Transformation Zone Figs 2831

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 epithelia from the adjacent primary ectocervical epithelium (Fig. 31). This "third mucosa" can only be recognized by the pinched off and often cysti-cally dilated endocervical glands underlying the squamous epithelium. When these become large retention cysts, they may be recognized grossly as rounded protuberances (ovula Nabothi, Nabothian cysts; Fig. 11).

Ovula Nabothi
Fig. 28. Transformation zone covered by squamous metaplasia in descending repair, early stage. H&E
Transformation Zone
Fig. 30. Squamous metaplasia, physiologic p16INK4a-expression in maturing epithelial cells. Focal staining pattern. p16INK4a immunostain (see p. 9 f)
Transformation Zone Cells
Fig. 31- Transformation zone covered by mature squamous epithelium, late stage. H&E

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