Mllerian Duct Remnants and Metaplasia Figs 3542

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 columnar ciliated cells resulting from a ciliated cell (tubal) metaplasia (Figs. 39-42). Such glands are devoid of surrounding endometrial-type stroma and correspond to the foci of endosal-pingiosis occasionally found scattered about the small pelvis (Wells and Brown 1986). Foci of intestinal metaplasia [7332/0] may also be observed within endocervical glands.

Transitional cell metaplasia is a rare lesion of the ectocervical epithelium usually seen in older women. It is thought to originate from Mullerian epithelium of the early genitourinary system with the potential to differentiate into urothelium (Weir et al. 1997). Since the reaction to CK 20 is negative, however, complete urothelial differentiation cannot be verified on immunohistological examination (Harnden et al. 1999). The ectocervical epithelium is replaced by transitional cells with lack of maturation and spindled nuclei with longitudinal nuclear grooves and perinuclear halos. Transitional cell metaplasia may be overdiagnosed as dysplasia, from which it can be differentiated by its regular nuclear shape and the lack of mitoses. Squamous cell metaplasia can be distinguished by its round nuclear shape.

Fig. 35. Focus of endometriosis underneath ectocervical epithelium. H&E

Müllerian Duct Remnants and Metaplasia

Müllerian Duct Remnants and Metaplasia

Mullerian Remnants
Fig.36. Focus of endometriosis underneath ectocervical epithelium. H&E, higher magnification
Mesonephric Duct Remnant
Fig. 37. Focus of endometriosis in the cervical wall. H&E
Mullerian Remnants
Fig. 39. Ciliated cell (tubal) metaplasia of endocervical glands. H&E
Endocervical Tubal Metaplasia
Fig. 40. Ciliated cell (tubal) metaplasia of endocervical glands. H&E, higher magnification
Tubal Metaplasia
Fig. 41. Ciliated cell (tubal) metaplasia of endocervical glands. H&E
Cervical Conization
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