which accounts for 59.3% of benign cervical lesions. 2 However, the differential diagnosis must include:

• Endocervical polyp - most common benign cervical lesion, typically brownish due to old blood or surface changes 3, 2
• Cervical intraepithelial neoplasia (CIN) - premalignant lesions that can appear as discolored areas 4, 1
• Invasive cervical carcinoma - squamous cell carcinoma or adenocarcinoma, which can present as exophytic masses 4

Critical Diagnostic Approach

Immediate colposcopy with targeted biopsy is mandatory for any ill-defined cervical lesion to establish definitive histologic diagnosis, regardless of benign appearance. 1

Required Evaluation Steps:

• Colposcopy assessment - determine if examination is satisfactory (entire squamocolumnar junction and lesion margins visible) 1, 5
• Targeted biopsy - obtain tissue from the lesion for histopathologic confirmation 1
• Endocervical curettage (ECC) - if colposcopy is unsatisfactory or the superior limit cannot be visualized 1

When to Proceed Directly to Excision:

Cone biopsy or LEEP without preliminary punch biopsy is indicated if: 1

• Colposcopy is unsatisfactory with high-grade cytology
• Suspected adenocarcinoma in situ
• High-grade disease is suspected based on appearance

Key Pathologic Features to Document

The pathology report must specify: 3

• Histologic type - benign polyp, squamous intraepithelial lesion (low or high grade), squamous cell carcinoma, or adenocarcinoma
• Lesion dimensions - maximum size in centimeters; for microinvasive lesions, depth of invasion and horizontal spread in millimeters
• Lymphovascular space invasion (LVSI) - presence or absence
• Surgical margins - status if excision performed
• HPV status - particularly HPV 16/18 if malignancy suspected

Management Algorithm Based on Histology

If Benign Polyp Confirmed:

• Simple polypectomy is curative 3
• No further treatment required if margins clear
• Routine cervical cancer screening continues

If CIN I Found:

• Repeat cytology, colposcopy, and ECC every 6 months until 2 consecutive negative results 1
• Consider LEEP/cone biopsy for definitive diagnosis if persistent

If CIN II-III Found:

• Treatment with LEEP, cone biopsy, cryotherapy, or laser ablation is recommended 1, 6
• LEEP or cone biopsy recommended before any hysterectomy to confirm diagnosis 1

If Invasive Cancer Found:

• Multidisciplinary team assessment with specialist surgeon and radiotherapist is mandatory 1
• FIGO staging required 4
• Treatment proceeds according to cervical cancer guidelines with staging lymphadenectomy 1

Critical Pitfalls to Avoid

Never assume a benign appearance means benign pathology - even non-bleeding, well-demarcated lesions can harbor high-grade dysplasia or early invasive cancer. 1 The brownish color could represent surface keratinization in squamous cell carcinoma or old blood in a polyp. 2

Do not perform excisional treatment without tissue diagnosis unless dealing with high-grade cytology where immediate excision is acceptable. 4 This prevents overtreatment of benign lesions and ensures appropriate staging if malignancy is present.

Ensure adequate sampling - if the lesion extends into the endocervical canal where visualization is limited, endocervical assessment is essential to avoid missing occult disease. 1