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Cervical Histology and Infectious Diseases

Kristyn Feldman

Gross anatomy
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The cervix is actually the lower, narrow portion of the uterus. Its name is derived from the Latin word for "neck." It is cylindrical or conical in shape.

Why its interesting


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Since nearly all cervical neoplasia (abnormal growth) occurs in the presence of HPV, the cervix provides the best-defined model of virus-mediated carcinogenesis in humans to date! Infectious disease + cancer

Normal Histology
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The cervix is covered by both columnar and stratified non-keratinising squamous epithelia. The squamocolumnar junction (SCJ), where these two meet, is the most important cytologic and colposcopic landmark, as this is where over 90% of lower genital tract neoplasia arises.

Mature squamous epithelium (H&E x 400): Different layers starting at the basement membrane (basal, parabasal, intermediate, superficial) are evident. Clear cytoplasm indicates glycogenation. As the cells mature, the nuclei get smaller and the cytoplasm amount increases.

Glandular or Columnar Epithelium


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The glandular or columnar epithelium Covers a variable amount of the ectocervix and lines the endocervical canal. It is comprised of a single layer of mucinsecreting cells. Longitudinal folds and invaginations make up the so-called endocervical glands (they are not true glands).

Endocervical glands (H&E x 400): Actually crypts lined by a single layer of columnar epithelium. Extend to a depth of 5-7 mm.

Changes in the SCJ


The location of the SCJ in relation to the anatomic external os varies with a variety of factors:
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At birth it is at or just above the external opening with the original squamous epithelium outside and the endocervical columnar epithelium on the inside. With growth of the uterus, especially from puberty and throughout reproductive life, the SCJ comes to lie at variable distances below the anatomic external opening.

The border between the stratified squamous epithelium of the ectocervix and the columnar epithelium of the endocervix is called the squamocolumnar junction (SCJ).

The new SCJ


This is a continuous remodeling process that is also influenced by other factors, and occurs throughout the life of a female producing two different SCJs: ! Original SCJ: is the site at which the neonatal squamous epithelium of the ectocervix meets the endocervical columnar epithelium at birth. ! New, functional or physiologic SCJ: newly formed SCJ as a result of the dynamic remodeling that takes place during the life of the female.

Endocervical ectropion. Note everted columnar epithelium, which is reddened and looks like "eroded" tissue

Transformation (transition) zone


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The area, formed by the metaplastic squamous epithelium, between the old and the new SCJ is called the transformation or transition zone (TZ). The new SCJ, and hence the extent of the TZ, can be observed from the vagina. However, in up to 15% of women the TZ extends into the endocervical canal beyond the field of vision from the vagina.

Human papilloma virus (HPV)


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Over 20 serotypes Cause a variety of lesions with the different serotypes associated with different lesions.

Mild dysplasia is usually caused by "low risk" HPV serotypes, 6 and 11 High- grade dysplasia is caused by "high (16 and 18) and moderate (31,33,35) risk" HPV serotypes

Normal

Koilocytes(visibly HPV-infected cells) Notice the binucleate one with the big halo.

Dysplasia, severe. The less cytoplasm, the more severe the dysplasia.

Normal

Border between normal and severe dysplasia. Most conspicuous is the high N/C ratio and the loss of the normal maturation.

List of terms that confused me


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Neoplasia = process of new growth Metaplasia = one adult cell type replaces another adult cell type. It may represent an adaptation of one cell type to another cell type that is more likely to survive in the environment Dysplasia = disordered growth Anaplasia = undifferentiated cell growth (malignant!)

Normal cervical squamous epithelium (left) Dysplastic on the right.

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