Tumors of Cervix

•BENIGN– Adenoma– Myoma– Papilloma and angioma

•MALIGNANTPrimary – Carcinoma– Sarcoma– Mesodermal mixed tumor

Secondary – From any source

Adenoma (Mucous Polyp)Clinical Features

– Asymptomatic– Vaginal discharge– Vaginal bleeding– Mass at the introitus

Differential Diagnosis– Carcinoma of the cervix– Cervical ectopy– Endometrial polyp– Products of conception

and blood clot– Ectropion– Cervical tags

Adenoma (Mucous Polyp)

Treatment– Asymptomatic must be removed and

examined by the histopathologist– Adenoma may be avulsed easily without

anaesthesia– Base of the polyp should be cauterized

to avoid recurrence– Perform curettage

Myomas of Cervix

Arise from body of uterus, rarely from cervixPolypoidalProtrude through cervical canal Types

SubserousIntramuralsubmucous

Myomas of CervixClinical Features

– Prone to trauma– Ulceration– Infection– Vaginal discharge– Irregular vaginal bleeding– Mass at the introitus

TreatmentVagival myomectomy or hysterectomy

Papilloma and Angioma

Clinical features– Small papillomas– Single or multiple associated with

vulva and vaginal papillomas– Angioma forms superficial growth

Treatment– Surgical removal

Pre Malignant Conditions of

Cervix

Cervical Intraepithelial Neoplasia (CIN)

or Dysplasia• Spectrum of disordered growth and

abnormal microscopic changes confined to epithelium

• May be– Mild (CIN I)– Moderate (CIN II) – Severe or carcinoma in situ (CIN III)

• Spontaneous regression of mild and moderate types possible

• Severe dysplasia may be irreversible• May progress into invasive carcinoma

Cervical Intraepithelial Neoplasia (CIN)

or Dysplasia•CIN I (mild)

Involves deeper 3rd of epithelium

•CIN II (moderate)Involves more than half thickness of epithelium

•CIN III (severe)Whole thickness of epithelium shows abnormal changes

Screening

• Screening programme• Cervical smear• Repeated every 3 y up to 60 y

Normal cervix, transition zone

anaplastic cancer cells show marked variation in size, in comparison with neutrophils

Invasive carcinoma of cervix, Pap smear

Treatment

• Cryocautry• Electrocuatry• Surgery

– Conization– LEEP– Hysterectomy

• Follow up

Malignant Tumours of

Cervix

Ca cervix

One of the most common cancers in the worldIncidence:

USA 10/1000000UK 15/1000000

Peak incidence at 35 and 55

Etiology

• Number of partners • Age of first coitus • Grand multi parity• Social status• Race and religion • Circumcision • Smoking• Viruses herpes simplex type 2 / human

papulama virus type 16 & 18• Atypical squamous metaplasia

Pathology

• SQ cell carcinoma 90 %• Adeno 5%• Mixed 5%Gross• Polypoidal • Ulcerative• Infiltrative

Squamous cell carcinoma cervix

Tumour extends to anterior and posterior lips, appears granular and hemorrhagic, cervix surrounding by narrow vaginal cuff

                                                            

lack of maturation, altered cell polarity, nuclear pleomorphism and increased nuclear / cytoplasmic ratio, confined to the epithelial layer, epithelial basement membrane not invaded, submucosal stroma contains chronic inflammatory cells

Normal epithelium

Squamous cell carcinoma in-situ of cervix

Spread

• Direct • Lymphatic• Blood born

Diagnosis

• History• Asymtpomatic• Irregular vaginal bleeding IMB, PCB,

PMB• Pain• Vaginal discharge• Examination• Normal cervix• Hard cervix• Ulcer• Growth

Carcinoma Cervix

Diagnosis

• Cytology• Schiller test• Colposcopy• Biopsy of cervix

• Punch biopsy• Wedge biopsy• Ring biopsy• Cone biobsy

Treatment

• Assessment• Radiotheraphy• Surgery young, pelvic sepsis, UV

prolapse, fibroid, ovarian tumor, recurrence, pregnancy

• Combined

Case HistoryAge 36, mass at endocervical os which thickens the barrel of the cervix and fixes the cervix to the surrounding soft tissue Pap smear shows

Case Historybiopsy showed invasive nests of abnormal squamous epithelium extending under the surface mucosa, extending all the way through the cervical wall and out into the surrounding paracervical soft tissue

Case HistoryThe patient underwent a hysterectomy. The gross specimen shows thickened area representing the cervix. Tumour has extended through the wall. cervix was fixed to the soft tissues of the paracervical area

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