Difference between revisions of "Uterine cervix"

Jump to navigation Jump to search

Uterine cervix (view source)

Revision as of 18:31, 17 November 2021

8,178 bytes removed ,  18:31, 17 November 2021
→‎Mesonephric adenocarcinoma
 
(7 intermediate revisions by the same user not shown)
Line 239: Line 239:
#Identify possible squamous lesions.
#Identify possible squamous lesions.
#Identify possible endocervical lesions.
#Identify possible endocervical lesions.
==Benign entities of the cervix==
The cervix is ''MANTLED'':
* Mullerian papilloma/Mesonephric hyperplasia/[[Microglandular hyperplasia]].
* [[Arias Stella reaction]].
* [[Nabothian cyst]].
* [[Tunnel cluster]]/Tuboendometrioid metaplasia.
* Lobular endocervical glandular hyperplasia.
* [[Endocervical polyp]]/Endocervicosis/[[Endometriosis]]/Ectopic prostatic tissue.
* Diffuse laminar endocervical hyperplasia.


=Benign=
=Benign=
Line 339: Line 349:
==Squamous metaplasia of the uterine cervix==
==Squamous metaplasia of the uterine cervix==
*Abbreviated ''SMC''.
*Abbreviated ''SMC''.
===General===
{{Main|Squamous metaplasia of the uterine cervix}}
*Benign process: columnar cells -> squamoid cells.
**Biologic response to irritation and/or inflammation.
 
===Gross===
*[[Acetowhite epithelium|Acetowhite lesion]].<ref name=pmid19256708>{{Cite journal  | last1 = Li | first1 = W. | last2 = Venkataraman | first2 = S. | last3 = Gustafsson | first3 = U. | last4 = Oyama | first4 = JC. | last5 = Ferris | first5 = DG. | last6 = Lieberman | first6 = RW. | title = Using acetowhite opacity index for detecting cervical intraepithelial neoplasia. | journal = J Biomed Opt | volume = 14 | issue = 1 | pages = 014020 | month =  | year =  | doi = 10.1117/1.3079810 | PMID = 19256708 }}</ref>
 
===Microscopic===
Features:
* Uniform cell spacing - no crowding - '''key feature'''.
* Nuclei are uniform size and round.
** [[Nucleoli]] present.
*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.<ref name=pmid21077478>{{Cite journal  | last1 = Sivridis | first1 = E. | last2 = Karpathiou | first2 = G. | last3 = Malamou-Mitsi | first3 = V. | last4 = Giatromanolaki | first4 = A. | title = Intestinal-type metaplasia in the original squamous epithelium of the cervix. | journal = Eur J Gynaecol Oncol | volume = 31 | issue = 3 | pages = 319-22 | month =  | year = 2010 | doi =  | PMID = 21077478 }}</ref>
 
DDx:
*[[CIN II]] - esp. for immature squamous metaplasia.
*[[CIN III]].
*[[Squamous cell carcinoma of the uterine cervix]].
 
Images:
*[http://www.sciencephoto.com/media/294722/view Squamous metaplasia - cervix (sciencephoto.com)].
*[http://commons.wikimedia.org/wiki/File:Bronchial_squamous_metaplasia.jpg Squamous metaplasia - bronchus (WC)].
*[http://nih.techriver.net/patientImages%5C6676.jpg Squamous metaplasia - cytology (techriver.net)].
*[http://www.eurocytology.eu/static/eurocytology/eng/cervical/mod1img4b.html Immature squamous metaplasia (eurocytology.eu)].<ref>URL: [http://www.eurocytology.eu/static/eurocytology/eng/cervical/LP1ContentAcontD.html http://www.eurocytology.eu/static/eurocytology/eng/cervical/LP1ContentAcontD.html]. Accessed on: 9 October 2013.</ref>
 
===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====
<pre>
UTERINE ENDOCERVIX, CURETTAGE:
- SQUAMOUS METAPLASTIC EPITHELIUM.
- VERY SCANT STRIPPED ENDOCERVICAL EPITHELIUM.
</pre>
 
====Cervical biopsy====
<pre>
UTERINE CERVIX, BIOPSY:
- SQUAMOUS METAPLASTIC EPITHELIUM.
- SCANT BENIGN ENDOCERVICAL GLANDS.
</pre>
 
<pre>
UTERINE CERVIX, BIOPSY:
- SQUAMOUS METAPLASTIC EPITHELIUM.
- SCANT BENIGN ENDOCERVICAL GLANDS.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
</pre>
 
====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.


==Reactive squamous epithelium of the uterine cervix==
==Reactive squamous epithelium of the uterine cervix==
Line 475: Line 417:
===IHC===
===IHC===
Features:<ref name=pmid8803599>{{Cite journal  | last1 = Marques | first1 = T. | last2 = Andrade | first2 = LA. | last3 = Vassallo | first3 = J. | title = Endocervical tubal metaplasia and adenocarcinoma in situ: role of immunohistochemistry for carcinoembryonic antigen and vimentin in differential diagnosis. | journal = Histopathology | volume = 28 | issue = 6 | pages = 549-50 | month = Jun | year = 1996 | doi =  | PMID = 8803599 }}</ref>
Features:<ref name=pmid8803599>{{Cite journal  | last1 = Marques | first1 = T. | last2 = Andrade | first2 = LA. | last3 = Vassallo | first3 = J. | title = Endocervical tubal metaplasia and adenocarcinoma in situ: role of immunohistochemistry for carcinoembryonic antigen and vimentin in differential diagnosis. | journal = Histopathology | volume = 28 | issue = 6 | pages = 549-50 | month = Jun | year = 1996 | doi =  | PMID = 8803599 }}</ref>
*Vimentin +ve.
*[[Vimentin]] +ve.
*CEA -ve/+ve.
*CEA -ve/+ve.
*p16 -ve.{{fact}}
*p16 -ve.{{fact}}
Line 547: Line 489:
==Stratified mucin-producing intraepithelial lesions of the cervix==
==Stratified mucin-producing intraepithelial lesions of the cervix==
*Abbreviated ''SMILE'' ('''S'''tratified '''M'''ucin-producing '''I'''ntraepithelial '''LE'''sion).
*Abbreviated ''SMILE'' ('''S'''tratified '''M'''ucin-producing '''I'''ntraepithelial '''LE'''sion).
===General===
{{Main|Stratified mucin-producing intraepithelial lesion of the cervix}}
*Rare.
*Often accompanied by [[cervical intraepithelial neoplasia]] and [[adenocarcinoma in situ]].<ref name=pmid11023104/>
 
===Microscopic===
Features:<ref name=pmid11023104>{{Cite journal  | last1 = Park | first1 = JJ. | last2 = Sun | first2 = D. | last3 = Quade | first3 = BJ. | last4 = Flynn | first4 = C. | last5 = Sheets | first5 = EE. | last6 = Yang | first6 = A. | last7 = McKeon | first7 = F. | last8 = Crum | first8 = CP. | title = Stratified mucin-producing intraepithelial lesions of the cervix: adenosquamous or columnar cell neoplasia? | journal = Am J Surg Pathol | volume = 24 | issue = 10 | pages = 1414-9 | month = Oct | year = 2000 | doi =  | PMID = 11023104 }}</ref>
*Stratified epithelium with:
**Nuclear atypia.
**Cytoplasmic clearing or vacuoles in lesions - through-out.
 
DDx:
*[[HSIL]].
**Mucin may be present superficially.<ref name=pmid11023104/>
 
Images:
*[http://sunnybrook.ca/uploads/cx_SMILE_S10-1021_vd_1.jpg SMILE (sunnybrook.ca)].<ref>URL: [http://sunnybrook.ca/content/?page=Dept_LabS_APath_GynPath_ImgAt_Cvx_mal_ais_smile http://sunnybrook.ca/content/?page=Dept_LabS_APath_GynPath_ImgAt_Cvx_mal_ais_smile]. Accessed on: 30 March 2012.</ref>
*[http://sunnybrook.ca/uploads/cx_SMILE_S10-1021_vd_2.jpg SMILE (sunnybrook.ca)].
 
===IHC===
Features:
*Ki-67 high.
*Keratin 14 -ve.
*p63 +ve/-ve -- only basal if positive.


=Uncommon types of cervical cancer=
=Uncommon types of cervical cancer=
Line 679: Line 599:


==Mesonephric adenocarcinoma==
==Mesonephric adenocarcinoma==
===General===
{{Main|Mesonephric adenocarcinoma}}
*Arises from the [[mesonephric duct remnants]].
 
===Microscopic===
Features:<ref name=Ref_WMSP442>{{Ref WMSP|442}}</ref>
*Nuclear atypia - '''key feature'''.
**Nuclear crowding.
*Variable architecture:
**Tubular, papillary, solid, retiform (net-like<ref>URL: [http://www.thefreedictionary.com/retiform http://www.thefreedictionary.com/retiform]. Accessed on: 25 August 2012.</ref>).
 
DDx:
*[[Mesonephric duct remnants]].
*[[Cervical adenocarcinoma]].
*[[Colorectal adenocarcinoma]].
*Endometrioid adenocarcinoma.
 
===IHC===
Features:<ref name=Ref_WMSP442>{{Ref WMSP|442}}</ref>
*CK7 +ve.
*CD10 +ve.
 
Others:<ref name=Ref_WMSP442>{{Ref WMSP|442}}</ref>
*[[CK20]] -ve.
*ER -ve.
*PR -ve.
*CEA -ve.


==Minimal deviation adenocarcinoma of the uterine cervix==
==Minimal deviation adenocarcinoma of the uterine cervix==
*[[AKA]] ''adenoma malignum''.
*[[AKA]] ''adenoma malignum''.
*[[AKA]] ''minimal deviation adenocarcinoma'', abbreviated ''MDA''.
*[[AKA]] ''minimal deviation adenocarcinoma'', abbreviated ''MDA''.
===General===
{{Main|Minimal deviation adenocarcinoma of the uterine cervix}}
*Rare and difficult diagnosis.<ref name=pmid12828609>{{Cite journal  | last1 = Tsuda | first1 = H. | last2 = Mikami | first2 = Y. | last3 = Kaku | first3 = T. | last4 = Akiyama | first4 = F. | last5 = Hasegawa | first5 = T. | last6 = Okada | first6 = S. | last7 = Hayashi | first7 = I. | last8 = Kasamatsu | first8 = T. | title = Interobserver variation in the diagnosis of adenoma malignum (minimal deviation adenocarcinoma) of the uterine cervix. | journal = Pathol Int | volume = 53 | issue = 7 | pages = 440-9 | month = Jul | year = 2003 | doi =  | PMID = 12828609 }}</ref>
**Requires a deep sampling;<ref name=pmid22385609>{{Cite journal  | last1 = Lim | first1 = KT. | last2 = Lee | first2 = IH. | last3 = Kim | first3 = TJ. | last4 = Kwon | first4 = YS. | last5 = Jeong | first5 = JG. | last6 = Shin | first6 = SJ. | title = Adenoma malignum of the uterine cervix: Clinicopathologic analysis of 18 cases. | journal = Kaohsiung J Med Sci | volume = 28 | issue = 3 | pages = 161-4 | month = Mar | year = 2012 | doi = 10.1016/j.kjms.2011.10.009 | PMID = 22385609 }}</ref> thus,  usually diagnosed on cone biopsy or hysterectomy.
*Associated with [[Peutz-Jeghers syndrome]].<ref name=pmid21503748>{{Cite journal  | last1 = Riegert-Johnson | first1 = D. | last2 = Roberts | first2 = M. | last3 = Gleeson | first3 = FC. | last4 = Krishna | first4 = M. | last5 = Boardman | first5 = L. | title = Case studies in the diagnosis and management of Peutz-Jeghers syndrome. | journal = Fam Cancer | volume = 10 | issue = 3 | pages = 463-8 | month = Sep | year = 2011 | doi = 10.1007/s10689-011-9438-x | PMID = 21503748 }}</ref><ref name=pmid22878090>{{Cite journal  | last1 = Ito | first1 = M. | last2 = Minamiguchi | first2 = S. | last3 = Mikami | first3 = Y. | last4 = Ueda | first4 = Y. | last5 = Sekiyama | first5 = K. | last6 = Yamamoto | first6 = T. | last7 = Takakura | first7 = K. | title = Peutz-Jeghers syndrome-associated atypical mucinous proliferation of the uterine cervix: A case of minimal deviation adenocarcinoma ('adenoma malignum') in situ. | journal = Pathol Res Pract | volume =  | issue =  | pages =  | month = Aug | year = 2012 | doi = 10.1016/j.prp.2012.06.008 | PMID = 22878090 }}</ref>
*Poor prognosis.<ref name=pmid2764221>{{Cite journal  | last1 = Gilks | first1 = CB. | last2 = Young | first2 = RH. | last3 = Aguirre | first3 = P. | last4 = DeLellis | first4 = RA. | last5 = Scully | first5 = RE. | title = Adenoma malignum (minimal deviation adenocarcinoma) of the uterine cervix. A clinicopathological and immunohistochemical analysis of 26 cases. | journal = Am J Surg Pathol | volume = 13 | issue = 9 | pages = 717-29 | month = Sep | year = 1989 | doi =  | PMID = 2764221 }}</ref>
 
===Microscopic===
Features:<ref name=Ref_WMSP441-2>{{Ref WMSP|441-2}}</ref>
*Deep infiltrating glands - '''key feature'''.
**Desmoplastic stroma - may be subtle.
**Perivascular and/or perineural location.
*Minimal nuclear atypia.
*Abnormal gland morphology<ref name=pmid2764221/> / loss of lobular (gland) architecture. †
 
Note:
*† '''Not''' a criterion required by all pathologists.<ref name=pmid12828609/>
 
DDx:<ref name=pmid12828609/>
*[[Adenocarcinoma of the uterine cervix]] - has "obvious" nuclear atypia.
*[[Tunnel cluster]].
 
===IHC===
Features:
*CEA +ve.<ref name=pmid2764221/>
*p16 -ve.{{fact}}


=See also=
=See also=
Michael
49,006

edits

Retrieved from "https://librepathology.org/wiki/Special:MobileDiff/31141...51649"

Navigation menu