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Cervical Histologyand
Infectious Diseases
Kristyn Feldman
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Gross anatomy
! The cervix is actually the lower, narrow
portion of the uterus.! Its name is derived from the Latin word for
"neck."
! It is cylindrical or conical in shape.
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Why its interesting
! Since nearly all cervical neoplasia (abnormal
growth) occurs in the presence of HPV, thecervix provides the best-defined model of
virus-mediated carcinogenesis in humans to
date!
! Infectious disease + cancer
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Normal Histology
! The cervix is covered by both columnarand
stratified non-keratinising squamousepithelia.
! The squamocolumnar junction (SCJ),
where these two meet, is the most important
cytologic and colposcopic landmark, as thisis where over 90% of lower genital tract
neoplasia arises.
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Mature squamous epithelium (H&E x 400): Different layers starting at the
basement membrane (basal, parabasal, intermediate, superficial) are evident.
Clear cytoplasm indicates glycogenation. As the cells mature, the nuclei get
smaller and the cytoplasm amount increases.
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Glandular or Columnar Epithelium
! The glandularor columnar epithelium
! Covers a variable amount of the ectocervixand lines the endocervical canal.
! It is comprised of a single layer of mucin-secreting cells.
! Longitudinal folds and invaginations make upthe so-called endocervical glands(they arenot true glands).
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Endocervical glands (H&E x 400): Actually crypts lined by a single layer of
columnar epithelium. Extend to a depth of 5-7 mm.
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Changes in the SCJ
The location of the SCJ in relation to the anatomicexternal os varies with a variety of factors:
! At birth it is at or just above the external opening withthe original squamous epithelium outside and theendocervical columnar epithelium on the inside.
! With growth of the uterus, especially from pubertyand throughout reproductive life, the SCJ comes tolie at variable distancesbelow the anatomicexternal opening.
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The border between the stratified squamous epithelium of the ectocervix and the
columnar epithelium of the endocervix is called the squamocolumnar junction
(SCJ).
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The new SCJ
This is a continuous remodeling process that is alsoinfluenced by other factors, and occurs throughoutthe life of a female producing two different SCJs:
! Original SCJ: is the site at which the neonatalsquamous epithelium of the ectocervix meets theendocervical columnar epithelium at birth.
! New, functional or physiologic SCJ: newly formedSCJ as a result of the dynamic remodeling that takesplace during the life of the female.
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Endocervical ectropion. Note everted columnar epithelium, which is reddened and
looks like "eroded" tissue
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Transformation (transition) zone
! The area, formed by the metaplastic
squamous epithelium, between the old andthe new SCJ is called the transformation ortransition zone (TZ).
! The new SCJ, and hence the extent of theTZ, can be observed from the vagina.However, in up to 15% of women the TZextends into the endocervical canal beyondthe field of vision from the vagina.
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Human papilloma virus (HPV)
! Over 20 serotypes
! Cause a variety of lesions with the differentserotypes associated with different lesions.
Mild dysplasiais usually caused by "low risk"
HPV serotypes, 6 and 11
High- grade dysplasiais caused by "high (16and 18) and moderate (31,33,35) risk" HPV
serotypes
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Normal
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Koilocytes(visibly HPV-infected cells) Notice the binucleate one with the big halo.
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Dysplasia, severe.The less cytoplasm, the more severe the dysplasia.
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Normal
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Border between normal and severe dysplasia.Most conspicuous is the high N/C ratio
and the loss of the normal maturation.
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List of terms that confused me
! Neoplasia = process of new growth
! Metaplasia = one adult cell type replacesanother adult cell type. It may represent anadaptation of one cell type to another celltype that is more likely to survive in theenvironment
! Dysplasia = disordered growth
! Anaplasia = undifferentiated cell growth(malignant!)
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Normal cervical squamous epithelium (left) Dysplastic on the right.
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