Pathology of cervix

1. Pathology of the
Cervix
By:Sorav Sorout

3. PATHOLOGY OF CERVIX
▪ INFLAMMATION
▪ METAPLASIA
▪ POLYPS
▪ DYSPLASIA
▪ CIN
▪ INFILTRATING
CARCINOMA

5. Endocervical Polyps
⮚ Benign exophytic growths
⮚ Occur in 2% to 5% of adult women
⮚ Irregular vaginal “spotting” or bleeding
⮚Treatment - Simple curettage or
surgical excision effects a cure

6. Site:
within the
endocervical canal
Size:
small and sessile to
large
(5-cm masses that
protrude through the
cervical os)
Consistency:
soft& mucoid

7. Microscopic -
▪fibromyxomatous stroma
▪mucus secreting endocervical glands
▪often accompanied by inflammation
Endocervical Polyps

8. Premalignant and Malignant Neoplasms
CERVICAL INTRAEPITHELIAL NEOPLASIA
Nearly all invasive cervical squamous cell
carcinomas arise from
precursor epithelial changes referred to as
CIN

9. CERVICAL INTRAEPITHELIAL NEOPLASIA
Not all cases of CIN progress to invasive
cancer
persist without change or even regress

10. Classification Systems for
Premalignant Squamous Cervical Lesions
Dysplasia CIN Squamous Intraepithelial Lesion (SIL)
Mild dysplasia CIN I Low-grade SIL (LSIL)
Moderate dysplasia CIN II High-grade SIL (HSIL)
Severe dysplasia CIN III High-grade SIL
(HSIL)
Carcinoma in situ CIN III High-grade SIL
(HSIL)

11. Papanicolaou (Pap) smear
Cytologic examination (Papanicolaou (Pap) smear)
can detect CIN long before any abnormality can be
seen grossly
The Pap smear - the most successful cancer
screening test
In populations that are screened regularly,
cervical cancer mortality is reduced by as much
as 99%

12. The cytology of CIN as seen on the Papanicolaou smear
Normal
exfoliated superficial squamous epithelial
cells CIN I
CIN II CIN III

13. DYSPLASIA / CIN (CERVICAL INTRAEPITHELIAL NEOPLASIA
) Spectrum of cervical intraepithelial neoplasia:
A. normal squamous epithelium for comparison
B. CIN I with koilocytotic atypia
C. CIN II with progressive atypia in all layers of the epithelium
D. CIN III (carcinoma in situ) with diffuse atypia and loss of
maturation

14. Carcinoma Cervix
second most common cancer in women
▪ Squamous cell carcinomas (75%)
▪ Adenocarcinomas & adenosquamous
carcinomas (20%)
▪ Small-cell neuroendocrine carcinomas
(<5%)

15. Pathogenesis of Carcinoma Cervix
High oncogenic risk HPVs are currently
considered to be the single most important
factor in cervical oncogenesis
HPV 16 and HPV 18

16. Pathogenesis of Carcinoma Cervix
The risk factors for cervical cancer are related to
both host and viral characteristics
⮚HPV exposure
⮚viral oncogenicity
⮚inefficiency of immune response
⮚presence of co-carcinogens

17. Risk Factors
1. Multiple sexual partners
2. A male partner with multiple previous or current
sexual partners
3. Young age at first intercourse
4. High parity
5. Persistent infection with a high oncogenic risk HPV,
e.g., HPV 16 or HPV18
6. Immunosuppression
7. Certain HLA subtypes
8. Use of oral contraceptives
9. Use of nicotine

18. Role of HPV in carcinoma cervix
How does HPVtransform cells?
Viral oncoproteins E6 and E7
▪ E6 binds - the product of tumor
suppressor gene TP53 and inactivates it
▪ E7 binds - the retinoblastoma gene (RB)
protein

19. MORPHOLOGY
pink-tan, friable
Fungating (exophytic)
lesion on the
anterior cervical lip

20. Squamous cell carcinoma of the cervix
Microinvasive squamous cell carcinoma
with invasive nest breaking through the basement membrane of HSIL
MORPHOLOGY
Invasive nest of tumor cells

21. squamous cell carcinomas are composed of
nests and tongues of malignant squamous epithelium
either keratinizing or non keratinizing
invading the underlying cervical stroma
MORPHOLOGY

22. MORPHOLOGY
Adencarcinoma in situ
Adenocarcinomas are characterized by proliferation of glandular
epithelium composed of malignant endocervical cells with large,
hyperchromatic nuclei
and relatively mucin-depleted cytoplasm, resulting in dark appearance of the glands
Invasive adencarcinoma

23. CLINICAL
FEATURES
▪ Asymptomatic
▪ unexpected vaginal bleeding
▪ Leukorrhea
▪ painful coitus (dyspareunia)
▪ Dysuria