Silent Intruders: A Case Report of Concurrent Atypical Endometrial Polyp with Cervical Intraepithelial Neoplasia

Postmenopausal bleeding is an alarming symptom that needs careful consideration. Endometrial polyps co-existing in the background of endometrial hyperplasia/endometrial cancer is well-established. However, it has been very sparsely reported in the background of atrophic endometrium. The authors report a unique case of concurrent atypical endometrial polyp with cervical intraepithelial neoplasia (CIN) in the background of an atrophic endometrium. A 53-year-old multiparous, postmenopausal lady of Asian ethnicity presented with recurrent episodes of bleeding per vaginum. She did not give any history of exogenous estrogen intake, diabetes, hypertension, or any other surgical risk factors for endometrial malignancy. Her body mass index was 23.9 kg/m2. Magnetic Resonance Imaging revealed a large cervical fibroid, endometrial thickness 8 mm (mixed with blood clots), and focal adenomyosis. Outpatient endometrial sampling was unsatisfactory. She underwent a total hysterectomy with bilateral salpingo-oophorectomy. An incidental hidden diagnosis of concurrent atypical endometrial polyp with CIN underlying the cervical leiomyoma was made. This is the first of its kind to be reported so far. It is not known whether such an association could be due to cervical leiomyoma or de novo.