Difference between revisions of "Uterine cervix"

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===Stains===
===Stains===
*[[PAS-D]]+ve (cytoplasm).
*[[PAS-D]]+ve (cytoplasm).
==Squamous metaplasia of the uterine cervix==
===General===
*Benign process: columnar cells -> squamoid cells.
**Biologic response to irritation and/or inflammation.
===Microscopic===
Features:
* Nuclei are uniform size and round.
** Nucleoli present.
* +/-Intercellular bridges (due to edema) - common.
* Uniform cell spacing, i.e. no crowding.
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 CIN III.
DDx:
*[[CIN III]].
*[[Squamous cell carcinoma of the uterine cervix]].
===IHC===
*p16 +ve - in SCC; a poor man's test for [[HPV]].
*Ki-67 - stains a large number of cells; proliferation marker.


=Non-invasive=
=Non-invasive=
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=Cancer=
=Cancer=
==Cervix cancer grading==
==Squamous cell carcinoma of the uterine cervix==
#Well-differentiated (keratinizing).
{{Main|Squamous cell carcinoma}}
#Moderately differentiated (nonkeratinizing).
===General===
#Poorly differentiated.
*Most common type of cervical cancer.
Ref.:<ref>{{Ref PBoD|1077}}</ref>
 
Risk factors:
*Low socioeconomic status.
*Smoking.
*Early first intercourse.
*High risk partners.
*HPV infection, esp. "high risk" HPV.


==Squamous cell carcinoma==
===Microscopic===
{{Main|Squamous cell carcinoma}}
Features:
The most common type of cervical cancer.
*Penetration of basement membrane.
**May be challenging to determine.
*Nuclear atypia.


===SCC of the cervix versus CIN III===
SCC of the cervix versus CIN III:
Invasive cancer look for:
Invasive cancer look for:
*Eosinophilia.  
*Eosinophilia.  
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*Desmoplastic stroma - increased cellularity, spindle cell morphology.
*Desmoplastic stroma - increased cellularity, spindle cell morphology.


Pitfalls:
Grading:<ref>{{Ref PBoD|1077}}</ref>
* Squamous metaplasia.
#Well-differentiated (keratinizing).
** If you can trace the squamous cells from a gland to the surface it is less likely to be invasive cancer.
#Moderately differentiated (nonkeratinizing).
See: [http://www.nature.com/modpathol/journal/v15/n3/pdf/3880520a.pdf http://www.nature.com/modpathol/journal/v15/n3/pdf/3880520a.pdf]
#Poorly differentiated.
 
===Squamous metaplasia of the uterine cervix===
====General====
*Benign process: columnar cells -> squamoid cells.
**Biologic response to irritation and/or inflammation.
 
====Microscopic====
Features:
* Nuclei are uniform size and round.
** Nucleoli present.
* +/-Intercellular bridges (due to edema) - common.
* Uniform cell spacing, i.e. no crowding.
 
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 CIN III.


DDx:
DDx:
* [[Squamous metaplasia of the uterine cervix]] - if you can trace the squamous cells from a gland to the surface it is less likely to be invasive cancer.<ref>[http://www.nature.com/modpathol/journal/v15/n3/pdf/3880520a.pdf http://www.nature.com/modpathol/journal/v15/n3/pdf/3880520a.pdf]</ref>
*[[CIN III]].
*[[CIN III]].
*[[Squamous cell carcinoma of the uterine cervix]].
===IHC===
*p16 +ve - in SCC; a poor man's test for [[HPV]].
*Ki-67 - stains a large number of cells; proliferation marker.


==Adenocarcinoma==
==Adenocarcinoma==
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