Cavernous Haemangiomatous Polyp of Uterine Endocervix: A Rare Cause of Recurrent Post Coital
Bleeding and Intrapartum Haemorrhage- A Case Report
Ali MJ,1,2 Salami OS,2 Mashor MI,3 Daru PH1,2
1Department of Obstetrics and Gynaecology, College of Health Sciences, Faculty of Clinical Sciences University of Jos,
Nigeria. 2. Department of Obstetrics and Gynaecology, Jos University Teaching Hospital Jos, Nigeria. 3. Department of
Pathology, Bingham University Teaching Hospital Jos, Nigeria
ABSTRACT
Correspondence:
Maryam J Ali
maryamjamila08@gmail.com,
alimj@unijos.edu.ng
+2348033803872
Background: Cavernous haemangioma of the uterine cervix is a very rare benign
vascular tumour. Few cases have been reported to date; and among them only
very few cases are associated with pregnancy. Although rare, it may cause
obstetrical and gynaecological complications. Case Presentation: A 27-year-old
woman initially presented with history of recurrent post coital bleeding and
infertility. She later conceived and presented at term with antepartum
haemorrhage. An emergency caesarean section was done in view of the excessive
bleeding, with findings of polypoid tortuous vessels on the lower uterine segment
that was clamped and excised. Histology revealed cavernous haemangioma.
Conclusion: Cavernous Haemangioma should be kept in mind as a differential
diagnosis by clinicians of recurrent post coital bleeding and antepartum
haemorrhage as it may cause severe maternal and fetal complications.
Keywords: Cavernous Haemangioma, Post Coital Bleeding, Antepartum
Haemorrhage, Endocervical Polyps, Jos Nigeria
INTRODUCTION
Haemangiomas are benign vascular tumors characterized
by abnormal growth or accumulation of blood vessels in
the skin or internal organs. They are broadly categorized
into capillary, cavernous, arteriovenous, or mixed types,
with capillary haemangiomas being the most common.1,2
Cavernous haemangiomas, although less common, are
typically found in internal organs and skin. However,
their occurrence in the uterine cervix is exceptionally
rare, especially during pregnancy. To date, only a few
sporadic cases have been documented in the literature.2
While most haemangiomas are congenital in origin, some
may develop later due to angiomatous proliferation.
Cervical cavernous haemangiomas may also arise from
prolonged angiomatous changes in polypoid endometrial
lesions. These lesions are often asymptomatic, but they
can present with symptoms such as menorrhagia,
postcoital bleeding (PCB), postmenopausal bleeding,
dyspareunia, or infertility.3,4,5 During pregnancy, they
may lead to significant obstetric complications, including
antepartum hemorrhage (APH), postpartum hemorrhage,
premature rupture of membranes, intrauterine fetal death,
and disseminated intravascular coagulation.6 When
present in the cervix, vagina, or other parts of the genital
Ali, et al. Cavernous Haemangiomatous Polyp of Uterine Endocervix
Tropical Journal of Obstetrics and Gynaecology (TJOG) Vol. 43 No. 4 (2025)/Published by Journalgurus
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tract, they can cause post-coital bleeding due to trauma to
the fragile, vascular tissue during sexual intercourse.7
This case report describes a 27-year-old woman
presenting with PCB and later developing APH at term,
necessitating an emergency cesarean section. The
findings of tortuous endocervical polypoid masses with
cavernous haemangioma underline the potential for life-
threatening complications associated with such rare
lesions during pregnancy.
By reporting this case, we aim to increase
awareness about the existence of cavernous
haemangiomas of the uterine cervix as a potential cause
of PCB and their capacity to present as APH during
pregnancy. Recognizing and managing these lesions
promptly is critical to prevent adverse maternal and fetal
outcomes.
CASE PRESENTATION
A 27year old nulliparous woman presented to the
gynaecological clinic with history of infertility and post
coital bleeding, her menstrual cycle has been regular and
of normal flow and duration. There was no history of use
of hormonal contraceptives. Speculum examination of
the cervix revealed a normal looking cervix, and pelvic
ultrasound revealed no pathology.
a b
Fig 1a. and 1b show multiple tortuous dilated vascular channels (Thick
arrows) containing blood (thin short arrows)
c d
Fig 1c. and 1d. show endocervical glands (thick arrow heads) adjacent
to congested vascular channels (thin arrow heads)
High vaginal swabs and endocervical swabs taken
revealed no abnormality. Papsmears was negative for
intraepithelial malignancy. The patient was scheduled to
have a colposcopy and directed biopsies if abnormal
lesions were seen. She was lost to follow up.
The patient presented 3 months later with an 8-
week pregnancy confirmed at Ultrasound. She was
treated for threatened miscarriage at 8weeks of gestation
and was placed on progesterone tablets, pregnancy was
uneventful and subsequent ultrasound scans revealed a
posterior fundal placenta.
She carried the pregnancy to term (40weeks) and
presented to the labour ward in latent phase of labour. She
was noticed to have excessive bleeding during her next
review which became torrential. She was immediately
planned for an emergency caesarean section for
antepartum haemorrhage at term. Intraoperative findings
included a healthy male baby that weighed 3.8kg with
good Apgar scores. Tortuous endocervical polypoid
masses were seen at the lower uterine segment. This was
clamped and excised and sent for histology. The patient
was transfused two units of whole blood. Histology
revealed multiple proliferating dilated endocervical type
glands with fibrocartilaginous stroma. There were
multiple dilated thick and thin-walled vascular channels,
no malignant cells were seen. Features in keeping with
endocervical polyp with cavernous haemangioma.
DISCUSSION
Intrapartum haemorrhage is a critical obstetric
emergency that poses significant risks to both maternal
and fetal health. This case highlights the rare occurrence
of cavernous haemangioma as the underlying cause of
intrapartum haemorrhage in a 27-year-old woman
presenting in labor.
Cavernous haemangioma of the lower uterine
segment or cervix is an exceedingly rare benign vascular
lesion, with only sporadic cases documented in the
literature.1 Typically congenital in origin, these lesions
may remain asymptomatic or undiagnosed until they
manifest through complications, such as abnormal
bleeding during pregnancy or labour. In this case, the
patient presented with acute intrapartum haemorrhage,
necessitating an emergency caesarean section.
During the caesarean section, tortuous vascular
structures were identified on the lower uterine segment,
which were excised to control the bleeding. This
immediate surgical intervention was life-saving and
crucial for achieving haemostasis. Histological
examination confirmed the presence of a cavernous
haemangioma, characterized by dilated blood-filled
vascular spaces lined by endothelial cells, consistent with
the benign nature of the lesion.
Cavernous haemangiomas are known for their
fragile vascular architecture, making them prone to
rupture and significant bleeding under conditions of
increased vascularity and hormonal influence, as seen
during pregnancy.2 Estrogen is thought to play a key role
Ali, et al. Cavernous Haemangiomatous Polyp of Uterine Endocervix
Tropical Journal of Obstetrics and Gynaecology (TJOG) Vol. 43 No. 4 (2025)/Published by Journalgurus
310
in the development and exacerbation of these lesions by
stimulating endothelial cell proliferation.
The lower uterine segment is a rare location for
haemangiomas, but their presence in this region is
clinically significant due to the potential for massive
haemorrhage during labour, delivery, or surgical
interventions. In this case, the combination of labour-
associated uterine contractions and increased vascular
pressure likely contributed to the rupture and subsequent
intrapartum haemorrhage.
During her pregnancy, the patient presented at 8
weeks with a threatened miscarriage, which was
successfully managed with progesterone
supplementation.8 Hormonal changes during pregnancy,
particularly the influence of estrogen,9 may have
exacerbated the vascular fragility of the haemangioma,
potentially contributing to both the early pregnancy
bleeding and the subsequent intrapartum haemorrhage.
Studies indicate that estrogen plays a significant role in
haemangioma development, as endothelial cells in
haemangiomas contain estrogen receptors.9,10 Few cases
of haemangiomas in pregnancy have been reported
previously.11,12,13
The patient’s prior history of recurrent postcoital
bleeding (PCB) is particularly noteworthy, as it may, in
hindsight, have been attributable to the cavernous
haemangioma, even though initial evaluations were
unremarkable.
PCB is a distressing symptom often linked to
structural abnormalities, infections, or hormonal
imbalances.7 Previous studies reported a case of a
multiparous women with a pedunculated polyp arising
from the endocervical canal.5,6 In this case, the patient
underwent a Pap test, high vaginal swabs (HVS), and
pelvic ultrasound, all of which returned normal results.
These findings ruled out common causes of PCB, but
they did not exclude rare vascular anomalies, such as
cavernous haemangiomas, which are difficult to detect
without advanced imaging or histological evaluation.
With hindsight, the recurrent PCB may have been an
early clinical manifestation of the cavernous
haemangioma, particularly given its fragile vascular
architecture and tendency to bleed with mechanical
stimulation.
CONCLUSION
This case illustrates the importance of vigilance in
managing PCB and its implications during pregnancy.
While benign lesions like endocervical polyps and
haemangiomas are rare causes, they can lead to
significant obstetric complications. Early detection, close
monitoring during pregnancy, and timely surgical
intervention can optimize outcomes for both mother and
baby. Future follow-up for this patient is essential to
ensure no recurrence of polyps or haemangiomas.
Declaration of Patient Consent
Written informed consent was obtained from the patient
for use of her clinical information and relevant images for
publication. The patient understands that her name and
other identifiers will not be published and all efforts will
be made to conceal her identity.
Funding Support and Sponsorship- Nil
Conflict of Interest- There are no conflict of interest
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