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Diseases of Cervix

  1. Non-specific acute and/or chronic inflammation is common in the cervix, particularly in the presence of an intrauterine contraceptive device, ectopy or prolapse. 
  2. Chlamydiae are obligate intracellular organisms containing DNA and RNA, and are larger than viruses. Q
  3. Chlamydia trachomatis is a common sexually transmitted infection which is often recognised by its persistence following treatment for gonorrhoea in males (post-gonococcal urethritis). Q Chlamydiae can be isolated from the cervices of about 50% of asymptomatic female partners of these infected males and from women with chronic cervicitis.
  4. Chlamydial infection may produce subepithelial reactive lymphoid follicles, a condition sometimes given the label of 'follicular cervicitis'. Q 
Cervical polyps 
  1. Benign polyps of the cervix are common.
  2. They are composed of columnar mucus-secreting epithelium and oedematousstroma. Q
  3. Vessels may be prominent and there may be acute or chronic inflammation of varying severity. Q
  4. These polyps have no malignant potential.
Cervical Squamous Neoplasia 
  1. Incidence associated with sexual intercourse (especially number of male partners)
  2. Human papillomavirus postulated as main causative factor, with cigarette smoking as independent risk factor Q
  3. Pre-invasive phase of intraepithelial neoplasia can be detected by cervical cytology
  4. Cervical intraepithelial neoplasia (CIN) graded from 1 to 3 according to severity of abnormality. Q
The features associated with human papillomavirus infection are:
  1. Koilocytosis
  2. Hyperkeratosis
  3. Parakeratosis
  4. Papillomatosis
  5. Individual cell keratinisation (dyskeratosis)
  6. Multinucleation.
These morphological features are also common accompaniments of vulval, vaginal and cervical intraepithelial neoplasia.

Cervical intraepithelial neoplasia (CIN)
  1. This refers to the spectrum of epithelial changes that take place in squamous epithelium as the precursors of invasive squamous carcinoma. Q
  2. The severity of the lesion is assessed subjectively as grade (CIN) 1 (low grade), 2 or 3 (high grade), according to the level in the epithelium at which cytoplasmic maturation is taking place.
The morphological abnormalities of the nucleus (dyskaryosis) in cervical smears are:
  • Disproportionate nuclear enlargement
  • Irregularity in form and outline
  • Hyperchromasia
  • Irregular chromatin condensation
  • Abnormalities of the number, size, and form of nucleoli
  • Multinucleation.
Invasive Ca Cervix
  1. The earliest sign of malignancy is early stromal invasion when small foci (less than 1 mm) are seen to arise from the basal epithelium and to breach the integrity of the basement membrane. 
  2. The concept of a microinvasive carcinoma is one in which there is a negligible risk of lymph node metastasis so that conservative management is appropriate. Q
  3. The tumour spreads by local and lymphatic invasion.
  4. The two principal factors that determine the prognosis of cervical carcinoma are: Q
    a. The size and depth of invasion of the primary tumour
    b. The presence and (more importantly) the extent of lymph node metastases.
The staging of cervical cancer is based on clinical and pathological assessment.
  1. Stage I cervical cancer is strictly confined to the cervix,
  2. Stage II cancer extends beyond the cervix but has not extended onto the pelvic wall.
It involves the vagina but not the lower third. Q
  1. Stage III cancer may extend onto the pelvic wall and involves the lower third of the vagina, and
  2. Stage IV implies extension outside the reproductive tract. Tumour may then involve the adjacent organs, e.g. the mucosa of the bladder or rectum.
  3. Involvement of para-aortic nodes is associated with a uniformly poor prognosis. Q
  4. The degree of histological differentiation of squamous carcinoma (whether it is well, moderately or poorly differentiated) is also an important factor.

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