Malignant Melanoma [87203 Fig 238

Gunshot Stippling

It is extremely rare for the cervix to be the primary tumor site for malignant melanoma (Fig. 238). Only a few cases have been reported in the literature (Hall et al. 1980) and recently summarized (Holmquist and Torres 1988 Cantuaria et al. 1999). Histogenetically, the tumor is of melanocytic origin. Occasional melanocytes can be found in the normal ectocervical epithelium (Stegner 1959). As in the skin, or elsewhere, the tumor is composed of pleomorphic round to spindle-shaped cells containing...

Large Cell Keratinizing Carcinoma [80713

The large cell keratinizing carcinoma representing about 25 consists of small or large nests of mature epithelial tumor cells that adhere to one another by intercellular bridges. The nuclei are large, round or irregular, often hyperchromatic. The cytoplasm is abundant, eosinophilic or pale. Besides the keratin pearls in the center of epithelial nests Fig. 170 , a scattered monocellular keratinization is frequently seen Figs. 168, 169 . As to be expected, these types do not always occur alone....

Adenoid Basal Carcinoma [80923

Adenoid Basal Cell Carcinoma

The adenoid basal carcinoma Fig. 219 must be differentiated from the adenoid cystic carcinoma because of its much better prognosis Hart 2002 . It consists of small, round to oval branching nests of cells, resembling those of basal cell carcinoma of the skin, with palisading of the peripheral cell layers. There are no or only rare cystic pseudoglands. The tumor cells are small and uniform, with rounded hyperchromatic nuclei in scanty cytoplasm. Mitoses are infrequent. Adenoid cystic and adenoid...

Mucinous Adenocarcinoma [84803

Immunostains Reactive Lymph Node

The mucinous endocervical type of adenocarcinoma Figs. 178-194 is most frequently encountered. All degrees of differentiation can be found. The amount of mucin roughly follows the degree of differentiation. Most of the mucinous adenocarcinomas are well or moderately differentiated. Their interbranching glands may show micro-glandular changes Young and Scully 1992, Fig. 186 and contain variable amounts of intracytoplasmic mucin Tambouret et al. 2000, Fig. 189 . In the poorly differentiated type...

Papillary Squamous Cell Carcinoma [80523

Invasive Squamous Cell Carcinoma

Papillary squamous cell carcinoma is another rare variant of cervical squamous cell carcinoma, presenting the gross and histological appearance of a benign papilloma undergoing dysplastic cellular change compare Figs. 128 and 129 . Beneath the papillary dysplasia, strands of invasive carcinoma can be detected Randall et al. 1986 Brinck et al. 2000 . Diagnosis of invasion, therefore, depends upon examining the entire papillary lesion. This papillary carcinoma of squamous cell type should not be...

Parakeratosis and Hyperkeratosis of the Ectocervix

Estrogens stimulate proliferation of the squamous epithelium of the ectocervix, resulting in a well-developed superficial cell layer often covered by a fairly thick layer of par-akeratotic cells Figs. 48,49 , which become keratinized prematurely. In endogenous or exogenous hyperestrogenism, the keratinization may become exaggerated, whereby a thin Fig. 50 or thick Fig. 51 layer of hyperkeratosis is devoid of nuclei. The proliferative effect of estrogens, furthermore, promotes ascending repair...

Premalignant Lesions

Hpv Replication

Dysplasia and carcinoma in situ are common lesions most pathology laboratories receive several cases weekly. It is important to have well-defined terms and criteria for each type of these lesions, thereby promoting correct diagnoses and proper treatment. Unfortunately, as the literature shows us, there is confusion about how to interpret these lesions, in part,because of disagreement about how best to name them e.g.,mild,mod-erate, severe dysplasia and carcinoma in situ versus cervical...

Inflammatory Lesions

Vaginal Herpes Lesions

Nonspecific Ecto- and Endocervicitis Figs. 70-76 Nonspecific cervicitis may be chemically induced or caused by trauma in the presence of a locus minoris resistentiae, such as postmenopausal atrophy of the ectocervical epithelium, or eversion of the vulnerable endocervical mucosa onto the ectocervix ectropion during the reproductive age. Acute and subacute ectocervicitis Figs. 70-72 is characterized by vascular congestion, edema, and infiltration of inflammatory cells, mainly neutrophilic...

Microinvasive Carcinoma [80763 Figs 150157

Microinvasive Squamous Carcinoma

A microinvasive carcinoma MIC FIGO stage IA, TNM iai and ia2 was originally defined as an early invasive carcinoma that could not be detected grossly, only histologically Mestwerdt 1947 . Attempts to define its maximal size in millimeters in order to distinguish it from frank invasive carcinoma resulted in controversial opinions Ferenc-zy and Winkler 1987 . Since microinvasion often develops from precancerous epithelium located on the surface, as well as from that located in the glands,...

Heterotopic Ectodermal and Mesodermal Structures Figs 4347

Heterotopic Sebaceous Glands

Rarely, heterotopic neometaplasia Young et al. 1981 may result in the formation of epidermoid or dermoid cysts 9084 0 Figs. 43-45 or give rise to sebaceous or sweat gland formations beneath the ectocervical epithelium Figs. 46, 47 Dougherty et al. 1962 . These structures have no clinical significance. Fig. 43. Epidermoid cyst of ectocervix. H amp E Fig. 43. Epidermoid cyst of ectocervix. H amp E Fig. 42. Ciliated cell tubal metaplasia of endocervical glands. Same case as in Fig. 41. Focal,...

Benign Tumors

Papilloma Stage

Squamous papillomas 8052 0 of the ectocervix Figs. 91-94 occur predominantly in young women and are mainly caused by infection with low-risk HPV LR-HPV types, such as types 6 and 11 Ward et al. 1992 see Table 3 . Some may be inverted, hence their surfaces are flat. Histologically they consist of thick layers of stratified squamous epithelium with elongated rete pegs that extend deeply into the lamina propria Fig. 91 . The basal membrane is intact, the epithelial layers are well differentiated,...

Mllerian Duct Remnants and Metaplasia Figs 3542

Cervical Conization

Foci of ectocervical endometriosis 7650 0 may be located beneath the ectocervical epithelium and bulge forth as nodules Fig. 35 , grossly recognizable by the old and fresh hemorrhages in and around them Figs. 35,36 , or be located deep in the cervical wall Figs. 37,38 . These deep foci correspond in their location and structure to adenom-yosis of the myometrium. The glands are characteristically surrounded by an endome-trial-type stroma. In some instances, endocervical glands may be lined by...

Cystic Hyperplasia of the Endocervix [33400

Reserve Cell Hyperplasia

Under estrogenic stimulation, the epithelial cells of the endocervical glands differentiate and produce mucin, which may become excessive with long-standing unopposed estrogen. Consequently, the glands become cystically dilated with inspissated mucin Figs. 52-54 . Thereby they become closely clustered, and the glandular region enlarges by extending down into the cervical wall. Reserve cells or areas of preceding reserve cell hyperplasia may differentiate and undergo squamous cell metaplasia see...

Microglandular Hyperplasia of the Endocervix [72480

Endocervical Polyp Microscopy

With increasing potency of the gestagen used, endocervical glandular proliferation is more likely to develop into microalveolar changes with disappearance of the intervening stroma Figs. 63-65 . The low cuboidal, undifferentiated, glandular epithelial cells can hardly be distinguished from the surrounding hyperplastic reserve cells. Occasionally a solid sheetlike proliferation of reserve cells, signet-ring cells or hobnail cells may be observed. These changes, too, may be misdiagnosed as...

Ascending Repair Figs 1013

Cap 2012 Blood Cell Differentiation

During reproductive life, and following eversion of the endocervical mucosa onto the portio, the ectocervical epithelium is capable of overgrowing the vulnerable endocervical epithelium by ascending repair Figs. 10,11 , thereby often occluding the openings of Fig. 10. Ascending repair following eversion of the endocervical mucosa onto the portio, early stage. H amp E Fig. 10. Ascending repair following eversion of the endocervical mucosa onto the portio, early stage. H amp E Fig. 11. Ascending...

Glandular Adenomatous Hyperplasia of the Endocervix

Pas Positive Mucous Cells Endocervix

New glands form and the glandular epithelial cells become pseudostratified Fig. 62 , containing elongated hyperchromatic nuclei in a less well-differentiated cytoplasm. The glands may ramify Fig. 59 or become crowded Fig. 60 , occasionally resulting in a diffuse laminar glandular pattern Jones et al. 1991 Nucci 2002 . The production of mucin is reduced or absent and occurs irregularly from one gland to another Fig. 61 or within the same gland Fig. 62 . Cells with mucin and those without may lie...

Glandular and Cystic Hyperplasia of the Endocervix [33400

Arias Stella Reaction

The physiologic hyperstimulation of the endocervical mucosa during gestation induces a mild or moderate hypersecretion of the glands and a proliferation of reserve cells Fig. 56 . The ectropionized mucosa usually is overgrown by an ascending regenerative epithelium Fig. 55 . Foci of ectopic decidua may be found in the endocervix and appear much like those seen at various other sites throughout the small pelvis during pregnancy. They show that they possess the inherent genetic potentialities of...

Normal Endocervix Figs 1418

Endocervical Mucosa

The normal endocervical mucosa consists of mucus-producing tubules and clefts mucosal infoldings, usually called glands , loosely arranged in a fibrous stroma. A single layer of tall, columnar epithelial cells covers the mucosal surface and lines the intricate folds, clefts, and tubules. The small nuclei are basally placed during the early proliferative phase. The clear cytoplasm contains abundant mucus, especially in the late proliferative phase Fig. 14 . Where the endocervical mucosa merges...

Transformation Zone Figs 2831

Transformation Zone

It is important to recognize and locate the transformation zone since most cervical neoplasias arise at or above this squamocolumnar junction. In their developmental stage they usually are limited to the transformation zone. When the squamous epithelium that covers this repair zone Figs. 28-30 does not undergo precancerous change, but, as in most instances, matures normally and completely, then at the end stage of repair it is impossible to distinguish the regenerative and metaplastic squamous...

Cold Knife Conization

Conization

If the cytology report is positive, but no lesion is visible on gross or colposcopic examination, a cervical conization will be necessary in order to survey the entire squamoco-lumnar junction. A conization must also be performed if a previous punch biopsy of a grossly suspicious lesion showed that the noninvasive precancerous epithelium had not been completely excised. A biopsy of malignant tumors can never give information about the depth of invasion. If the clinical signs fail to reveal how...