Difference between revisions of "Uterine cervix"

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The '''uterine cervix''', also simply '''cervix''', 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 '''uterine cervix''', also simply '''cervix''', is the gateway to the uterine corpus.  It is not infrequently afflicted by cancer -- [[squamous cell carcinoma]]. Prior to routine [[Pap test]]s 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.
[[Cytopathology]] of the uterine cervix is dealt with in the ''[[gynecologic cytopathology]]'' article.


=Introduction=
=Introduction=
*Consists of non-keratinized squamous epithelium and simple columnar epithelium.   
==Overview==
*Most cervix cancer is [[squamous cell carcinoma of the uterine cervix|squamous cell carcinoma]].
**An effective screening test to detect this is the ''Pap test'', which is dealt with in the ''[[gynecologic cytopathology]]'' article.
*The work-up of a suspicious ''Pap test'' is a ''colposcopic examination'' and biopsies, which are the topic of ''this'' article.
 
Indications for coloposcopic exam (based on the ''ASCCP Consensus Guidelines'' of 2001):<ref name=pmid16148248>{{Cite journal  | last1 = Dresang | first1 = LT. | title = Colposcopy: an evidence-based update. | journal = J Am Board Fam Pract | volume = 18 | issue = 5 | pages = 383-92 | month =  | year =  | doi =  | PMID = 16148248 |URL = www.jabfm.org/cgi/pmidlookup?view=long&pmid=16148248 }}</ref>
*[[High-grade squamous intraepithelial lesion]] ([[HSIL]]).
*Repeated [[low-grade squamous intraepithelial lesion]] ([[LSIL]]).
*[[Atypical squamous cells of undetermined significance]] ([[ASCUS]]) and a positive [[HPV]] test.
*[[ASC-H]].
*[[Atypical glandular cells]] ([[AGC]]) not otherwise specified.
*[[Adenocarcinoma in situ]] ([[AIS]]).
 
==Colposcopic examination==
*Performed by gynecologists.
*Exam usually includes a search for ''acetowhite epithelium'' (AWE); this is accomplished by the application of acetic acid (to help identify lesions for biopsy).
**[[cervical intraepithelial neoplasia|Neoplastic cervical lesions]] are typically white.<ref name=pmid23224202>{{Cite journal  | last1 = Zonios | first1 = G. | title = Reflectance model for acetowhite epithelium. | journal = J Biomed Opt | volume = 17 | issue = 8 | pages = 87003-1 | month = Aug | year = 2012 | doi = 10.1117/1.JBO.17.8.087003 | PMID = 23224202 }}</ref>
**[[Squamous metaplasia of the uterine cervix|Squamous metaplasia]] is also white.<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>
*Cervical ectropian (AKA cervical eversion, AKA ectropian) = endocervical epithelium at external os, considered benign, grossly has a granulation tissue-like appearance.<ref name=pmid21270291>{{Cite journal  | last1 = Casey | first1 = PM. | last2 = Long | first2 = ME. | last3 = Marnach | first3 = ML. | title = Abnormal cervical appearance: what to do, when to worry? | journal = Mayo Clin Proc | volume = 86 | issue = 2 | pages = 147-50; quiz 151 | month = Feb | year = 2011 | doi = 10.4065/mcp.2010.0512 | PMID = 21270291 | PMC = 3031439 }}</ref>
 
==Cervical specimens==
===Cytology===
* Pap test - see ''[[gynecologic cytopathology]]''.
 
===Biopsies===
The types of biopsies that are done are:
# Cervical biopsies - prompted by abnormal Pap test, e.g. [[HSIL]], to look for [[squamous cell carcinoma of the uterine cervix]].
# Endocervical curettage (ECC) - to work-up columnar dysplasia, e.g. [[endocervical adenocarcinoma]]/[[endometrial adenocarcinoma]].
 
===Surgical specimens===
# [[Loop electrosurgical excision procedure]] (LEEP).
#* [[AKA]] large loop excision of the transformation zone (LLETZ).<ref>{{Cite journal  | last1 = Kenwright | first1 = D. | last2 = Braam | first2 = G. | last3 = Maharaj | first3 = D. | last4 = Langdana | first4 = F. | title = Multiple levels on LLETZ biopsies do not contribute to patient management. | journal = Pathology | volume = 44 | issue = 1 | pages = 7-10 | month = Jan | year = 2012 | doi = 10.1097/PAT.0b013e32834d7b5d | PMID = 22173237 }}</ref><ref>URL: [http://www.webmd.com/cancer/cervical-cancer/loop-electrosurgical-excision-procedure-leep-for-abnormal-cervical-cell-changes http://www.webmd.com/cancer/cervical-cancer/loop-electrosurgical-excision-procedure-leep-for-abnormal-cervical-cell-changes]. Accessed on: 20 March 2014.</ref>
# Radical trachelectomy - removal of the uterine cervix and parametria, preserves fertility.
# Radical hysterectomy - advanced cervical carcinoma (Stage IA2 and Stage IB1), recurrent carcinoma.<ref name=pmid20871657>{{Cite journal  | last1 = Ware | first1 = RA. | last2 = van Nagell | first2 = JR. | title = Radical hysterectomy with pelvic lymphadenectomy: indications, technique, and complications. | journal = Obstet Gynecol Int | volume = 2010 | issue =  | pages =  | month =  | year = 2010 | doi = 10.1155/2010/587610 | PMID = 20871657 }}</ref>
 
===Other===
*Total abdominal hysterectomy - for non-cervical pathology, e.g. [[uterine leiomyoma]]s, [[uterine adenomyosis]].
*Radical hysterectomy - for [[endometrial carcinoma]] with endocervical involvement.
 
=Normal histology=
Features:
*The uterine cervix consists of non-keratinized squamous epithelium and simple columnar epithelium.   
*The area of overlap (between squamous & columnar) is known as the "transformation zone".<ref>URL: [http://www.med-ed.virginia.edu/Courses/path/gyn/cervix1.cfm http://www.med-ed.virginia.edu/Courses/path/gyn/cervix1.cfm]. Accessed on: 12 May 2010.</ref>
*The area of overlap (between squamous & columnar) is known as the "transformation zone".<ref>URL: [http://www.med-ed.virginia.edu/Courses/path/gyn/cervix1.cfm http://www.med-ed.virginia.edu/Courses/path/gyn/cervix1.cfm]. Accessed on: 12 May 2010.</ref>
**Also known as "transition zone".
**Also known as "transition zone".  
*Most cervix cancer is squamous cell carcinoma.
 
Notes:
*Considered from the perspective of histology:
**The squamous component is referred to as the ''exocervix'' (or ''ectocervix''<ref>URL: [http://www.cancer.org/cancer/cervicalcancer/detailedguide/cervical-cancer-what-is-cervical-cancer http://www.cancer.org/cancer/cervicalcancer/detailedguide/cervical-cancer-what-is-cervical-cancer]. Accessed on: 27 January 2014.</ref>).
**The simple columnar (or glandular) component is referred to as the ''endocervix''.
 
Images:
*[http://www.proteinatlas.org/dictionary/normal/cervix,+uterine+1 Normal cervix (proteinatlas.org)].
 
==Negative LEEP==
{{Main|LEEP}}
 
==Transformation zone - biopsy==
===Microscopic===
Features:
*Small round cells.
*Usually no halos.
**May be seen in pseudokoilocytes.
*No nuclear membrane irregularities.
*No nuclear hyperchromasia.
 
===Images===
<gallery>
Image: Uterine cervix -- intermed mag.jpg | [[NILM]] with pseudokoilocytes - intermed. mag. (WC)
Image: Uterine cervix -- high mag.jpg | NILM with pseudokoilocytes - high mag. (WC)
Image: Uterine cervix -- very high mag.jpg | NILM with pseudokoilocytes - very high mag. (WC)
Image: Exocervix_--_high_mag.jpg | Benign stripped exocervix - high mag. (WC)
</gallery>
 
www:
*[http://www.flickr.com/photos/euthman/2797778604/in/photostream/ Normal cervix (flickr.com/euthman)].
*[http://www.flickr.com/photos/euthman/2796932803/in/photostream/ CIN I versus normal (flickr.com/euthman)].
 
===Sign out===
<pre>
UTERINE CERVIX, BIOPSY:
- TRANSFORMATION ZONE WITHOUT APPARENT PATHOLOGY.
- NEGATIVE FOR DYSPLASIA.
</pre>
 
<pre>
UTERINE CERVIX, BIOPSY:
- SQUAMOUS MUCOSA WITHOUT APPARENT PATHOLOGY.
- STRIPPED ENDOCERVICAL EPITHELIUM WITHOUT APPARENT PATHOLOGY.
- NEGATIVE FOR DYSPLASIA.
</pre>


=Normal histology=
==Endocervical glands==
==Endocervical glands==
===Microscopic===
Features:
Cervical glands normally have round nuclei and vaguely resemble the colonic mucosa.   
Cervical glands normally have round nuclei and vaguely resemble the colonic mucosa.   
Notes:
*If the nuclei are columnar think cancer!  This is like in the colon-- columnar nuclei = badness.
*If the nuclei are columnar think cancer!  This is like in the colon-- columnar nuclei = badness.
**Memory device: The Cs (Cervix & Colon) are similar.
*Endocervical epithelium (ECE) has a morphology similar to the epithelium of [[secretory phase endometrium]] (SPE):
**ECE - grey foamy appearing cytoplasm.
**SPE - eosinophilic cytoplasm.
***Most useful feature to differentiate ECE and SPE is the accompanying stroma.
===Sign out===
<pre>
UTERINE ENDOCERVIX, CURETTAGE:
- ENDOCERVICAL MUCOSA AND STRIPPED ENDOCERVICAL EPITHELIUM WITHIN NORMAL LIMITS.
</pre>
====Inflamed with squamous epithelium====
<pre>
UTERINE ENDOCERVIX, CURETTAGE:
- BENIGN STRIPPED ENDOCERVICAL EPITHELIUM AND SCANT INFLAMED ENDOCERVICAL MUCOSA.
- VERY SCANT SUPERFICIAL SQUAMOUS EPITHELIUM WITHOUT APPARENT PATHOLOGY.
</pre>
====Squamous epithelium present====
<pre>
UTERINE ENDOCERVIX, CURETTAGE:
- ENDOCERVICAL MUCOSA WITHIN NORMAL LIMITS.
- SQUAMOUS EPITHELIUM WITHOUT APPARENT PATHOLOGY.
</pre>
====Endometrium present====
<pre>
UTERINE ENDOCERVIX, CURETTAGE:
- ENDOCERVICAL MUCOSA WITHIN NORMAL LIMITS.
- SCANT NON-PROLIFERATIVE ENDOMETRIUM.
</pre>
====Inflamed====
<pre>
UTERINE ENDOCERVIX, CURETTAGE:
- INFLAMED ENDOCERVICAL MUCOSA.
- REACTIVE SQUAMOUS EPITHELIUM.
- NEGATIVE FOR MALIGNANCY.
</pre>
<pre>
UTERINE ENDOCERVIX, CURETTAGE:
- BENIGN INFLAMED ENDOCERVICAL MUCOSA.
- STRIPPED ENDOCERVICAL EPITHELIUM WITHIN NORMAL LIMITS.
</pre>
====No stroma present====
<pre>
UTERINE ENDOCERVIX, CURETTAGE:
- STRIPPED ENDOCERVICAL EPITHELIUM WITHOUT APPARENT PATHOLOGY.
</pre>
====Limited tissue====
<pre>
UTERINE ENDOCERVIX, CURETTAGE:
- ONE MINUTE FRAGMENT OF ENDOCERVICAL EPITHELIUM WITHOUT APPARENT PATHOLOGY,
SEE COMMENT.
- VERY SCANT SUPERFICIAL SQUAMOUS EPITHELIUM WITHOUT APPARENT PATHOLOGY.
COMMENT:
The assessment is severely limited by the small amount of tissue. A re-biopsy
should be considered within the clinical context.
</pre>
<pre>
UTERINE ENDOCERVIX, CURETTAGE:
- ONE MINUTE FRAGMENT OF ENDOCERVICAL EPITHELIUM WITHOUT APPARENT PATHOLOGY,
SEE COMMENT.
- VERY SCANT SUPERFICIAL SQUAMOUS EPITHELIUM WITHOUT APPARENT PATHOLOGY.


Memory device: The Cs (Cervix & Colon) are similar.
COMMENT:
The assessment is severely limited by the small amount of tissue. Clinical correlation is
suggested.
</pre>
 
<pre>
UTERINE ENDOCERVIX, CURETTAGE:
- BENIGN SQUAMOUS EPITHELIUM WITH METAPLASTIC CHANGE.
- VERY SCANT BENIGN ENDOCERVICAL EPITHELIUM, SUBOPTIMAL SAMPLING.
</pre>
 
<pre>
UTERINE CERVIX, BIOPSY:
- MINUTE FRAGMENTS OF SUPERFICIAL SQUAMOUS EPITHELIUM WITHOUT APPARENT PATHOLOGY.
- SCANT MUCOUS AND INFLAMMATORY CELLS.
- SEE COMMENT.
 
COMMENT:
The assessment is severely limited by the small amount of tissue. A re-biopsy should be
considered within the clinical context.
</pre>
 
=Inadequate biopsy=
*Unfortunately, inadequate biopsies are common.
 
==Endocervix==
===Sign out===
====No endocervical epithelium====
<pre>
UTERINE ENDOCERVIX, CURETTAGE:
- SQUAMOUS EPITHELIUM WITHOUT APPARENT PATHOLOGY.
- NO ENDOCERVICAL EPITHELIUM IDENTIFIED.
- MUCOUS AND INFLAMMATORY CELLS.
</pre>
 
====No epithelium====
<pre>
UTERINE ENDOCERVIX, CURETTAGE:
- MUCOUS AND INFLAMMATORY CELLS.
- NO EPITHELIUM IDENTIFIED.
</pre>
 
====No tissue====
<pre>
UTERINE ENDOCERVIX, CURETTAGE:
- NO TISSUE PRESENT, SEE COMMENT.
 
COMMENT:
No tissue identified on gross or microscopy.
</pre>
 
<pre>
UTERINE ENDOCERVIX, CURETTAGE:
- NO TISSUE PRESENT, SEE COMMENT.
 
COMMENT:
No tissue identified on microscopy. No tissue is seen on inspection of the paraffin block.
</pre>


=Where to start=
=Where to start=
Line 24: Line 240:
#Identify possible endocervical lesions.
#Identify possible endocervical lesions.


=Benign (common)=
==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=
==Nabothian cyst==
==Nabothian cyst==
===General===
*Benign.
*Common.
===Gross===
*Bump.
*Pale colour.
DDx - clinical:
*[[Benign endocervical polyp]].
====Image====
<gallery>
Image:Ovula_nabothi.jpg | Nabothian cyst. (WC/euthman)
</gallery>
===Microscopic===
Features:
Features:
*Simple endocervical cyst.
*Simple endocervical cyst.
**Lined by endocervical epithelial cells.
**Usually lined by endocervical epithelial cells - may be flattened.
***Columnar morphology with large clear, apical vacuoles.  
***Columnar morphology with large clear, apical vacuoles.  
**+/-Macrophages.
**+/-Mucus.
Note:
*May be lined by tubal epithelium.
**Cilia.
**High [[NC ratio]] ~ 1:1.{{fact}}


Image:
Image:
*[http://www.gfmer.ch/selected_images_v2/detail_list.php?cat1=4&cat2=23&cat3=130&cat4=5&stype=n Nabothian cyst (gfmer.ch)].
*[http://www.gfmer.ch/selected_images_v2/detail_list.php?cat1=4&cat2=23&cat3=130&cat4=5&stype=n Nabothian cyst (gfmer.ch)].
===Sign out===
<pre>
CERVICAL POLYP, REMOVAL:
- BENIGN POLYPOID FRAGMENT OF EXOCERVICAL MUCOSA WITH NABOTHIAN CYSTS AND
BENIGN ENDOCERVICAL EPITHELIUM.
</pre>
<pre>
POLYPOID LESION ("CERVICAL POLYP"), EXCISION:
- POLYPOID NABOTHIAN CYST.
</pre>


==Tunnel cluster==
==Tunnel cluster==
Line 38: Line 299:
*Benign.<ref name=pmid12352183>{{Cite journal  | last1 = Nucci | first1 = MR. | title = Symposium part III: tumor-like glandular lesions of the uterine cervix. | journal = Int J Gynecol Pathol | volume = 21 | issue = 4 | pages = 347-59 | month = Oct | year = 2002 | doi =  | PMID = 12352183 }}</ref>
*Benign.<ref name=pmid12352183>{{Cite journal  | last1 = Nucci | first1 = MR. | title = Symposium part III: tumor-like glandular lesions of the uterine cervix. | journal = Int J Gynecol Pathol | volume = 21 | issue = 4 | pages = 347-59 | month = Oct | year = 2002 | doi =  | PMID = 12352183 }}</ref>
*Not the same as ''[[microglandular hyperplasia]]''.<ref name=pmid10757337>{{Cite journal  | last1 = Zaino | first1 = RJ. | title = Glandular lesions of the uterine cervix. | journal = Mod Pathol | volume = 13 | issue = 3 | pages = 261-74 | month = Mar | year = 2000 | doi = 10.1038/modpathol.3880047 | PMID = 10757337 | URL = http://www.nature.com/modpathol/journal/v13/n3/full/3880047a.html }}</ref>
*Not the same as ''[[microglandular hyperplasia]]''.<ref name=pmid10757337>{{Cite journal  | last1 = Zaino | first1 = RJ. | title = Glandular lesions of the uterine cervix. | journal = Mod Pathol | volume = 13 | issue = 3 | pages = 261-74 | month = Mar | year = 2000 | doi = 10.1038/modpathol.3880047 | PMID = 10757337 | URL = http://www.nature.com/modpathol/journal/v13/n3/full/3880047a.html }}</ref>
*Considered a special type of [[nabothian cyst]].<ref name=pmid12640157>{{Cite journal  | last1 = Okamoto | first1 = Y. | last2 = Tanaka | first2 = YO. | last3 = Nishida | first3 = M. | last4 = Tsunoda | first4 = H. | last5 = Yoshikawa | first5 = H. | last6 = Itai | first6 = Y. | title = MR imaging of the uterine cervix: imaging-pathologic correlation. | journal = Radiographics | volume = 23 | issue = 2 | pages = 425-45; quiz 534-5 | month =  | year =  | doi =  | PMID = 12640157 | URL = http://radiographics.rsna.info/content/23/2/425.full }}</ref>


===Microscopic===
===Microscopic===
Line 50: Line 312:
Notes:
Notes:
#Usually '''no''' nuclear atypia and '''no''' mitotic activity.
#Usually '''no''' nuclear atypia and '''no''' mitotic activity.
#Important only as one could possibly mistake it as ''minimal deviation adenocarcinoma'', [[AKA]] ''adenoma malignum''.<ref name=pmid2764221>{{cite journal |author=Gilks CB, Young RH, Aguirre P, DeLellis RA, Scully 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 |year=1989 |month=September |pmid=2764221 |doi= |url=}}</ref>  
#Important only as one could possibly mistake it as ''[[minimal deviation adenocarcinoma of the uterine cervix|minimal deviation adenocarcinoma]]'', [[AKA]] ''adenoma malignum''.<ref name=pmid2764221>{{cite journal |author=Gilks CB, Young RH, Aguirre P, DeLellis RA, Scully 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 |year=1989 |month=September |pmid=2764221 |doi= |url=}}</ref>  


Images:
====Images====
*[[WC]]:
<gallery>
**[http://commons.wikimedia.org/wiki/File:Tunnel_cluster_-_intermed_mag.jpg Tunnel cluster - intermed. mag. (WC)].
Image:Tunnel_cluster_-_very_low_mag.jpg | Tunnel cluster - very low mag. (WC)
**[http://commons.wikimedia.org/wiki/File:Tunnel_cluster_-_very_high_mag.jpg Tunnel cluster - very high mag. (WC)].
Image:Tunnel_cluster_-_low_mag.jpg | Tunnel cluster - low mag. (WC)
*[[www]]:
Image:Tunnel_cluster_-_intermed_mag.jpg | Tunnel cluster - intermed. mag. (WC)
**[http://surgpath4u.com/caseviewer.php?case_no=477 Tunnel cluster (surgpath4u.com)].
Image:Tunnel_cluster_-_high_mag.jpg | Tunnel cluster - high mag. (WC)
**[http://www.ajronline.org/content/195/2/517/F30.expansion Tunnel cluster (ajronline.org)].
Image:Tunnel_cluster_-_very_high_mag.jpg | Tunnel cluster - very high mag. (WC)
</gallery>
[[www]]:
*[http://surgpath4u.com/caseviewer.php?case_no=477 Tunnel cluster (surgpath4u.com)].
*[http://www.ajronline.org/content/195/2/517/F30.expansion Tunnel cluster (ajronline.org)].


==Microglandular hyperplasia==
==Microglandular hyperplasia==
:'''''Not''' to be confused with [[microglandular adenosis]]''.
:'''''Not''' to be confused with [[microglandular adenosis]]''.
*Abbreviated ''MGH''.
*Abbreviated ''MGH''.
===General===
*[[AKA]] ''microglandular change''.
*Associated with [[OCP]] use.<ref name=pmid10757337>{{Cite journal  | last1 = Zaino | first1 = RJ. | title = Glandular lesions of the uterine cervix. | journal = Mod Pathol | volume = 13 | issue = 3 | pages = 261-74 | month = Mar | year = 2000 | doi = 10.1038/modpathol.3880047 | PMID = 10757337 | URL = http://www.nature.com/modpathol/journal/v13/n3/full/3880047a.html }}</ref>
{{Main|Microglandular hyperplasia}}
 
===Microscopic===
Features:<ref name=pmid10757337/>
*Cytologically benign - '''important'''.
**Usually cuboidal morphology.
**Typically clear cytoplasm.
*Crowded small glands (classic), reticular or solid.
 
Significant negatives:
*Nuclear atypia absent.
*[[NC ratio]] not significantly increased.
 
DDx:
*[[Adenocarcinoma of the uterine cervix]], in situ.
*Endometrial mucinous microglandular adenocarcinoma - very rare.<ref name=pmid16306789>{{Cite journal  | last1 = Giordano | first1 = G. | last2 = D'Adda | first2 = T. | last3 = Gnetti | first3 = L. | last4 = Merisio | first4 = C. | last5 = Melpignano | first5 = M. | title = Endometrial mucinous microglandular adenocarcinoma: morphologic, immunohistochemical features, and emphasis in the human papillomavirus status. | journal = Int J Gynecol Pathol | volume = 25 | issue = 1 | pages = 77-82 | month = Jan | year = 2006 | doi =  | PMID = 16306789 }}</ref>
 
Images:
*[http://www.nature.com/modpathol/journal/v13/n3/fig_tab/3880047f14.html#figure-title MGH (nature.com)].
*[http://sunnybrook.ca/uploads/cx_MGH_5_vd.jpg MGH (sunnybrook.ca)].<ref>URL: [http://sunnybrook.ca/content/?page=Dept_LabS_APath_GynPath_ImgAt_Cvx_neo_micro http://sunnybrook.ca/content/?page=Dept_LabS_APath_GynPath_ImgAt_Cvx_neo_micro]. Accessed on: 25 February 2012.</ref>


==Wolffian duct hyperplasia==
==Wolffian duct hyperplasia==
Line 93: Line 340:
*Abundant small tubules with a simple cuboidal epithelium.
*Abundant small tubules with a simple cuboidal epithelium.
*Round small bland nucleus.
*Round small bland nucleus.
DDx:
*[[Wolffian duct remnant]].


===Stains===
===Stains===
Line 98: Line 348:


==Squamous metaplasia of the uterine cervix==
==Squamous metaplasia of the uterine cervix==
*Abbreviated ''SMC''.
{{Main|Squamous metaplasia of the uterine cervix}}
==Reactive squamous epithelium of the uterine cervix==
*[[AKA]] ''reactive squamous epithelium''.
*[[AKA]] ''reactive changes''.
===General===
===General===
*Benign process: columnar cells -> squamoid cells.
*Common.
**Biologic response to irritation and/or inflammation.
*Individuals with persistent inflammation on [[Pap test]] may have occult [[SIL]].<ref name=pmid21768670>{{Cite journal  | last1 = Bhutia | first1 = K. | last2 = Puri | first2 = M. | last3 = Gami | first3 = N. | last4 = Aggarwal | first4 = K. | last5 = Trivedi | first5 = SS. | title = Persistent inflammation on Pap smear: does it warrant evaluation? | journal = Indian J Cancer | volume = 48 | issue = 2 | pages = 220-2 | month =  | year =  | doi = 10.4103/0019-509X.82901 | PMID = 21768670 }}</ref>


===Microscopic===
===Microscopic===
Features:
Features:
* Nuclei are uniform size and round.
#Inflammation - '''key feature'''.
** [[Nucleoli]] present.
#*Lymphocytes.
* +/-Intercellular bridges (due to edema) - common.
#*Plasma cells.
* Uniform cell spacing, i.e. no crowding.  
#Mild nuclear enlargement. †
#Nucleoli - '''important'''.


Negatives:
Note:
* No mitoses (think cancer/CIN if you see 'em).
*† Normal squamous cell nuclei are approximately 8 μm.<ref>URL: [http://www.curran.pwp.blueyonder.co.uk/cytology.htm http://www.curran.pwp.blueyonder.co.uk/cytology.htm]. Accessed on: 5 November 2012.</ref>
* Usually no hyperchromatism (think cancer/CIN if you see it).
**Mild enlargement ~ 2-3x normal.
 
**CIN I nuclei are ~ 3x normal (24 μm).
Notes:
*NC ratio high - possible to confuse CIN III.


DDx:
DDx:
*[[CIN III]].
*[[Cervical intraepithelial neoplasia I]].
*[[Squamous cell carcinoma of the uterine cervix]].
*[[CIN II|Cervical intraepithelial neoplasia II]].
*[[NILM]].


===IHC===
===IHC===
*p16 +ve - in SCC; a poor man's test for [[HPV]].
*p16 -ve.
*Ki-67 - stains a large number of cells; proliferation marker.


=Non-invasive=
===Sign out===
==Cervical intraepithelial neoplasia==
<pre>
*Abbreviated ''CIN''.
UTERINE CERVIX, BIOPSY:
- REACTIVE SQUAMOUS EPITHELIUM.
- BENIGN ENDOCERVICAL GLANDS.
- NEGATIVE FOR MALIGNANCY.
</pre>
 
<pre>
COMMENT:
The squamous epithelium is negative for p16 staining. Ki-67 staining is predominantly in
the lower third of the epithelium.
</pre>


==Tubal metaplasia of the uterine cervix==
*[[AKA]] ''tubal metaplasia'', abbreviated ''TM''.
===General===
===General===
*Refers to changes in squamous epithelium.
*Benign.
*Mimics the appearance of [[Endocervical adenocarcinoma in situ|AIS]] - especially at low power.
 
===Microscopic===
Features - like the [[fallopian tube]]:
*Nuclear crowding vis-à-vis benign endocervical epithelium (low power).
*Mixed cell population (high power):
**Peg cells - "tall" and "skinny".
***Columnar/golf tee-like appearance.
**Ciliated cells - cilia, pale cytoplasm, round central nucleus.
**Secretory cells - non-ciliated, basophilic cytoplasm, round small basal nuclei.
 
DDx:
*[[Endocervical adenocarcinoma in situ]].


Grades (squamous intraepithelial neoplasia):
Image:
*CIN I = mild dysplasia.
*[http://www.nature.com/modpathol/journal/v13/n3/fig_tab/3880047f17.html Tubal metaplasia (nature.com)].
*CIN II = moderate dysplasia.
*CIN III = severe dysplasia.


Bethesda system:
===IHC===
*LSIL ([[low-grade squamous intraepithelial lesion]]) = CIN I.
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>
*HSIL ([[high-grade squamous intraepithelial lesion]]) = CIN II, CIN III.
*[[Vimentin]] +ve.
*CEA -ve/+ve.
*p16 -ve.{{fact}}


====Treatment====
==Atrophy of the uterine cervix==
*[[LSIL]]: nothing, as usually regress.
*[[AKA]] ''cervical atrophy''.
*[[HSIL]]: excision (e.g. cone, LEEP, laser) + followup.
*[[AKA]] ''atrophy of the cervix''.
*[[AKA]] ''cervix with atrophic changes''.
{{Main|Uterine cervix with atrophic changes}}
 
==Radiation changes of the endocervical epithelium==
{{Main|Radiation changes}}
{{Main|Radiation changes in cervical cytology}}
===General===
*Uncommon.
*Clinical history: radiation treatment for cervical carcinoma.<ref name=pmid2209348/>


LEEP = Loop Electrosurgical Excision Procedure (LEEP) Procedure.  
===Microscopic===
*Used for squamous lesions -- pathologist typically gets several pieces.
Features:<ref name=pmid2209348>{{Cite journal  | last1 = Frierson | first1 = HF. | last2 = Covell | first2 = JL. | last3 = Andersen | first3 = WA. | title = Radiation changes in endocervical cells in brush specimens. | journal = Diagn Cytopathol | volume = 6 | issue = 4 | pages = 243-7 | month =  | year = 1990 | doi =  | PMID = 2209348 }}</ref>
*Nuclear enlargement with a normal [[NC ratio]].
*+/-Coarse chromatin.
*+/-Nucleoli.
*+/-Multinucleation - very common.
*Histiocytes - common.


Cone
==Reactive endocervical cells==
*Used for endocervical lesions, i.e. adenocarcinoma in situ (AIS).
===General===
*Pathologist gets a ring or donut-shaped piece of tissue.
*Benign.


===Microscopic===
===Microscopic===
Features:
Features:
*CIN I = cytoplasmic halos (koilocytic atypia), atypical cells close to basement membrane only.
*Mild nuclear enlargement.
**Nuclear enlargement -- >=3:1 enlarged nucleus:normal nucleus.
*+/-Multinucleation.<ref>URL: [http://www.surgpath4u.com/caseviewer.php?case_no=229 http://www.surgpath4u.com/caseviewer.php?case_no=229]. Accessed on: 2 January 2014.</ref>
**Binucleation may be seen (cytopathic effect of [[HPV]]).<ref name=pmid11491378>{{cite journal |author=Roteli-Martins CM, Derchain SF, Martinez EZ, Siqueira SA, Alves VA, Syrjänen KJ |title=Morphological diagnosis of HPV lesions and cervical intraepithelial neoplasia (CIN) is highly reproducible |journal=Clin Exp Obstet Gynecol |volume=28 |issue=2 |pages=78–80 |year=2001 |pmid=11491378 |doi= |url=}}</ref>
*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.
*CIN III = same changes as in CIN II + outer third (or full thickness).
Ref.:<ref>{{Ref PBoD|1075-6}}</ref>


Notes:
Notes:
#Hyperchromasia is a very useful feature for identifying CIN (particularly at low power, i.e. 25x).
DDx of multinucleated endocervical cells:
#Koilocytes are the key feature of CIN I.
*[[HSV]].<ref name=pmid4352382>{{Cite journal  | last1 = Naib | first1 = ZM. | last2 = Nahmias | first2 = AJ. | last3 = Josey | first3 = WE. | last4 = Zaki | first4 = SA. | title = Relation of cytohistopathology of genital herpesvirus infection to cervical anaplasia. | journal = Cancer Res | volume = 33 | issue = 6 | pages = 1452-63 | month = Jun | year = 1973 | doi =  | PMID = 4352382 | URL = http://cancerres.aacrjournals.org/cgi/pmidlookup?view=long&pmid=4352382 }}</ref>
#Koilocytes are ''not'' considered to be part of a CIN II lesion or CIN III lesion.
*Benign endocervical cells.
#Large irregular nuclei are not required for CIN II... but you should think about it.
#Some mild changes at the squamo-columnar junction are expected.
#Look for the location of mitoses...
#* If there is a mitosis in the inner third (of the epithelial layer) = at least CIN I. 
#* 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.
#Nucleoli are usually NOT present in CIN.<ref>STC. January 2009.</ref>
#*Nucleoli are common in reactive changes.<ref>STC. January 2009.</ref>
#The most probably place for CIN is the posterior cervix (6 o'clock position) - risk is marginally increased.<ref name=pmid16378031>{{Cite journal  | last1 = Pretorius | first1 = RG. | last2 = Zhang | first2 = X. | last3 = Belinson | first3 = JL. | last4 = Zhang | first4 = WH. | last5 = Ren | first5 = SD. | last6 = Bao | first6 = YP. | last7 = Qiao | first7 = YL. | title = Distribution of cervical intraepithelial neoplasia 2, 3 and cancer on the uterine cervix. | journal = J Low Genit Tract Dis | volume = 10 | issue = 1 | pages = 45-50 | month = Jan | year = 2006 | doi =  | PMID = 16378031 }}
</ref>


====Koilocytes versus benign squamous====
====Images====
Koilocytes:
<gallery>
*Perinuclear clearing.
Image: Endocervical epithelium with multinucleation -- high mag.jpg | Multinucleated endocervix - high mag.
*Nuclear changes.  
Image: Endocervical epithelium with multinucleation -- very high mag.jpg | Multinucleated endocervix - very high mag.
**Size similar (or larger) to those in the basal layer of the epithelium.
Image: Endocervical epithelium with multinucleation -- extremely high mag.jpg | Multinucleated endocervix - extremely high mag.
**Nuclear enlargement should be evident on low power, i.e. 25x. <ref>V. Dube 2008.</ref>
</gallery>
**Central location - nucleus should be smack in the middle of the cell.
www:
*[http://www.surgpath4u.com/caseviewer.php?case_no=229 Reactive endocervical cells (surgpath4u.com)].


Notes:
=Non-invasive=
# Both perinuclear clearing and nuclear changes are essential.
==Cervical intraepithelial neoplasia==
# Benign cells have a small nucleus that is peripheral.
*Previously known as ''cervical intraepithelial neoplasia'' and ''cervical dysplasia''.
{{Main|Squamous intraepithelial lesion of the uterine cervix}}


==Endocervical adenocarcinoma in situ==
==Endocervical adenocarcinoma in situ==
:''For the cytology see [[Gynecologic_cytopathology#Endocervical_adenocarcinoma_in_situ]]''
:''For the cytology see [[Gynecologic cytopathology#Endocervical adenocarcinoma in situ]]''
*[[AKA]] ''adenocarcinoma in situ'', abbreviated ''AIS''.
*[[AKA]] ''adenocarcinoma in situ'', abbreviated ''AIS''.
===General===
{{Main|Endocervical adenocarcinoma in situ}}
*Usually to [[HPV]].
*May be found together with squamous neoplasias of the cervix.
*AIS of the cervix is much less common than squamous dysplasia of the cervix/SCC of the cervix.
 
===Microscopic===
Features:<ref name=pmid10757337>{{Cite journal  | last1 = Zaino | first1 = RJ. | title = Glandular lesions of the uterine cervix. | journal = Mod Pathol | volume = 13 | issue = 3 | pages = 261-74 | month = Mar | year = 2000 | doi = 10.1038/modpathol.3880047 | PMID = 10757337 | url = http://www.nature.com/modpathol/journal/v13/n3/full/3880047a.html }}</ref>
#Nuclear changes - '''key feature''':
#*Variable nuclear stratification.
#**Nuclear crowding/pseudostratification.
#*Nuclear enlargement.
#**Often cigar-shaped nuclei.
#*Coarse chromatin.
#*Small nucleolus or [[nucleoli]].
#+/-Mitoses.
#+/-Reduced cytoplasmic mucin.
#Preservation of glandular architecture.
#*Normal gland spacing - lack of complexity.
#*Normal gland depth (subjective).
 
DDx:
*[[Endocervical adenocarcinoma]].


=Cancer=
=Cancer=
Line 218: Line 479:
{{Main|Squamous cell carcinoma}}
{{Main|Squamous cell carcinoma}}
*[[AKA]] ''cervical squamous cell carcinoma''.
*[[AKA]] ''cervical squamous cell carcinoma''.
===General===
{{Main|Squamous cell carcinoma of the uterine cervix}}
*Most common type of cervical cancer.
 
Risk factors:
*Low socioeconomic status.
*Smoking.
*Early first intercourse.
*High risk partners.
*[[Human papillomavirus]] (HPV) infection, esp. "high risk HPV".
**HPV 16 closely assoc. with SCC.<ref name=pmid15551313>{{Cite journal  | last1 = De Boer | first1 = MA. | last2 = Peters | first2 = LA. | last3 = Aziz | first3 = MF. | last4 = Siregar | first4 = B. | last5 = Cornain | first5 = S. | last6 = Vrede | first6 = MA. | last7 = Jordanova | first7 = ES. | last8 = Fleuren | first8 = GJ. | title = Human papillomavirus type 18 variants: histopathology and E6/E7 polymorphisms in three countries. | journal = Int J Cancer | volume = 114 | issue = 3 | pages = 422-5 | month = Apr | year = 2005 | doi = 10.1002/ijc.20727 | PMID = 15551313 }}</ref>
 
===Microscopic===
Features:
*Penetration of basement membrane.
**May be challenging to determine.
*Nuclear atypia.
 
SCC of the cervix versus CIN III:
Invasive cancer look for:
*Eosinophilia.
*Extra large nuclei, i.e. nuclei 5x normal size.
*Stromal inflammation (lymphocytes, plasma cells).
*Long rete ridges.
*Numerous beeds/blobs of epithelial cells that seem unlikely to be rete ridges.
*Desmoplastic stroma - increased cellularity, spindle cell morphology.
 
Grading:<ref>{{Ref PBoD|1077}}</ref>
#Well-differentiated (keratinizing).
#Moderately differentiated (nonkeratinizing).
#Poorly differentiated.
 
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]].


==Adenocarcinoma of the uterine cervix==
==Adenocarcinoma of the uterine cervix==
*[[AKA]] ''endocervical adenocarcinoma''.
*[[AKA]] ''endocervical adenocarcinoma''.
*[[AKA]] ''cervical adenocarcinoma''.
*[[AKA]] ''cervical adenocarcinoma''.
===General===
{{Main|Adenocarcinoma of the uterine cervix}}
*Adenocarcinoma of the cervix is much less common than squamous dysplasia of the cervix/SCC of the cervix.
*Arises from the endocervical glands.
 
===Microscopic===
Features:
*Stromal changes - "[[desmoplastic stroma]]/[[desmoplastic reaction]]".
**Fibrosis/streaming cells.
*Gland fusion.
*Glands too deep -- very fuzzy criterion.
 
Notes:
*AIS changes - similar to [[colon|colonic]] dysplasia.
*AIS may occur together with CIN.
**Not infrequently they (AIS, CIN) occur together - both are due, indirectly, to HPV infection.
*May be difficult to be certain of invasion.
 
DDx:
*[[Microglandular hyperplasia]] - [[NC ratio]] normal, no nuclear atypia.
*[[Endocervical adenocarcinoma in situ]].
*Metastatic adenocarcinoma.
 
Images:
*[http://commons.wikimedia.org/wiki/File:Cervical_adenocarcinoma_-_low_mag.jpg Cervical adenocarcinoma - low mag. (WC)].
*[http://commons.wikimedia.org/wiki/File:Cervical_adenocarcinoma_-_intermed_mag.jpg Cervical adenocarcinoma - intermed. mag. (WC)].
*[http://commons.wikimedia.org/wiki/File:Cervical_adenocarcinoma_-_high_mag.jpg Cervical adenocarcinoma - high mag. (WC)].
 
===IHC===
Uterus vs. cervix:<ref>LAE. 15 January 2009.</ref>
*Cervix (typically): CEA +ve, p16 +ve.
**ER -ve, PR -ve, vimentin -ve.
*Uterus (typically): vimentin +ve, ER +ve, PR +ve.
**CEA -ve, p16 -ve.


=Uncommon non-invasive=
=Uncommon non-invasive=
==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=
There are a number of uncommon type of cervical cancer.
There are a number of uncommon type of cervical cancer.


==Adenosquamous carcinoma==
==Serous carcinoma of the uterine cervix==
===General===
*Poor prognosis.<ref name=pmid21876330>{{Cite journal  | last1 = Togami | first1 = S. | last2 = Kasamatsu | first2 = T. | last3 = Sasajima | first3 = Y. | last4 = Onda | first4 = T. | last5 = Ishikawa | first5 = M. | last6 = Ikeda | first6 = S. | last7 = Kato | first7 = T. | last8 = Tsuda | first8 = H. | title = Serous adenocarcinoma of the uterine cervix: a clinicopathological study of 12 cases and a review of the literature. | journal = Gynecol Obstet Invest | volume = 73 | issue = 1 | pages = 26-31 | month =  | year = 2012 | doi = 10.1159/000329319 | PMID = 21876330 }}</ref>
*Extremely rare.
 
===Microscopic===
Features:
Features:
*Morphologic features of both squamous carcinoma and adenocarcinoma:
*Like other [[serous carcinoma]]s.
**Adenocarcinoma: gland forming ''or'' mucin vacuoles.
**[[Squamous carcinoma]]: abundant eosinophilic cytoplasm, central nucleus.


Image: [http://commons.wikimedia.org/wiki/File:Adenosquamous_carcinoma_high_mag.jpg Adenosquamous carcinoma - high mag. (WC)].
==Adenosquamous carcinoma of the uterine cervix==
{{Main|Adenosquamous carcinoma of the uterine cervix}}


==Clear cell carcinoma of the uterine cervix==
==Clear cell carcinoma of the uterine cervix==
*[[AKA]] ''cervical clear cell carcinoma''.
{{Main|Clear cell carcinoma of the uterine cervix}}
===General===
*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>
 
===Microscopic===
Features:
*Like [[clear cell carcinoma]] elsewhere:
**+/-Clear cytoplasm.
**Cells have large free/luminal surface area (hobnailing pattern) and small non-free surface.
**Moderate-to-severe [[nuclear pleomorphism]].


==Small cell carcinoma of the cervix==
==Small cell carcinoma of the cervix==
Line 360: Line 529:
*Nests of cells with basaloid rim and squamoid center.
*Nests of cells with basaloid rim and squamoid center.
**Basaloid cells look benign.
**Basaloid cells look benign.
DDx:
*Ectopic [[prostate gland]].


Image:
Image:
Line 365: Line 537:


==Glassy cell carcinoma==
==Glassy cell carcinoma==
===General===
{{Main|Glassy cell carcinoma}}
*Rare.
*Rapid growth, poor prognosis.<ref name=pmid19527406>{{Cite journal  | last1 = Nasu | first1 = K. | last2 = Takai | first2 = N. | last3 = Narahara | first3 = H. | title = Multimodal treatment for glassy cell carcinoma of the uterine cervix. | journal = J Obstet Gynaecol Res | volume = 35 | issue = 3 | pages = 584-7 | month = Jun | year = 2009 | doi = 10.1111/j.1447-0756.2008.00968.x | PMID = 19527406 }}</ref>
 
===Microscopic===
Features:<ref name=pmid11393075>{{Cite journal  | last1 = Reis-Filho | first1 = JS. | last2 = Fillus Neto | first2 = J. | last3 = Schonemann | first3 = E. | last4 = Sanderson | first4 = A. | last5 = Schmitt | first5 = FC. | title = Glassy cell carcinoma of the uterine cervix. Report of a case with cytohistologic and immunohistochemical study. | journal = Acta Cytol | volume = 45 | issue = 3 | pages = 407-10 | month =  | year =  | doi =  | PMID = 11393075 }}</ref>
*Epithelioid cells in sheets or cords.
*Round/oval nucleus.
*One or more prominent nucleoli.
*Abundant finely vacuolated eosinophilic to amphophilic cytoplasm.
*Distinct cell borders.
*Inflammation - esp. eosinophils.<ref>URL: [http://www.webpathology.com/image.asp?n=2&Case=561 http://www.webpathology.com/image.asp?n=2&Case=561]. Accessed on: 4 September 2011.</ref>
 
DDx:
*[[Squamous carcinoma]].
 
Images:
*[[WC]]:
**[http://commons.wikimedia.org/wiki/File:Glassy_cell_carcinoma_-_low_mag.jpg GCC - low mag. (WC)].
**[http://commons.wikimedia.org/wiki/File:Glassy_cell_carcinoma_-_high_mag.jpg GCC - high mag. (WC)].
*www:
**[http://www.webpathology.com/image.asp?n=1&Case=561 GCC - low mag. (webpathology.com)].
**[http://www.webpathology.com/image.asp?n=2&Case=561 GCC - high mag. (webpathology.com)].
**[http://path.upmc.edu/cases/case100/dx.html GCC - several images (upmc.edu)].
 
===Stains===
*[[PAS stain]] - marks plasma membrane.<ref name=pmid15318016>{{Cite journal  | last1 = Deshpande | first1 = AH. | last2 = Kotwal | first2 = MN. | last3 = Bobhate | first3 = SK. | title = Glassy cell carcinoma of the uterine cervix a rare histology. Report of three cases with a review of the literature. | journal = Indian J Cancer | volume = 41 | issue = 2 | pages = 92-5 | month =  | year =  | doi =  | PMID = 15318016 | URL = http://www.indianjcancer.com/text.asp?2004/41/2/92/12353}}</ref>


==Villoglandular adenocarcinoma of the cervix==
==Villoglandular adenocarcinoma of the cervix==
Line 412: Line 558:
*Serous carcinoma of the cervix.
*Serous carcinoma of the cervix.


Images:
====Images====
*www:
www:
**[http://www.webpathology.com/image.asp?n=11&Case=560 VGA (webpathology.com)].
*[http://www.webpathology.com/image.asp?n=11&Case=560 VGA (webpathology.com)].
*[[WC]]:
<gallery>
**[http://commons.wikimedia.org/wiki/File:Villoglandular_adenocarcinoma_-_very_low_mag.jpg VGA - very low mag. (WC)].
Image:Villoglandular_adenocarcinoma_-_very_low_mag.jpg | VGA - very low mag. (WC)
**[http://commons.wikimedia.org/wiki/File:Villoglandular_adenocarcinoma_-_intermed_mag.jpg VGA - intermed. mag. (WC)].
Image:Villoglandular_adenocarcinoma_-_intermed_mag.jpg | VGA - intermed. mag. (WC)
**[http://commons.wikimedia.org/wiki/File:Villoglandular_adenocarcinoma_-_very_high_mag.jpg VGA - very high mag. (WC)].
Image:Villoglandular_adenocarcinoma_-_very_high_mag.jpg | VGA - very high mag. (WC)
</gallery>


==Mucoepidermoid carcinoma==
==Mucoepidermoid carcinoma of the uterine cervix==
{{Main|Mucoepidermoid carcinoma}}
{{Main|Mucoepidermoid carcinoma}}
===General===
===General===
Line 426: Line 573:


===Microscopic===
===Microscopic===
Features:<ref name=pmid19092631/>
Features:<ref name=pmid1700969/>
*Like [[salivary gland]] tumour.
*[[Squamous cell carcinoma]]-like with:
*#No glands formation.
*#Intracellular mucin.
*#*Classically have ''mucous cells'' - cells with abundant fluffy cytoplasm and large mucin vacuoles - '''key feature'''.
 
Notes:
*Similar to the [[salivary gland]] tumour.<ref name=pmid19092631/>
 
DDx:
*[[Cervical intraepithelial neoplasia]], i.e. [[CIN II]], [[CIN III]].
*Adenosquamous carcinoma.
 
===Stains===
Mucin stains:<ref name=pmid1700969/>
*[[Alcian blue stain]] 
*[[PAS-D|Periodic acid-Schiff-diastase stain]].
 
===IHC===
*CEA +ve.<ref name=pmid1700969>{{Cite journal  | last1 = Thelmo | first1 = WL. | last2 = Nicastri | first2 = AD. | last3 = Fruchter | first3 = R. | last4 = Spring | first4 = H. | last5 = DiMaio | first5 = T. | last6 = Boyce | first6 = J. | title = Mucoepidermoid carcinoma of uterine cervix stage IB. Long-term follow-up, histochemical and immunohistochemical study. | journal = Int J Gynecol Pathol | volume = 9 | issue = 4 | pages = 316-24 | month =  | year = 1990 | doi =  | PMID = 1700969 }}</ref>


===Molecular===
===Molecular===
Like the salivary gland tumour:
Like the salivary gland tumour:
*t(11;19) CRTC1/MAML2.<ref name=pmid19092631/>
*t(11;19) CRTC1/MAML2.<ref name=pmid19092631/>
==Mesonephric adenocarcinoma==
{{Main|Mesonephric adenocarcinoma}}
==Minimal deviation adenocarcinoma of the uterine cervix==
*[[AKA]] ''adenoma malignum''.
*[[AKA]] ''minimal deviation adenocarcinoma'', abbreviated ''MDA''.
{{Main|Minimal deviation adenocarcinoma of the uterine cervix}}


=See also=
=See also=
Line 437: Line 610:
*[[Cervical polyp]].
*[[Cervical polyp]].
*[[Gynecologic cytopathology]].
*[[Gynecologic cytopathology]].
*[[Gynecologic pathology]].


=References=
=References=
{{reflist|2}}
{{reflist|2}}
=External links=
*[http://www.medecine.ups-tlse.fr/dcem1/histologie/courtade/CINtec.pdf Interpretation altas for p16 staining (ups-tlse.fr)].
*[http://www.glowm.com/section_view/heading/Pathology%20of%20Cervical%20Carcinoma/item/230#26011 Cervical carcinoma (glowm.com)].
*[http://www.obgyn.net/gynecological-oncology/electrosurgery-cervical-intraepithelial-neoplasia Treatments for CIN (obgyn.net)].


[[Category:Gynecologic pathology]]
[[Category:Gynecologic pathology]]
Michael
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