Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
 Benign diseases of the cervix are common and are
unusually asymptomatic or cause minor symptoms but
must be differentiat...
Transformational zone:
The area of cervix between the old and new squamo-
columnar junction.
It is the area of risk of dev...
1) Cervical ectopy (erosion)
2) Cervical eversion (ectropion)
3) Cervical tears
4) Cervical cyst
5) Endocervical polyp.
6)...
 CLINICAL FEATURES
Symptoms
-Vaginal discharge
-Contact bleeding
-Associated cervicitis may produce
backache, pelvic pain...
 DIAGNOSIS
It can be confused with
-ectropion
-early carcinoma (indurated, friable and bleeds to touch)
-primary chancre ...
 In chronic cervicitis there is marked thickening of
cervical mucosa with underlying tissue edema. These
thickened tissue...
 It frequently occurs during vaginal delivery.
 One or both sides of cx may be torn, or it may b irregular
(stellate) ty...
These include
1. Nabothian cyst
2. Endometriotic cyst
3. Mesonephric cyst
Endocervical glands in the transformational zone become
covered with squamous cells and forms mucus filled
cysts.
As this ...
ENDOMETRIOTIC
CYST
Situated in portio vaginalis part of
cx.
It is small reddish and <1cm dia.
Implantaion of endometrium d...
 It is one of the most common neoplasms
 It is a hyperplastic projection of the endocervical folds.
 These lesions are ...
ACUTE CERVICITIS
Usually follows child birth, abortion or any
operative procedure on cervix.
Responsible organisms aregono...
Cervical
cancer
Normal cervix
 DNA virus.
 Over 100 different types and subtypes of this virus.
 Common infection effecting epithelial surface.
 Gen...
Factors that increase risk of transmission:
 Smoking.
 Increasing parity.
 Early age of intercourse.
 Oral contracepti...
 Metaplasia: change of epithelium from one cell lining
(columnar) to another (squamous).
 Dysplasia: abnormal epithelial...
CIN1
Normal
CIN 1
(condyloma
)
CIN 1
(mild
dysplasia)
CIN 2
(moderate
dysplasia)
CIN 3
(severe dysplasia/CIS) Invasive can...
 Low grade squamous intraepithelial lesion (LSIL); HPV
infection, CIN I.
 High grade squamous intraepithelial lesion (HS...
Outcome of CIN
 Spontaneous regression.
 Progression to invasive cancer.
 Progression from one stage to another takes y...
 Screening for dyskariosis by obtaining cervical cytology.
 Cervical screening should be carried out every 3-5 years
in ...
Smear Risk of
having HSIL
Management If next smear is negative
Normal 0.1% Repeat in 3-5 years Routine
Inflammatory <6% Re...
 Is the inspection of the cervix with a low powered
microscope.
 Magnifies the cervix 4-20 times.
 The patient is put i...
 Inspection of the cervix and its vasculature.
 Green filter may help studying vasculature.
 Abnormal vascular structur...
 CIN II,CIN III. ?CIN I.
Techniques for treatment:
Excisional: LEEP (loop electrosurgical excision
procedure) CO2 laser c...
 Less common than squamous intraepithelial neoplsia.
 Has same risk factors.
 Can not be reliably screened by colposcop...
 The first vaccine that intends to prevent cancer.
 2 forms of vaccine are available
 Bivalent 16, 18 (cervarix)
 Quad...
 Benign diseases of cervix are harmless but malignancy
should be excluded.
 Cervical intraepithelial neoplasia proceedes...
Benign n pre malignant diseases of cx
Benign n pre malignant diseases of cx
Benign n pre malignant diseases of cx
Benign n pre malignant diseases of cx
Benign n pre malignant diseases of cx
Benign n pre malignant diseases of cx
Benign n pre malignant diseases of cx
Benign n pre malignant diseases of cx
Upcoming SlideShare
Loading in …5
×

Benign n pre malignant diseases of cx

3,445 views

Published on

Published in: Science, Health & Medicine
  • Be the first to comment

Benign n pre malignant diseases of cx

  1. 1.  Benign diseases of the cervix are common and are unusually asymptomatic or cause minor symptoms but must be differentiated from malignancy.  Cervical cancer is the second commonest cancer in women. It is proceeded by a premalignant form years before its invasion.  Screening for premalignant disease of the cervix markedly reduces the deaths from cervical cancer.
  2. 2. Transformational zone: The area of cervix between the old and new squamo- columnar junction. It is the area of risk of developing premalignant and malignant disease of the cervix.
  3. 3. 1) Cervical ectopy (erosion) 2) Cervical eversion (ectropion) 3) Cervical tears 4) Cervical cyst 5) Endocervical polyp. 6) Inflammatory conditions of cervix
  4. 4.  CLINICAL FEATURES Symptoms -Vaginal discharge -Contact bleeding -Associated cervicitis may produce backache, pelvic pain Signs p/s bright red area extending beyond external os. Neither tender nor bleeds on touch. Outer edge clearly demarcated The feel is soft, granular and gives rise to grating sensation aetiology
  5. 5.  DIAGNOSIS It can be confused with -ectropion -early carcinoma (indurated, friable and bleeds to touch) -primary chancre (ulcer has a punched out appearance. -tubercular ulcer (indurated with caseation at base)  MANAGEMENT All cases should be subjected to cytological examination to exclude dysplasia and malignancy In symptomatic cases -Pill should be stopped and barrier method is advised. -persistent ectopy with troublesome discharge thermal cautrisation cryosurgery laser vaporisation
  6. 6.  In chronic cervicitis there is marked thickening of cervical mucosa with underlying tissue edema. These thickened tissue tend to push out through the ex. Os along direction of least resistance.  More marked if cx already lacerated  As a result lips of cx curl upwards and outwards exposing red looking endocervix
  7. 7.  It frequently occurs during vaginal delivery.  One or both sides of cx may be torn, or it may b irregular (stellate) type  If these is no infection the torn surfaces approximate and heal leaving a notch if infection persists it causes eversion.  Non obstetric causes include lacerations due to operative procedures of DNC  Postmenopausal atrophy or chronic cervicitis also predisposes to tear.
  8. 8. These include 1. Nabothian cyst 2. Endometriotic cyst 3. Mesonephric cyst
  9. 9. Endocervical glands in the transformational zone become covered with squamous cells and forms mucus filled cysts. As this benign process continues, smooth, clear or yellow glandular elevations are visible during routine examination Nabothian cyst warrants no further therapy..
  10. 10. ENDOMETRIOTIC CYST Situated in portio vaginalis part of cx. It is small reddish and <1cm dia. Implantaion of endometrium due to surgery or during labour occurs giving rise to cyst Symptoms -PCB, intermenstrual bleeding -Dysmenorrhoea Treatment Destruction by cauterisation Rarely excision MESONEPHRIC CYST Usually situated in outer side of cervical stroma Seldom increase 2.5cm. Lined by cuboidal epithelium. They are asymptomatic . Warrants no further treatment
  11. 11.  It is one of the most common neoplasms  It is a hyperplastic projection of the endocervical folds.  These lesions are commonly found and may be associated with leukorrhea and post coital spotting  If it has a slender stalk it is removed my continuous twisting using a ring forceps. Twisting leads to occlusion of supporting vessels and avulsion of mass  A thick pedicled polyp needs surgical excision  Excised cervical polyps require pathologic evaluation to rule out malignancy
  12. 12. ACUTE CERVICITIS Usually follows child birth, abortion or any operative procedure on cervix. Responsible organisms aregonococcal, chlamydia, thrichomonal vaginosis, mycoplasma and HPV. Clinical features -Painful vaginal examination -Tender, Oedematous and congested cx -Muco purulent discharge seen at os Prognosis -Resolve completely. -infection spreads to adjacent structures. -becomes chronic Treatment -high vaginal endocervical swab to be taken for bacteriological examination -treat with appropriate antibiotics. CHRONIC CERVICITIS Follows attack of acute cervicitis Endocervix ia a potential reservoir of infection with N. gonorrhoeae, chlamydia, HPV, bacterial vaginosis. Clinical features -asymptomatic -excessive mucoid discharge might be present -h/o contact bleeding might be there On examination -Cx is tender On p/s mucopurulent discharge escaping ex. Os Treatment 1) No role of antimicrobial therapy except in gonococcal 2) Diseased tissue destroyed by electo or diathermy cauterisation or laser cryosurgery.
  13. 13. Cervical cancer Normal cervix
  14. 14.  DNA virus.  Over 100 different types and subtypes of this virus.  Common infection effecting epithelial surface.  Genital HPV is divided into  Low risk type (HPV 6,11) cause genital warts.  High risk types (HPV 16, 18, 31, 33, 45, 56).  HPV is a common infection while cervical cancer is a rare disease.
  15. 15. Factors that increase risk of transmission:  Smoking.  Increasing parity.  Early age of intercourse.  Oral contraceptive pills.  Immunity.
  16. 16.  Metaplasia: change of epithelium from one cell lining (columnar) to another (squamous).  Dysplasia: abnormal epithelial cells that fail to maturate. (hyperchromasia, larger, variable size, mitosis).  It may be mild, moderate or severe
  17. 17. CIN1 Normal CIN 1 (condyloma ) CIN 1 (mild dysplasia) CIN 2 (moderate dysplasia) CIN 3 (severe dysplasia/CIS) Invasive cancer Histolog y of squamo us cervical epitheliu m1
  18. 18.  Low grade squamous intraepithelial lesion (LSIL); HPV infection, CIN I.  High grade squamous intraepithelial lesion (HSIL); CIN II, CIN III. Squamous cell Glandular cell Atypical squamous cell (ASC) Atypical glandular cells (AGC) Endocervical, endometrial, or not otherwise specified ACS of undetermined significance(ASCUS) Atypical glandular cells, favour neoplastic or not otherwise specified ACSH cannot exclude HSIL Low grade sq. intraepithelial lesion(LSIL) Endocervical adenocarcinoma in situ adenocarcinoma H SIL Sq cell carcinoma
  19. 19. Outcome of CIN  Spontaneous regression.  Progression to invasive cancer.  Progression from one stage to another takes years.  Detection and treatment of CIN prevents cancer cervix.
  20. 20.  Screening for dyskariosis by obtaining cervical cytology.  Cervical screening should be carried out every 3-5 years in all sexually active women from 20-60 years of age.  There is a 10-15 % chance of false positive or false negative results.
  21. 21. Smear Risk of having HSIL Management If next smear is negative Normal 0.1% Repeat in 3-5 years Routine Inflammatory <6% Repeat in 3-5 years Routine Borderline 20-30% Repeat 6 months Repeat 1 year then 2 then routine. Colposcopy if 3 borderline. Mild dyskaryosis 30-50% Repeat in 3 months Or refer for colposcopy Repeat 1 year then 2 then routine. Colposcopy if 3 borderline. moderate dyskaryosis 50-70% Colposcopy Repeat after treatment Severe dyskaryosis 80-90% Colposcopy Repeat after treatment Invasion suspected 50% invasion Urgent colposcopy
  22. 22.  Is the inspection of the cervix with a low powered microscope.  Magnifies the cervix 4-20 times.  The patient is put in lithotomy position.  Passing a bivalve speculum gently into the vagina.
  23. 23.  Inspection of the cervix and its vasculature.  Green filter may help studying vasculature.  Abnormal vascular structure includes punctuation and mosaicism.  Acetic acid test: application of 3% acetic acid stained the abnormal area. The degree of staining correlates with severity of the lesion.  Schiller test: application of Lugol’s iodine stains the normal cervix brown.  Colposcopy gives a clinical diagnosis.  Punch biopsy from the abnormal area gives a histopathological diagnosis.
  24. 24.  CIN II,CIN III. ?CIN I. Techniques for treatment: Excisional: LEEP (loop electrosurgical excision procedure) CO2 laser cone, knife cone, hysterectomy. Ablative: radical electrodiathermy, cold coagulation, cryocautery, laser.  90-95% cure rate
  25. 25.  Less common than squamous intraepithelial neoplsia.  Has same risk factors.  Can not be reliably screened by colposcopy.  Does not have particular colposcopic features.  Divided into high grade and low grade.  Characterized by skip lesions.  Treatment by large cone biopsy.
  26. 26.  The first vaccine that intends to prevent cancer.  2 forms of vaccine are available  Bivalent 16, 18 (cervarix)  Quadrevalent 6, 11, 16, 18.(gardasil)  Now licensed in a number of countries.
  27. 27.  Benign diseases of cervix are harmless but malignancy should be excluded.  Cervical intraepithelial neoplasia proceedes cancer cervix by years. (CIN 1 to CIN 3 twenty years)  Screening for CIN reduces mortality from cancer cervix.  Those with positive screening test should be referred to colposcopy for diagnosis and treatment.

×