13 Uterine Cervix - Libre Pathology

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Uterine cervix
From Libre Pathology
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.
Polyps associated with the cervix are discussed the cervical polyp article.
Cytopathology of the uterine cervix is dealt with in the gynecologic cytopathology article.
Contents
1 Introduction
1.1 Overview
1.2 Colposcopic examination
1.3 Cervical specimens
1.3.1 Cytology
1.3.2 Biopsies
1.3.3 Surgical specimens
1.3.4 Other
2 Normal histology
2.1 Negative LEEP
2.2 Transformation zone - biopsy
2.2.1 Microscopic
2.2.2 Images
2.2.3 Sign out
2.3 Endocervical glands
2.3.1 Microscopic
2.3.2 Sign out
2.3.2.1 Inflamed with squamous epithelium
2.3.2.2 Squamous epithelium present
2.3.2.3 Endometrium present
2.3.2.4 Inflamed
2.3.2.5 No stroma present
2.3.2.6 Limited tissue
3 Inadequate biopsy
3.1 Endocervix
3.1.1 Sign out
3.1.1.1 No endocervical epithelium
3.1.1.2 No epithelium
3.1.1.3 No tissue
4 Where to start
4.1 Benign entities of the cervix
5 Benign
5.1 Nabothian cyst
5.1.1 General
5.1.2 Gross
5.1.2.1 Image
https://librepathology.org/w/index.php?title=Uterine_cervix&printable=yes 1/21
5.1.3 Microscopic
5.1.4 Sign out
5.2 Tunnel cluster
5.2.1 General
5.2.2 Microscopic
5.2.2.1 Images
5.3 Microglandular hyperplasia
5.4 Wolffian duct hyperplasia
5.4.1 General
5.4.2 Microscopic
5.4.3 Stains
5.5 Squamous metaplasia of the uterine cervix
5.6 Reactive squamous epithelium of the uterine cervix
5.6.1 General
5.6.2 Microscopic
5.6.3 IHC
5.6.4 Sign out
5.7 Tubal metaplasia of the uterine cervix
5.7.1 General
5.7.2 Microscopic
5.7.3 IHC
5.8 Atrophy of the uterine cervix
5.9 Radiation changes of the endocervical epithelium
5.9.1 General
5.9.2 Microscopic
5.10 Reactive endocervical cells
5.10.1 General
5.10.2 Microscopic
5.10.2.1 Images
6 Non-invasive
6.1 Cervical intraepithelial neoplasia
6.2 Endocervical adenocarcinoma in situ
7 Cancer
7.1 Squamous cell carcinoma of the uterine cervix
7.2 Adenocarcinoma of the uterine cervix
8 Uncommon non-invasive
8.1 Stratified mucin-producing intraepithelial lesions of the cervix
9 Uncommon types of cervical cancer
9.1 Serous carcinoma of the uterine cervix
9.1.1 General
9.1.2 Microscopic
9.2 Adenosquamous carcinoma of the uterine cervix
9.3 Clear cell carcinoma of the uterine cervix
9.4 Small cell carcinoma of the cervix
9.4.1 IHC
9.5 Adenoid basal carcinoma
9.5.1 General
9.5.2 Microscopic
9.6 Glassy cell carcinoma
9.7 Villoglandular adenocarcinoma of the cervix
9.7.1 General
9.7.2 Microscopic
9.7.2.1 Images
9.8 Mucoepidermoid carcinoma of the uterine cervix
9.8.1 General
9.8.2 Microscopic
9.8.3 Stains
9.8.4 IHC
9.8.5 Molecular
9.9 Mesonephric adenocarcinoma
9.9.1 General
9.9.2 Microscopic
9.9.3 IHC
9.10 Minimal deviation adenocarcinoma of the uterine cervix
10 See also
11 References
12 External links
Introduction
Overview
Most cervix cancer is 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):[1]
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).
Neoplastic cervical lesions are typically white.[2]
Squamous metaplasia is also white.[3]
Cervical ectropian (AKA cervical eversion, AKA ectropian) = endocervical epithelium at external os,
considered benign, grossly has a granulation tissue-like appearance.[4]
Cervical specimens
Cytology
Pap test - see gynecologic cytopathology.
Biopsies
The types of biopsies that are done are:
1. Cervical biopsies - prompted by abnormal Pap test, e.g. HSIL, to look for squamous cell carcinoma of the
uterine cervix.
2. Endocervical curettage (ECC) - to work-up columnar dysplasia, e.g. endocervical
adenocarcinoma/endometrial adenocarcinoma.
Surgical specimens
1. Loop electrosurgical excision procedure (LEEP).

AKA large loop excision of the transformation zone (LLETZ).[5][6]
2. Radical trachelectomy - removal of the uterine cervix and parametria, preserves fertility.
3. Radical hysterectomy - advanced cervical carcinoma (Stage IA2 and Stage IB1), recurrent carcinoma.[7]
Other
Total abdominal hysterectomy - for non-cervical pathology, e.g. uterine leiomyomas, 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".[8]
Also known as "transition zone".
Notes:
Considered from the perspective of histology:

The squamous component is referred to as the exocervix (or ectocervix[9]).
The simple columnar (or glandular) component is referred to as the endocervix.
Images:
Normal cervix (proteinatlas.org) (http://www.proteinatlas.org/dictionary/normal/cervix,+uterine+1).
Negative LEEP
Main article: 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
NILM with NILM with NILM with Benign stripped

pseudokoilocytes - pseudokoilocytes - high pseudokoilocytes - very exocervix - high mag.
intermed. mag. (WC) mag. (WC) high mag. (WC) (WC)
www:
Normal cervix (flickr.com/euthman) (http://www.flickr.com/photos/euthman/2797778604/in/photostream/).

CIN I versus normal (flickr.com/euthman) (http://www.flickr.com/photos/euthman/2796932803/in/photostre
am/).
Sign out
UTERINE CERVIX, BIOPSY:

- TRANSFORMATION ZONE WITHOUT APPARENT PATHOLOGY.
- NEGATIVE FOR DYSPLASIA.

- SQUAMOUS MUCOSA WITHOUT APPARENT PATHOLOGY.
- STRIPPED ENDOCERVICAL EPITHELIUM WITHOUT APPARENT PATHOLOGY.
- NEGATIVE FOR DYSPLASIA.
Endocervical glands
Microscopic
Features: 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.
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
UTERINE ENDOCERVIX, CURETTAGE:

- ENDOCERVICAL MUCOSA AND STRIPPED ENDOCERVICAL EPITHELIUM WITHIN NORMAL LIMITS.
Inflamed with squamous epithelium

- BENIGN STRIPPED ENDOCERVICAL EPITHELIUM AND SCANT INFLAMED ENDOCERVICAL MUCOSA.
- VERY SCANT SUPERFICIAL SQUAMOUS EPITHELIUM WITHOUT APPARENT PATHOLOGY.
Squamous epithelium present

- ENDOCERVICAL MUCOSA WITHIN NORMAL LIMITS.
- SQUAMOUS EPITHELIUM WITHOUT APPARENT PATHOLOGY.
Endometrium present

- ENDOCERVICAL MUCOSA WITHIN NORMAL LIMITS.
- SCANT NON-PROLIFERATIVE ENDOMETRIUM.
Inflamed

- INFLAMED ENDOCERVICAL MUCOSA.
- REACTIVE SQUAMOUS EPITHELIUM.
- NEGATIVE FOR MALIGNANCY.

- BENIGN INFLAMED ENDOCERVICAL MUCOSA.
- STRIPPED ENDOCERVICAL EPITHELIUM WITHIN NORMAL LIMITS.
No stroma present

- STRIPPED ENDOCERVICAL EPITHELIUM WITHOUT APPARENT PATHOLOGY.
Limited tissue

- ONE MINUTE FRAGMENT OF ENDOCERVICAL EPITHELIUM WITHOUT APPARENT PATHOLOGY,
SEE COMMENT.
COMMENT:
The assessment is severely limited by the small amount of tissue. A re-biopsy
should be considered within the clinical context.

- ONE MINUTE FRAGMENT OF ENDOCERVICAL EPITHELIUM WITHOUT APPARENT PATHOLOGY,
SEE COMMENT.
COMMENT:
The assessment is severely limited by the small amount of tissue. Clinical correlation is
suggested.

- BENIGN SQUAMOUS EPITHELIUM WITH METAPLASTIC CHANGE.
- VERY SCANT BENIGN ENDOCERVICAL EPITHELIUM, SUBOPTIMAL SAMPLING.

- 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.
Inadequate biopsy
Unfortunately, inadequate biopsies are common.
Endocervix
Sign out
No endocervical epithelium

- SQUAMOUS EPITHELIUM WITHOUT APPARENT PATHOLOGY.
- NO ENDOCERVICAL EPITHELIUM IDENTIFIED.
- MUCOUS AND INFLAMMATORY CELLS.
No epithelium

- MUCOUS AND INFLAMMATORY CELLS.
- NO EPITHELIUM IDENTIFIED.
No tissue

- NO TISSUE PRESENT, SEE COMMENT.
COMMENT:
No tissue identified on gross or microscopy.

- NO TISSUE PRESENT, SEE COMMENT.
COMMENT:
No tissue identified on microscopy. No tissue is seen on inspection of the paraffin block.
Where to start
1. Identify epithelium - exocervical (stratified squamous), endocervical (simple columnar), both.
If there is both exocervix and endocervix --> transition zone.
2. Identify possible squamous lesions.
3. Identify possible endocervical lesions.
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
General
Benign.
Common.
Gross
Bump.
Pale colour.
DDx - clinical:
Benign endocervical polyp.
Image
Nabothian cyst.
(WC/euthman)
Microscopic
Features:
Simple endocervical cyst.

Usually lined by endocervical epithelial cells - may be flattened.
Columnar morphology with large clear, apical vacuoles.
+/-Macrophages.
+/-Mucus.
Note:
May be lined by tubal epithelium.

Cilia.
High NC ratio ~ 1:1.[citation needed]
Image:
Nabothian cyst (gfmer.ch) (http://www.gfmer.ch/selected_images_v2/detail_list.php?cat1=4&cat2=23&cat3

=130&cat4=5&stype=n).
Sign out
CERVICAL POLYP, REMOVAL:

- BENIGN POLYPOID FRAGMENT OF EXOCERVICAL MUCOSA WITH NABOTHIAN CYSTS AND
BENIGN ENDOCERVICAL EPITHELIUM.
POLYPOID LESION ("CERVICAL POLYP"), EXCISION:

- POLYPOID NABOTHIAN CYST.
Tunnel cluster
General
Benign.[10]
Not the same as microglandular hyperplasia.[11]
Considered a special type of nabothian cyst.[12]
Microscopic
Features:[13][14]
Well-circumscribed lesion consisting of:

Benign endocervical glands.
Dilated & filled with mucin or (less commonly) eosinophilic secretions.
Lining epithelium compressed/flattened (attenuated).
Gland architecture: branching, tortuous.
Scant intervening stroma.
Notes:
1. Usually no nuclear atypia and no mitotic activity.

2. Important only as one could possibly mistake it as minimal deviation adenocarcinoma, AKA adenoma
malignum.[15]
Images
Tunnel cluster - very Tunnel cluster - low Tunnel cluster - Tunnel cluster - high
low mag. (WC) mag. (WC) intermed. mag. (WC) mag. (WC)
Tunnel cluster - very

high mag. (WC)
www:
Tunnel cluster (surgpath4u.com) (http://surgpath4u.com/caseviewer.php?case_no=477).

Tunnel cluster (ajronline.org) (http://www.ajronline.org/content/195/2/517/F30.expansion).
Microglandular hyperplasia
Not to be confused with microglandular adenosis.
Abbreviated MGH.
AKA microglandular change.
Main article: Microglandular hyperplasia
Wolffian duct hyperplasia

General
Benign.
Microscopic
Features:
Abundant small tubules with a simple cuboidal epithelium.

Round small bland nucleus.
DDx:
Wolffian duct remnant.
Stains
PAS-D+ve (cytoplasm).
Squamous metaplasia of the uterine cervix

Abbreviated SMC.
Main article: Squamous metaplasia of the uterine cervix
Reactive squamous epithelium of the uterine cervix

AKA reactive squamous epithelium.
AKA reactive changes.
General
Common.
Individuals with persistent inflammation on Pap test may have occult SIL.[16]
Microscopic
Features:
1. Inflammation - key feature.

Lymphocytes.
Plasma cells.
2. Mild nuclear enlargement. †

3. Nucleoli - important.
Note:
† Normal squamous cell nuclei are approximately 8 μm.[17]

Mild enlargement ~ 2-3x normal.
CIN I nuclei are ~ 3x normal (24 μm).
DDx:
Cervical intraepithelial neoplasia I.

Cervical intraepithelial neoplasia II.
NILM.
IHC
p16 -ve.
Sign out

- REACTIVE SQUAMOUS EPITHELIUM.
- BENIGN ENDOCERVICAL GLANDS.
- NEGATIVE FOR MALIGNANCY.
COMMENT:
The squamous epithelium is negative for p16 staining. Ki-67 staining is predominantly in
the lower third of the epithelium.
Tubal metaplasia of the uterine cervix

AKA tubal metaplasia, abbreviated TM.
General
Benign.
Mimics the appearance of 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.
Image:
Tubal metaplasia (nature.com) (http://www.nature.com/modpathol/journal/v13/n3/fig_tab/3880047f17.html).
IHC
Features:[18]
Vimentin +ve.
CEA -ve/+ve.
p16 -ve.[citation needed]
Atrophy of the uterine cervix

AKA cervical atrophy.
AKA atrophy of the cervix.
AKA cervix with atrophic changes.
Main article: Uterine cervix with atrophic changes
Radiation changes of the endocervical epithelium

Main article: Radiation changes
Main article: Radiation changes in cervical cytology
General
Uncommon.
Clinical history: radiation treatment for cervical carcinoma.[19]
Microscopic
Features:[19]
Nuclear enlargement with a normal NC ratio.

+/-Coarse chromatin.
+/-Nucleoli.
+/-Multinucleation - very common.
Histiocytes - common.
Reactive endocervical cells

General
Benign.
Microscopic
Features:
Mild nuclear enlargement.

+/-Multinucleation.[20]
Notes: DDx of multinucleated endocervical cells:
HSV.[21]
Benign endocervical cells.
Images
Multinucleated Multinucleated Multinucleated

endocervix - high mag. endocervix - very high endocervix - extremely
mag. high mag.
www:
Reactive endocervical cells (surgpath4u.com) (http://www.surgpath4u.com/caseviewer.php?case_no=229).
Non-invasive
Cervical intraepithelial neoplasia
Previously known as cervical intraepithelial neoplasia and cervical dysplasia.
Main article: Squamous intraepithelial lesion of the uterine cervix
Endocervical adenocarcinoma in situ

For the cytology see Gynecologic cytopathology#Endocervical adenocarcinoma in situ
AKA adenocarcinoma in situ, abbreviated AIS.
Main article: Endocervical adenocarcinoma in situ
Cancer
Squamous cell carcinoma of the uterine cervix
Main article: Squamous cell carcinoma
AKA cervical squamous cell carcinoma.
Main article: Squamous cell carcinoma of the uterine cervix
Adenocarcinoma of the uterine cervix

AKA endocervical adenocarcinoma.
AKA cervical adenocarcinoma.
Main article: Adenocarcinoma of the uterine cervix
Uncommon non-invasive
Stratified mucin-producing intraepithelial lesions of the cervix
Abbreviated SMILE (Stratified Mucin-producing Intraepithelial LEsion).
Main article: Stratified mucin-producing intraepithelial lesion of the cervix
Uncommon types of cervical cancer

There are a number of uncommon type of cervical cancer.
Serous carcinoma of the uterine cervix

General
Poor prognosis.[22]
Extremely rare.
Microscopic
Features:
Like other serous carcinomas.
Adenosquamous carcinoma of the uterine cervix

Main article: Adenosquamous carcinoma of the uterine cervix
Clear cell carcinoma of the uterine cervix

Main article: Clear cell carcinoma of the uterine cervix
Small cell carcinoma of the cervix

Main article: Small cell carcinoma
Like small cell carcinoma elsewhere.
DDx:
Small cell carcinoma of the lung.

Small cell carcinoma of the ovary, hypercalcemic type.
IHC
HPV +ve.
Adenoid basal carcinoma

See also: Basal cell carcinoma.
General
Good prognosis.[23]
Microscopic
Features:[23]
Nests of cells with basaloid rim and squamoid center.

Basaloid cells look benign.
DDx:
Ectopic prostate gland.
Image:
Adenoid basal carcinoma (webpathology.com) (http://www.webpathology.com/image.asp?n=5&Case=561).
Glassy cell carcinoma

Main article: Glassy cell carcinoma
Villoglandular adenocarcinoma of the cervix

AKA well-differentiated papillary villoglandular adenocarcinoma,[24] AKA villoglandular papillary
adenocarcinoma, AKA well-differentiated villoglandular adenocarcinoma.
General
Rare.
Younger patients and relatively good prognosis.[25]
Associated with HPV.
May also arise from the endometrium.[26]
Microscopic
Features:[27]
Papillary structures (nipple-like shapes with a fibrovascular core) that are long.
Nobody defines "long".
Perhaps - long >3:1 length:width.
Covered by columnar (or cuboidal) epithelium.
Intracellular mucin (focal).
DDx:
Serous carcinoma of the cervix.
Images
www:
VGA (webpathology.com) (http://www.webpathology.com/image.asp?n=11&Case=560).
VGA - very low mag. VGA - intermed. mag. VGA - very high mag.
(WC) (WC) (WC)
Mucoepidermoid carcinoma of the uterine cervix

Main article: Mucoepidermoid carcinoma
General
Controversial - not in the WHO.[28]
Microscopic
Features:[29]
Squamous cell carcinoma-like with:

1. No glands formation.
2. Intracellular mucin.
Classically have mucous cells - cells with abundant fluffy cytoplasm and large mucin vacuoles -
key feature.
Notes:
Similar to the salivary gland tumour.[28]
DDx:
Cervical intraepithelial neoplasia, i.e. CIN II, CIN III.

Adenosquamous carcinoma.
Stains
Mucin stains:[29]
Alcian blue stain

Periodic acid-Schiff-diastase stain.
IHC
CEA +ve.[29]
Molecular
Like the salivary gland tumour:
t(11;19) CRTC1/MAML2.[28]
Mesonephric adenocarcinoma
General
Arises from the mesonephric duct remnants.
Microscopic
Features:[30]
Nuclear atypia - key feature.

Nuclear crowding.
Variable architecture:
Tubular, papillary, solid, retiform (net-like[31]).
DDx:
Mesonephric duct remnants.

Cervical adenocarcinoma.
Colorectal adenocarcinoma.
Endometrioid adenocarcinoma.
IHC
Features:[30]
CK7 +ve.
CD10 +ve.
Others:[30]
CK20 -ve.
ER -ve.
PR -ve.
CEA -ve.
Minimal deviation adenocarcinoma of the uterine cervix

AKA adenoma malignum.
AKA minimal deviation adenocarcinoma, abbreviated MDA.
Main article: Minimal deviation adenocarcinoma of the uterine cervix
See also
Vulvar intraepithelial neoplasia.
Cervical polyp.
Gynecologic cytopathology.
Gynecologic pathology.
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External links
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CINtec.pdf).
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epithelial-neoplasia).
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13 Uterine Cervix - Libre Pathology

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12019/4/ Uterine cervix - Libre Pathology

High-grade squamous intraepithelial lesion (HSIL).

Pap test - see gynecologic cytopathology.

The types of biopsies that are done are:

1. Loop electrosurgical excision procedure (LEEP).

Considered from the perspective of histology:

Normal cervix (proteinatlas.org) (http://www.proteinatlas.org/dictionary/normal/cervix,+uterine+1).

Transformation zone - biopsy

Small round cells.

NILM with NILM with NILM with Benign stripped

Normal cervix (flickr.com/euthman) (http://www.flickr.com/photos/euthman/2797778604/in/photostream/).

UTERINE CERVIX, BIOPSY:

UTERINE CERVIX, BIOPSY:

UTERINE ENDOCERVIX, CURETTAGE:

Inflamed with squamous epithelium

UTERINE ENDOCERVIX, CURETTAGE:

Squamous epithelium present

UTERINE ENDOCERVIX, CURETTAGE:

UTERINE ENDOCERVIX, CURETTAGE:

UTERINE ENDOCERVIX, CURETTAGE:

UTERINE ENDOCERVIX, CURETTAGE:

UTERINE ENDOCERVIX, CURETTAGE:

UTERINE ENDOCERVIX, CURETTAGE:

UTERINE ENDOCERVIX, CURETTAGE:

UTERINE ENDOCERVIX, CURETTAGE:

UTERINE CERVIX, BIOPSY:

UTERINE ENDOCERVIX, CURETTAGE:

UTERINE ENDOCERVIX, CURETTAGE:

UTERINE ENDOCERVIX, CURETTAGE:

UTERINE ENDOCERVIX, CURETTAGE:

Benign entities of the cervix

Mullerian papilloma/Mesonephric hyperplasia/Microglandular hyperplasia.

Benign endocervical polyp.

Simple endocervical cyst.

May be lined by tubal epithelium.

Nabothian cyst (gfmer.ch) (http://www.gfmer.ch/selected_images_v2/detail_list.php?cat1=4&cat2=23&cat3

CERVICAL POLYP, REMOVAL:

POLYPOID LESION ("CERVICAL POLYP"), EXCISION:

Well-circumscribed lesion consisting of:

1. Usually no nuclear atypia and no mitotic activity.

Tunnel cluster - very

Tunnel cluster (surgpath4u.com) (http://surgpath4u.com/caseviewer.php?case_no=477).

Not to be confused with microglandular adenosis.

Main article: Microglandular hyperplasia

Wolffian duct hyperplasia

Abundant small tubules with a simple cuboidal epithelium.

Wolffian duct remnant.

Squamous metaplasia of the uterine cervix

Main article: Squamous metaplasia of the uterine cervix

Reactive squamous epithelium of the uterine cervix

1. Inflammation - key feature.

2. Mild nuclear enlargement. †

† Normal squamous cell nuclei are approximately 8 μm.[17]

Cervical intraepithelial neoplasia I.

UTERINE CERVIX, BIOPSY:

Tubal metaplasia of the uterine cervix

Features - like the fallopian tube:

Nuclear crowding vis-à-vis benign endocervical epithelium (low power).

Endocervical adenocarcinoma in situ.

Tubal metaplasia (nature.com) (http://www.nature.com/modpathol/journal/v13/n3/fig_tab/3880047f17.html).

Atrophy of the uterine cervix

Main article: Uterine cervix with atrophic changes

Radiation changes of the endocervical epithelium