Cervix Flashcards
What is ectropian (aka ectopy) and what does it look like?
Eversion of the columnar epithelium of the lower part of the endocervical canal on to the ectocervix
Occurs under influence of estrogen during puberty and the reproductive period → cervix swells and enlarges and the endocervical canal elongates
Visible as a large reddish area on the ectocervix surrounding the external os
*Becomes more pronounced during pregnancy
Ectocervix consists of what type of cells?
Stratified non-keratinizing, glycogen containing epithelium
- Cells divide at the basal layer and move upward as they mature
- Basal → parabasal → intermediate → superficial
- Estrogen promotes maturation
Endocervix consists of what type of cells?
Columnar epithelium
- “Glandular” - secrete mucus
- Single layer
- Appear red (vascular)
What is metaplasia?
The transformation of one type of epithelium to another.
I.e everted columnar epithelium in ectropion exposed to the acidic vaginal environment and destroyed → eventual replacement metaplastic squamous epithelium.
What are Nabothian cysts (follicles)?
Retention cysts that develop as a result of the occlusion of an endocervical crypt opening or outlet by the overlying metaplastic squamous epithelium
The buried columnar epithelium continues to secrete mucus, which eventually fills and distends the cyst.
Cysts are a ivory-white to yellowish hue
What is the cervical transformation zone?
Region of cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium
What is the squamous-columnar junction
Where non-keratinized, stratified squamous epithelium and columnar epithelium meet
What is dysplasia?
Pathologic epithelial abnormality of growth/differentiation
What is neoplasia?
Abnormal tissue proliferation
What is the Bethesda system?
- Standardization of reporting of cervical cytology
- Every pap should be reported under this system
• Includes the following categories:
• Specimen type - liquid vs conventional
• Specimen adequacy - satisfactory vs unsatisfactory
• General categorization - i.e. NILM, LSIL
• Interpretation/Result
• Adjunctive testing, computer-assisted interpretation,
notes and comments
Describe what makes a pap satisfactory for evaluation vs unsatisfactory.
Satisfactory:
• 5,000 well-visualized/preserved squamous or metaplastic cells
• 10 Endocervical / transformation zone component presence specified: requires at least ten well-preserved endocervical or squamous metaplastic cells
• Quality indicator for clinician
• Absence should not trigger earlier rescreening
Unsatisfactory:
• Scant cellularity
• Obscuring blood, inflammation, or other substance
• Must repeat!
How is abnormality determined in cervical cytology?
- Nuclear size and ratio to area of cytoplasm
- Nuclear membrane characteristics
- Chromatin characteristics
- Bi- or multi- nucleation
- Presence of keratinization
What is ASCUS?
Atypical Squamous Cells of Undetermined Significance
• Most common abnormal pap result
• Benign reactive vs. HPV associated cell
changes
• Reflex HPV testing and closer follow up if positive
• If ASCUS + HPV, 5 year risk of CIN3+ 6.8%
What is LSIL?
Low Grade Squamous Intraepithelial Lesion
• HPV present in > 3⁄4 of LSIL paps
• 5 year risk of CIN3+ 5.2%
• If LSIL + HPV, risk increases to 6.1%
What is HSIL?
High Grade Squamous Intraepithelial Lesion
• 5 year risk of CIN3+ is 47%
• May proceed straight to diagnostic/therapeutic excision
• If colpo and biopsy are done and no CIN is identified, close follow up is indicated
