Challenges in Assessing Stromal Invasion and Staging Cervical Carcinomas Arising In or Confined to Endocervical Polyps

Abstract

The staging of cervical carcinomas that appear confined to endocervical polyps presents a rare but recurring diagnostic and reporting challenge. Current classification systems, including the International Federation of Gynecology and Obstetrics (FIGO) 2018 staging system, the American Joint Committee on Cancer (AJCC) eighth edition, and College of American Pathologists (CAP) protocols, do not provide specific guidance for this scenario. Endocervical polyps are typically benign lesions, but in rare instances they may harbor invasive carcinoma. When invasion appears limited to the polyp stroma, assessment of the depth of invasion and assignment of a pathologic stage becomes challenging due to the polyp's limited, distorted, or fragmented architecture. Importantly, it is often difficult in routine practice to distinguish a truly polyp-confined carcinoma from an exophytic cervical tumor involving a polyp. This review highlights the gaps in staging of cervical carcinomas arising in or confined to endocervical polyps and draws cautious conceptual parallels to staging approaches in other organ systems, not to propose guideline changes, but to highlight existing gaps and reporting ambiguities. Currently, for reporting and staging purposes, pathologists use the same approach as that for other exophytic tumors. Here, we emphasize standardized documentation and transparent reporting of staging limitations as a practical interim approach, while acknowledging the absence of evidence sufficient to support formal staging modifications. Until additional data are available, careful descriptive reporting may facilitate clinical decision-making and enable future data collection needed to inform evidence-based revisions.