Page 741 - Textbook of Pathology, 6th Edition

chronic cervicitis are the normal mixed vaginal flora that 725
includes streptococci, enterococci (e.g. E. coli) and
staphylococci. Other infecting organisms include gonococci,
Trichomonas vaginalis, Candida albicans and herpes simplex.
Factors predisposing to chronic cervicitis are sexual
intercourse, trauma of childbirth, instrumentation and excess
or deficiency of oestrogen.
Grossly, there is eversion of ectocervix with hyperaemia,
oedema and granular surface. Nabothian (retention) cysts
may be grossly visible from the surface as pearly grey
vesicles.
Histologically, chronic cervicitis is characterised by
extensive subepithelial inflammatory infiltrate of
lymphocytes, plasma cells, large mononuclear cells and a
few neutrophils. There may be formation of lymphoid
follicles termed follicular cervicitis. The surface epithelium
may be normal, or may show squamous metaplasia. The
squamous epithelium of the ectocervix in cases of uterine
prolapse may develop surface keratinisation and
hyperkeratosis, so called epidermidisation. Areas of Figure 24.3 Endocervical polyp. The surface is covered by
squamous metaplasia and hyperkeratosis may be endocervical mucosa with squamous metaplasia. The stromal core is
mistaken on cursory microscopic look for a well- composed of dense fibrous tissue which shows nonspecific inflammation.
differentiated squamous carcinoma.

TUMOURS endocervical glands without intervening stroma. The
condition is caused by progestrin stimulation such as during CHAPTER 24
Both benign and malignant tumours are common in the pregnancy, postpartum period and in women taking oral
cervix. In addition, cervix is the site of ‘shades of grey’ lesions contraceptives. Morphologically, condition may be mistaken
that include cervical dysplasia and carcinoma in situ (cervical for well-differentiated adenocarcinoma.
intraepithelial neoplasia, CIN), currently termed squamous
intraepithelial lesions (SIL). Benign tumours of the cervix Squamous Intraepithelial Lesion (SIL)
consist most commonly of cervical polyps. Uncommon (Cervical Intraepithelial Neoplasia, CIN)
benign cervical tumours are leiomyomas, papillomas and
condyloma acuminatum which resemble in morphology with TERMINOLOGY. Presently, the terms dysplasia, CIN,
similar tumours elsewhere in the genital tract. The most carcinoma in situ, and SIL are used synonymously as follows:
common malignant tumour is squamous carcinoma of the DYSPLASIA. The term ‘dysplasia’ (meaning ‘bad moul-
cervix. ding’) has been commonly used for atypical cytologic The Female Genital Tract
changes in the layers of squamous epithelium, the changes
Cervical Polyps
being progressive (Chapter 3). Depending upon the thickness
Cervical polyps are localised benign proliferations of of squamous epithelium involved by atypical cells, dysplasia
endocervical mucosa though they may protrude through the is conventionally graded as mild, moderate and severe. Carci-
external os. They are found in 2-5% of adult women and noma in situ is the full-thickness involvement by atypical
produce irregular vaginal spotting. cells, or in other words carcinoma confined to layers above
the basement membrane. At times, severe dysplasia may not
MORPHOLOGIC FEATURES. Grossly, cervical polyp is be clearly demarcated from carcinoma in situ. It is well
a small (up to 5 cm in size), bright red, fragile growth accepted that invasive cervical cancer evolves through
which is frequently pedunculated but may be sessile.
Microscopically, most cervical polyps are endocervical progressive stages of dysplasia and carcinoma in situ.
polyps and are covered with endocervical epithelium CIN. An alternative classification is to group various grades
which may show squamous metaplasia. Less frequently, of dysplasia and carcinoma in situ together into cervical
the covering is by squamous epithelium of the portio intraepithelial neoplasia (CIN) which is similarly graded
vaginalis. The stroma of the polyp is composed of loose from grade I to III. According to this concept, the criteria are
and oedematous fibrous tissue with variable degree of as under:
inflammatory infiltrate and contains dilated mucus- CIN-1 represents less than one-third involvement of the
secreting endocervical glands (Fig. 24.3). thickness of epithelium (mild dysplasia).
CIN-2 is one-third to two-third involvement (moderate
Microglandular Hyperplasia dysplasia).
Microglandular hyperplasia is a benign condition of the CIN-3 is full-thickness involvement or equivalent to
cervix in which there is closely packed proliferation of carcinoma in situ (severe dysplasia and carcinoma in situ).