Difference between revisions of "Uterine cervix"
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The '''cervix''', or uterine cervix to be more precise, is the gateway to the uterine corpus. It is not infrequently afflicted by cancer -- squamous cell carcinoma. Prior to routine pap tests it was a leading cause of cancer death in women in the Western world. | The '''cervix''', or uterine cervix to be more precise, is the gateway to the uterine corpus. It is not infrequently afflicted by cancer -- squamous cell carcinoma. Prior to routine pap tests it was a leading cause of cancer death in women in the Western world. | ||
Polyps associated with the cervix are discussed the ''[[cervical polyp]]'' article. | |||
Polyps associated with the cervix are discussed the ''[[cervical polyp]]'' article. | |||
[[Cytopathology]] of the cervix is dealt with in the ''[[gynecologic cytopathology]]'' article. | |||
==Introduction== | ==Introduction== | ||
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===Histologic changes in CIN I, CIN II and CIN III=== | ===Histologic changes in CIN I, CIN II and CIN III=== | ||
*CIN I = cytoplasmic halos (koilocytic atypia), atypical cells close to basement membrane only. | *CIN I = cytoplasmic halos (koilocytic atypia), atypical cells close to basement membrane only. | ||
**3:1 enlargement of nucleus vs. normal<ref>[need ref]</ref> | **3:1 enlargement of nucleus vs. normal.<ref>[need ref]</ref> | ||
**Binucleation may be seen (cytopathic effect of HPV)<ref>[need ref]</ref> | **Binucleation may be seen (cytopathic effect of HPV).<ref>[need ref]</ref> | ||
*CIN II = increased nuclear-cytoplasmic ratio, loss of polarity, incr. mitoses, hyperchromasia. | *CIN II = increased nuclear-cytoplasmic ratio, loss of polarity, incr. mitoses, hyperchromasia. | ||
**If there are large nuclei... you should seen 'em on low power, i.e. 25x. | **If there are large nuclei... you should seen 'em on low power, i.e. 25x. | ||
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** If there is a mitosis in the middle third (of the epithelial layer) = at least CIN II. | ** If there is a mitosis in the middle third (of the epithelial layer) = at least CIN II. | ||
** If there is a mitosis in the outer third = CIN III. | ** If there is a mitosis in the outer third = CIN III. | ||
*Nucleoli are usually NOT present in CIN.<ref>STC. | *Nucleoli are usually NOT present in CIN.<ref>STC. January 2009.</ref> | ||
**Nucleoli are common in reactive changes.<ref>STC. | **Nucleoli are common in reactive changes.<ref>STC. January 2009.</ref> | ||
====Kiolocytes versus benign squamous==== | ====Kiolocytes versus benign squamous==== | ||
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==Cervix cancer grading== | ==Cervix cancer grading== | ||
#Well-differentiated (keratinizing). | #Well-differentiated (keratinizing). | ||
#Moderately | #Moderately differentiated (nonkeratinizing). | ||
#Poorly differentiated. | #Poorly differentiated. | ||
Ref.:<ref>{{Ref PBoD|1077}}</ref> | Ref.:<ref>{{Ref PBoD|1077}}</ref> | ||
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*Long rete ridges. | *Long rete ridges. | ||
*Numerous beeds/blobs of epithelial cells that seem unlikely to be rete ridges. | *Numerous beeds/blobs of epithelial cells that seem unlikely to be rete ridges. | ||
*Desmoplastic stroma - increased cellularity, spindle cell morphology | *Desmoplastic stroma - increased cellularity, spindle cell morphology. | ||
Pitfalls: | Pitfalls: | ||
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* Uniform cell spacing, i.e. NO crowding. | * Uniform cell spacing, i.e. NO crowding. | ||
* NEGATIVES: | * NEGATIVES: | ||
** No mitoses (think cancer/CIN if you see 'em) | ** No mitoses (think cancer/CIN if you see 'em). | ||
** Usually no hyperchromatism (think cancer/CIN if you see it) | ** Usually no hyperchromatism (think cancer/CIN if you see it). | ||
Notes: | Notes: | ||
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*AIS/adenocarcinoma arises can arise from the endocervical glands. | *AIS/adenocarcinoma arises can arise from the endocervical glands. | ||
===AIS=== | ===Adenocarcinoma in situ (AIS)=== | ||
*Diagnosis of AIS dependent primarily on nuclear changes: | *Diagnosis of AIS dependent primarily on nuclear changes: | ||
**Nuclear crowding. | **Nuclear crowding. | ||
**Nuclear hyperchromasia. | **Nuclear hyperchromasia. | ||
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**Hyperchromasia. | **Hyperchromasia. | ||
===Invasive=== | ===Invasive adenocarcinoma=== | ||
Features: | |||
*Stromal changes - "[[desmoplastic stroma]]/[[desmoplastic reaction]]". | |||
**Fibrosis/streaming cells. | |||
*Gland fusion. | |||
*Glands too deep -- very fuzzy criterion. | |||
Notes: | Notes: | ||
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*AIS may occur together with CIN. | *AIS may occur together with CIN. | ||
**not infrequently they (AIS, CIN) occur together - both are due, indirectly, to HPV infection. | **not infrequently they (AIS, CIN) occur together - both are due, indirectly, to HPV infection. | ||
*May be difficult to be certain of invasion. | |||
===IHC=== | ===IHC=== | ||
Uterus vs. cervix:<ref>LAE 15 | Uterus vs. cervix:<ref>LAE. 15 January 2009.</ref> | ||
*Cervix (typically): CEA+, p16+. | *Cervix (typically): CEA+, p16+. | ||
** ... and ER-, PR-, vimentin-. | ** ... and ER-, PR-, vimentin-. | ||
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===Clear cell carcinoma=== | ===Clear cell carcinoma=== | ||
Associated with ''diethylstilbestrol'' exposure ''in utero''.<ref name=pmid19857300>{{Cite journal | last1 = van Dijck | first1 = JA. | last2 = Doorduijn | first2 = Y. | last3 = Bulten | first3 = JH. | last4 = Verloop | first4 = J. | last5 = Massuger | first5 = LF. | last6 = Kiemeney | first6 = BA. | title = [Vaginal and cervical cancer due to diethylstilbestrol (DES); end epidemic] | journal = Ned Tijdschr Geneeskd | volume = 153 | issue = | pages = A366 | month = | year = 2009 | doi = | PMID = 19857300 }} | Associated with ''diethylstilbestrol'' exposure ''in utero''.<ref name=pmid19857300>{{Cite journal | last1 = van Dijck | first1 = JA. | last2 = Doorduijn | first2 = Y. | last3 = Bulten | first3 = JH. | last4 = Verloop | first4 = J. | last5 = Massuger | first5 = LF. | last6 = Kiemeney | first6 = BA. | title = [Vaginal and cervical cancer due to diethylstilbestrol (DES); end epidemic] | journal = Ned Tijdschr Geneeskd | volume = 153 | issue = | pages = A366 | month = | year = 2009 | doi = | PMID = 19857300 }}</ref> | ||
</ref> | |||
==See also== | ==See also== | ||