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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 | 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 | Polyps associated with the cervix are discussed the ''[[cervical polyp]]'' article. | ||
==Introduction== | ==Introduction== | ||
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==Common benign== | ==Common benign== | ||
Nabothian cyst | ===Nabothian cyst=== | ||
*Simple endocervical cyst. | *Simple endocervical cyst. | ||
**Lined by endocervical epithelial cells. | **Lined by endocervical epithelial cells. | ||
***Columnar morphology with large clear, apical vacuoles. | ***Columnar morphology with large clear, apical vacuoles. | ||
Tunnel cluster | 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)]. | |||
===Tunnel cluster=== | |||
*Benign proliferation of endocervical glands<ref>[http://pathologyoutlines.com/cervix.html#tunnelclusters http://pathologyoutlines.com/cervix.html#tunnelclusters]</ref> | *Benign proliferation of endocervical glands<ref>[http://pathologyoutlines.com/cervix.html#tunnelclusters http://pathologyoutlines.com/cervix.html#tunnelclusters]</ref> | ||
*Important only as one could mistake minimal deviation adenocarcinoma for it. | *Important only as one could mistake minimal deviation adenocarcinoma for it. (???) | ||
==Where to start== | ==Where to start== | ||
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*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 ( | **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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Notes: | Notes: | ||
*Hyperchromasia is a very useful feature for identifying CIN ( | *Hyperchromasia is a very useful feature for identifying CIN (particularly at low power, i.e. 25x). | ||
*Kiolocytes are the key feature of CIN I. | *Kiolocytes are the key feature of CIN I. | ||
*Kiolocytes are ''not'' considered to be part of a CIN II lesion or CIN III lesion. | *Kiolocytes are ''not'' considered to be part of a CIN II lesion or CIN III lesion. | ||
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Pitfalls: | Pitfalls: | ||
* Squamous metaplasia | * Squamous metaplasia. | ||
** If you can trace the squamous cells from a gland to the surface it is less likely to be invasive cancer | ** If you can trace the squamous cells from a gland to the surface it is less likely to be invasive cancer. | ||
See: [http://www.nature.com/modpathol/journal/v15/n3/pdf/3880520a.pdf http://www.nature.com/modpathol/journal/v15/n3/pdf/3880520a.pdf] | See: [http://www.nature.com/modpathol/journal/v15/n3/pdf/3880520a.pdf http://www.nature.com/modpathol/journal/v15/n3/pdf/3880520a.pdf] | ||
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* Intercellular bridges are often seen/edema is often seen. | * Intercellular bridges are often seen/edema is often seen. | ||
* 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) | ||
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===IHC=== | ===IHC=== | ||
Uterus vs. cervix<ref>LAE 15 Jan 2009.</ref> | Uterus vs. cervix:<ref>LAE 15 Jan 2009.</ref> | ||
*Cervix (typically): CEA+, p16+ | *Cervix (typically): CEA+, p16+. | ||
** ... and ER-, PR-, vimentin- | ** ... and ER-, PR-, vimentin-. | ||
*Uterus (typically): vimentin+, ER+, PR+ | *Uterus (typically): vimentin+, ER+, PR+. | ||
** ... and CEA-, p16- | ** ... and CEA-, p16-. | ||
==See also== | ==See also== | ||
*[[Vulvar intraepithelial neoplasia]] | *[[Vulvar intraepithelial neoplasia]]. | ||
*[[Cervical polyp]] | *[[Cervical polyp]]. | ||
==References== | ==References== | ||