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Difference between revisions of "Squamous metaplasia of the uterine cervix"
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Squamous metaplasia of the uterine cervix (view source)
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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]]. | |||
It may be abbreviated '''SMC'''. | |||
==General== | |||
*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=== | |||
<gallery> | |||
Image: Endocervical epithelium and squamous metaplasia -- high mag.jpg | Endocx and SM - high mag. | |||
Image: Endocervical epithelium and squamous metaplasia -- very high mag.jpg | Endocx and SM - very high mag. | |||
</gallery> | |||
www: | |||
*[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)].<ref>URL: [http://nih.techriver.net/view.php?patientId=1 http://nih.techriver.net/view.php?patientId=1]. Accessed on: 17 September 2015.</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. | |||
==See also== | |||
*[[Squamous metaplasia]]. | |||
*[[Uterine cervix]]. | |||
==References== | |||
{{Reflist|2}} | |||
[[Category:Uterine cervix]] | |||
[[Category:Diagnosis]] | |||