Difference between revisions of "Squamous metaplasia of the uterine cervix"

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{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Endocervical_epithelium_and_squamous_metaplasia_--_very_high_mag.jpg
| Width      =
| Caption    = Squamous metaplasia and endocervical epithelium. [[H&E stain]].
| Synonyms  =
| Micro      = uniform cell spacing (no "crowding"), nuclei are uniform size and round, +/-[[nucleoli]], distinct cell borders +/- intercellular bridges visible (common), adjacent/closely associated with endocervical epithelium - classically sits on surface (immature metaplasia), mitoses - rare, usually no nuclear hyperchromasia
| Subtypes  =
| LMDDx      = [[HSIL]], [[reactive squamous epithelium of the uterine cervix]], [[squamous cell carcinoma of the uterine cervix]]
| Stains    =
| IHC        = p16 patchy +ve (''not'' diffuse), Ki-67 low & predominantly basal
| EM        =
| Molecular  =
| IF        =
| Gross      =
| Grossing  =
| Site      = [[uterine cervix]]
| Assdx      =
| Syndromes  =
| Clinicalhx =
| Signs      = [[acetowhite lesion]]
| Symptoms  = none
| Prevalence = common
| Bloodwork  =
| Rads      =
| Endoscopy  =
| Prognosis  = benign
| Other      =
| ClinDDx    = [[squamous intraepithelial lesion of the uterine cervix]]
| Tx        =
}}
'''Squamous metaplasia of the uterine cervix''' is a common change of the [[uterine cervix]] that may resemble [[squamous intraepithelial lesion]].
'''Squamous metaplasia of the uterine cervix''' is a common change of the [[uterine cervix]] that may resemble [[squamous intraepithelial lesion]].


Revision as of 02:05, 6 May 2014

Squamous metaplasia of the uterine cervix
Diagnosis in short

Squamous metaplasia and endocervical epithelium. H&E stain.
LM uniform cell spacing (no "crowding"), nuclei are uniform size and round, +/-nucleoli, distinct cell borders +/- intercellular bridges visible (common), adjacent/closely associated with endocervical epithelium - classically sits on surface (immature metaplasia), mitoses - rare, usually no nuclear hyperchromasia
LM DDx HSIL, reactive squamous epithelium of the uterine cervix, squamous cell carcinoma of the uterine cervix
IHC p16 patchy +ve (not diffuse), Ki-67 low & predominantly basal
Site uterine cervix
Signs acetowhite lesion
Symptoms none
Prevalence common
Prognosis benign
Clin. DDx squamous intraepithelial lesion of the uterine cervix

Squamous metaplasia of the uterine cervix is a common change of the uterine cervix that may resemble squamous intraepithelial lesion.

It may be abbreviated SMC.

General

  • Benign process: columnar cells -> squamoid cells.
    • Biologic response to irritation and/or inflammation.

Gross

Microscopic

Features:

  • Uniform cell spacing - no crowding - key feature.
  • Nuclei are uniform size and round.
  • Distinct cell borders
  • +/-Intercellular bridges (due to edema) - common.
  • Adjacent/closely associated with columnar epithelium.
    • Columnar epithelium superficial in immature metaplasia.

Negatives:

  • No mitoses (think cancer/CIN if you see 'em).
  • Usually no hyperchromatism (think cancer/CIN if you see it).

Notes:

  • NC ratio high - possible to confuse with CIN III.
  • May have goblet cells - uncommon.[2]

DDx:

Images

IHC

  • p16 weak-to-moderate patchy +ve -- checkerboard-like; not full thickness.
    • Strong diffuse full thickness positivity in HSIL and SCC.
  • Ki-67 - low proliferative rate.

Sign out

ECC

UTERINE ENDOCERVIX, CURETTAGE: 
- SQUAMOUS METAPLASTIC EPITHELIUM.
- VERY SCANT STRIPPED ENDOCERVICAL EPITHELIUM.

Cervical biopsy

UTERINE CERVIX, BIOPSY: 
- SQUAMOUS METAPLASTIC EPITHELIUM.
- SCANT BENIGN ENDOCERVICAL GLANDS.

UTERINE CERVIX, BIOPSY: 
- SQUAMOUS METAPLASTIC EPITHELIUM.
- SCANT BENIGN ENDOCERVICAL GLANDS.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.

Micro

The sections show stratified squamous epithelium. The cells are equally spaced and spaces are seen between the cells (edema).

The nuclei are not significantly enlarged (<3x resting lymphocyte diameter). No nuclear halos are apparent. The nuclear membranes are regular. Mild inflammation is present. Nucleoli are present focally.

No endocervical cells are identified.

See also

References

  1. ↑ Li, W.; Venkataraman, S.; Gustafsson, U.; Oyama, JC.; Ferris, DG.; Lieberman, RW.. "Using acetowhite opacity index for detecting cervical intraepithelial neoplasia.". J Biomed Opt 14 (1): 014020. doi:10.1117/1.3079810. PMID 19256708.
  2. ↑ Sivridis, E.; Karpathiou, G.; Malamou-Mitsi, V.; Giatromanolaki, A. (2010). "Intestinal-type metaplasia in the original squamous epithelium of the cervix.". Eur J Gynaecol Oncol 31 (3): 319-22. PMID 21077478.
  3. ↑ URL: http://www.eurocytology.eu/static/eurocytology/eng/cervical/LP1ContentAcontD.html. Accessed on: 9 October 2013.
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