Benign Tumors
Squamous papillomas 8052 0 of the ectocervix Figs. 91-94 occur predominantly in young women and are mainly caused by infection with low-risk HPV LR-HPV types, such as types 6 and 11 Ward et al. 1992 see Table 3 . Some may be inverted, hence their surfaces are flat. Histologically they consist of thick layers of stratified squamous epithelium with elongated rete pegs that extend deeply into the lamina propria Fig. 91 . The basal membrane is intact, the epithelial layers are well differentiated,...
Descending Repair Figs 1927
Endocervical mucosal surface epithelium that everts out onto the portio may become replaced by squamous epithelium in two ways 1 by overgrowth from adjacent regenerative ectocervical epithelium, as in ascending repair Figs. 10-13 , or 2 by squamous metaplasia of the reserve cells of the endocervical epithelium, as in descending repair. Both processes may occur simultaneously or separately. In general, ascending repair is stimulated by endogenous or exogenous estrogens, whereas descending repair...
Mllerian Duct Remnants and Metaplasia Figs 3542
Foci of ectocervical endometriosis 7650 0 may be located beneath the ectocervical epithelium and bulge forth as nodules Fig. 35 , grossly recognizable by the old and fresh hemorrhages in and around them Figs. 35,36 , or be located deep in the cervical wall Figs. 37,38 . These deep foci correspond in their location and structure to adenom-yosis of the myometrium. The glands are characteristically surrounded by an endome-trial-type stroma. In some instances, endocervical glands may be lined by...
Cystic Hyperplasia of the Endocervix [33400
Under estrogenic stimulation, the epithelial cells of the endocervical glands differentiate and produce mucin, which may become excessive with long-standing unopposed estrogen. Consequently, the glands become cystically dilated with inspissated mucin Figs. 52-54 . Thereby they become closely clustered, and the glandular region enlarges by extending down into the cervical wall. Reserve cells or areas of preceding reserve cell hyperplasia may differentiate and undergo squamous cell metaplasia see...
Microglandular Hyperplasia of the Endocervix [72480
With increasing potency of the gestagen used, endocervical glandular proliferation is more likely to develop into microalveolar changes with disappearance of the intervening stroma Figs. 63-65 . The low cuboidal, undifferentiated, glandular epithelial cells can hardly be distinguished from the surrounding hyperplastic reserve cells. Occasionally a solid sheetlike proliferation of reserve cells, signet-ring cells or hobnail cells may be observed. These changes, too, may be misdiagnosed as...
Ascending Repair Figs 1013
During reproductive life, and following eversion of the endocervical mucosa onto the portio, the ectocervical epithelium is capable of overgrowing the vulnerable endocervical epithelium by ascending repair Figs. 10,11 , thereby often occluding the openings of Fig. 10. Ascending repair following eversion of the endocervical mucosa onto the portio, early stage. H amp E Fig. 10. Ascending repair following eversion of the endocervical mucosa onto the portio, early stage. H amp E Fig. 11. Ascending...
Glandular Adenomatous Hyperplasia of the Endocervix
New glands form and the glandular epithelial cells become pseudostratified Fig. 62 , containing elongated hyperchromatic nuclei in a less well-differentiated cytoplasm. The glands may ramify Fig. 59 or become crowded Fig. 60 , occasionally resulting in a diffuse laminar glandular pattern Jones et al. 1991 Nucci 2002 . The production of mucin is reduced or absent and occurs irregularly from one gland to another Fig. 61 or within the same gland Fig. 62 . Cells with mucin and those without may lie...
Mesonephric Duct Remnants [26370 and Hyperplasia [72580
Remnants of the mesonephric duct Gartner's duct are occasionally found deep in the lateral cervical wall Fig. 32 . They consist of small round tubules lined by a single layer of low cuboidal epithelium which contains no glycogen or mucin, whereas in the lumina one often finds eosinophilic homogenous material Fig. 34 which is PAS-positive compare Fig. 207 . The tubules are often arranged in clusters, occasionally around an elongated remnant of a larger tubule Fig. 33 . Mesonephric duct...
Glandular and Cystic Hyperplasia of the Endocervix [33400
The physiologic hyperstimulation of the endocervical mucosa during gestation induces a mild or moderate hypersecretion of the glands and a proliferation of reserve cells Fig. 56 . The ectropionized mucosa usually is overgrown by an ascending regenerative epithelium Fig. 55 . Foci of ectopic decidua may be found in the endocervix and appear much like those seen at various other sites throughout the small pelvis during pregnancy. They show that they possess the inherent genetic potentialities of...
Normal Endocervix Figs 1418
The normal endocervical mucosa consists of mucus-producing tubules and clefts mucosal infoldings, usually called glands , loosely arranged in a fibrous stroma. A single layer of tall, columnar epithelial cells covers the mucosal surface and lines the intricate folds, clefts, and tubules. The small nuclei are basally placed during the early proliferative phase. The clear cytoplasm contains abundant mucus, especially in the late proliferative phase Fig. 14 . Where the endocervical mucosa merges...
Transformation Zone Figs 2831
It is important to recognize and locate the transformation zone since most cervical neoplasias arise at or above this squamocolumnar junction. In their developmental stage they usually are limited to the transformation zone. When the squamous epithelium that covers this repair zone Figs. 28-30 does not undergo precancerous change, but, as in most instances, matures normally and completely, then at the end stage of repair it is impossible to distinguish the regenerative and metaplastic squamous...
Normal Ectocervix Figs 39
A normal ectocervix is covered by a nonkeratinizing stratified squamous epithelium. Its height is influenced by endogenous hormone production and varies accordingly with age and hormonal stimulation. During reproductive age Fig. 3 the epithelium is high and well differentiated. It consists of a basal cell layer with elongated nuclei perpendicular to the basal membrane, of one or several layers of small parabasal cells, of a broad intermediate cell zone with abundant cytoplasmic glycogen, and of...
Simple Hysterectomy
A simple hysterectomy is indicated if the conservative treatment has failed and there is extensive involvement of cervix and vagina. It may also serve as a definitive management of microinvasive carcinoma stage IA2 or of ACIS. More invasive procedures radical surgery may be appropriate but depend on clinical staging and or type and origin of the tumor in question. The value of a colposcopically directed biopsy prior to excisional treatment has been debated. The reproducibility and the accuracy...
Cold Knife Conization
If the cytology report is positive, but no lesion is visible on gross or colposcopic examination, a cervical conization will be necessary in order to survey the entire squamoco-lumnar junction. A conization must also be performed if a previous punch biopsy of a grossly suspicious lesion showed that the noninvasive precancerous epithelium had not been completely excised. A biopsy of malignant tumors can never give information about the depth of invasion. If the clinical signs fail to reveal how...