Dokument 1

Cervix
Last revised 19 April 2011 19. 2011

Last major update February 2006
2006
Copyright 2003-2009, PathologyOutlines.com, Inc.
2003-2009, .,
Reviewed by Dr. Branko Perunovic (see Reviewers Page)
( )
Home Page
Printer Friendly Version
See also Cervix-cytology , Uterus
- ,
Table of contents - Cervix -
Primary references
Cervix: embryology , normal anatomy, normal histology
, metaplasia : ,
, ,
Inflammation: inflammation-general , actinomycosis , amebiasis , bacterial

vaginosis , Candida/fungi , chlamydia , chronic cervicitis , CMV , Enterobius,
granuloma : , ,
, , / , ,
, , ,
Benign/non-neoplastic lesions: adenomyoma , adenosis ,
Arias-Stella reaction , atrophy , atypical polypoid
adenomyoma , blue nevus , cervical pregnancy ,
decidual nodule , decidual reaction , diffuse laminar
endocervical glandular hyperplasia , ectopic
tissue/heterotopia , endocervical polyp , endometrial
polyp , endometriosis , endosalpingiosis , florid deep
glands , glial polyp , hemangioma , inflammatory
pseudotumor , inverted urothelial papilloma ,
leiomyoma , lipoleiomyoma , lobular endocervical
hyperplasia , melanosis , mesonephric papilloma ,
mesonephric rests , mesonephric hyperplasia ,
microglandular hyperplasia , myofibroblastoma ,
Nabothian cysts , necrobiotic granulomas ,
neurofibroma , pagetoid dyskeratosis , papillary
adenofibroma , papillary endocervicitis , placental site
nodule , post-operative spindle cell nodule ,
pseudosarcomatous fibroepithelial stromal polyps ,
pyogenic granuloma , rhabdomyoma , squamous

papilloma , traumatic neuroma , tunnel clusters
/ - : , ,
- , ,
, ,
, ,
,
,
/ ,
, , ,
, ,
, ,
, ,
, ,
, ,
, ,
,
, ,
, , ,
,
, ,
,
,
, ,
, ,
,
Premalignant/preinvasive lesions: HPV , condyloma ,
atypical squamous lesion , SIL-general , LSIL/CIN I ,
HSIL/CIN II , HSIL/CINIII , SIL variants , endocervical
glandular atypia/dysplasia , adenocarcinoma in situ ,
radiation atypia , stratified mucin producing
intraepithelial lesions / :
- , , ,
- , / , / ,
/ , ,
/ ,
, ,

Carcinoma: WHO classification , squamous cell and
variants , microinvasive squamous cell ,
adenocarcinoma and variants , microinvasive
adenocarcinoma , adenoid basal , adenoid cystic ,
adenosquamous , basaloid squamous cell , carcinoid ,
clear cell , endometrioid , epithelioid trophoblastic
tumor , glassy cell , large cell neuroendocrine ,
lymphoepithelioma-like , mesonephric
adenocarcinoma , metastases to cervix , minimal
deviation adenocarcinoma , mixed , serous papillary
adenocarcinoma , small cell , spindle cell , urothelial ,
verrucous , villoglandular papillary adenocarcinoma ,
warty : ,
,
, ,
, ,
, ,
, , ,
,
, ,
, ,
,
, ,
, ,
, , ,
,
,
Sarcoma/lymphoma/other: adenosarcoma , aggressive
angiomyxoma , alveolar soft parts sarcoma , Ewing's
sarcoma/PNET , granulocytic sarcoma ,
leiomyosarcoma , lymphoma , malignant mixed
mullerian tumor , melanoma , other (case reports),
plasmacytoma , rhabdomyosarcoma , stromal
sarcoma , teratoma , Wilm's tumor , yolk sac tumor
/ / : ,
, ,
/ , ,
, ,
, , (
), , ,
, , ,

Miscellaneous: procedures , grossing , staging of
cervical carcinoma , features to report :
, ,
,
Go to Cervix-cytology -
Primary references
top
AJCC Cancer Staging Manual (7th ed)

(7. .)
American Journal of Clinical Pathology (AJCP), August
1975 to February 2006
(), 1975 2006
American Journal of Surgical Pathology (AJSP), March
1977 to January 2006 ,
(), 1977 2006
Archives of Pathology and Laboratory Medicine

(Archives) , June 1976 to January 2006
(), 1976
2006
Human Pathology (Hum Path) , May 1974 to January 2006

( ), 1974 2006
Modern Pathology (Mod Path) , March 1988 to January 2006
( ), 1988 2006
Kurman: Tumors of the Cervix, Vagina, and Vulva

(AFIP, 3rd Series, Vol 4) : ,
, (, 3. , 4)
Rosai, J: Ackerman's Surgical Pathology (9th Ed);
Mosby, 2004 , .:
(9. ), , 2004
Sternberg, S: Diagnostic Surgical Pathology (4th Ed);
Lippincott Williams & Wilkins, 2004 :
(4. );
& , 2004
Website: Histopathology and cytopathology of the
Uterine Cervix Digital Atlas :
-
Journal search terms: cervix, cervicovaginal

: ,
Please refer to these primary references for more detailed
discussions and photographs

Cervix-embryology ,
top
Mesoderm derived mullerian ducts fuse at day 54 post-conception
and form uterovaginal canal, lined by mullerian columnar epithelium
54.
,

Uterovaginal canal joins endoderm lined urogenital sinus at mullerian
tubercle, which becomes vaginal orifice at hymenal ring

,

Epithelium stratifies at caudal uterovaginal canal to become
squamous; epithelium proliferates to become almost purely
squamous in vagina by day 77
;
77
Endocervical glands and vaginal fornices appear between days 91
and 105
91 105
Cervix responds to estrogenic stimulation by marked growth

Cervix-normal anatomy -
top
Lower 1/2 to 1/3 of uterus, cylindrical, connects uterus to vagina via
endocervical canal 1 / 2 1 / 3 , ,

Consists of portio vaginalis (portion that protrudes into vagina) and
supravaginal portion (
)
2.5 to 3.0 cm long and 2.0 to 2.5 cm in diameter 2,5 3,0
2,0 2,5
Anteriorly abuts on bladder; posteriorly is covered by peritoneum that

forms lining of cul-de-sac ,
--
Endocervix: relates to endocervical canal :

Ectocervix (exocervix): vaginal portion of cervix
():
External os: opening of endocervical canal to ectocervix
:
Fornix: reflection of vaginal wall that surrounds ectocervix :

Internal os: indistinct upper limit of endocervical canal :

Transformation zone: see also under histology; usually appears red
due to rich capillary network and is called cervical erosion, although
ectropion is a better term :
;
,
Cardinal ligaments: fibromuscular bands that fan out from lower
uterine segment and cervix to lateral pelvic walls and provide main
support for cervix :

Uterosacral ligaments: connective tissue surrounding cervix and
vagina that extends towards vertebrae :

Lymphatics: cervix is drained by parametrial, cardinal and

uterosacral ligament routes :
,
Drawings: local anatomy ; microanatomy ; saggital

section of local anatomy #1 ; #2 ; uterus, cervix and
vagina #1 ; #2 ; vasculature :
; ;
# 1 , # 2 ; ,
# 1 , # 2 ;
Gross: nulliparous cervix ; endocervical canal :
;
References: ASCCP :
Cervix-normal histology -
top
Most of cervix is composed of fibromuscular tissue

Epithelium is either squamous or columnar

Endocervix: lined by columnar epithelium that secretes mucus;
epithelium has complex infoldings that resemble glands or clefts on
cross section; mucosa rests on inconspicuous layer of reserve cells
: ;

;

Ectocervix (exocervix): (): covered by
nonkeratinizing, stratified squamous epithelium, either native or
metaplastic; has basal, midzone and superficial layers; after
menopause is atrophic with mainly basal and parabasal cells with
high N/C ratio that resembles dysplasia; prepubertal girls have similar
appearing epithelium ,
, ; ,
,
/
;

Stem cells are in suprabasal layer
Squamocolumnar junction: where squamous and glandular

epithelium meets; usually in exocervix; nearby reserve cells are
involved in squamous metaplasia, dysplasia and carcinoma
:
; ;
,
Transformation zone: also called ectropion, between original
squamocolumnar junction and border of metaplastic squamous
epithelium; epidermalization and squamous differentiation of reserve
cells transform this area to squamous epithelium; site of squamous
cell carcinomas and dysplasia :
,
;

;
Note: endocrine cells and melanocytes are seen occasionally in

cervix; multinucleated giant cells may be a normal finding, often
accompanied by edema ( Archives 1985;109:200 ) :

;
, ( 1985; 109:200 )
Basal cells (reserve cells): cuboidal to low columnar with scant
cytoplasm and round/oval nuclei; acquire eosinophilic cytoplasm as
they mature; positive for low molecular weight keratin and estrogen
receptor; negative for high molecular weight keratin and involucrin
( ):
/ ;
;
;

Suprabasal cells: have variable amount of glycogen, detectable with
Lugol/Schiller's test (application of iodine) or microscopically by PAS
stain; positive for high molecular weight keratin and involucrin
: ,
/ ( )
-;

Glandular epithelium: positive for estrogen receptor
:
Menarche: ovaries produce estrogen, which stimulates glycogen
update by cervical and vaginal mucosa, which promotes growth of
endogenous vaginal microorganisms, which produce acid and drop in
vaginal pH; basal/reserve cells respond by proliferating, causing
squamous and columnar metaplasia; squamous epithelium overgrows

columnar epithelium, obstructing crypt openings and forming
Nabothian cysts; also produces acute and chronic inflammatory
infiltrate : ,

,
,
; / ,
;
,
;

Drawings: location of glandular and squamous
epithelium :
Gross images: squamocolumnar
junction :

Micro images: ectocervix (H&E, stains, EM) ; normal
nonkeratinizing squamous epithelium #1 ; #2 ; #3 ; #4
: ( & , , ) ;
# 1 ,
#2;#3;#4
transformation zone #1-various images ; #2 ; #3
# 1- , # 2 ; # 3
endocervix (H&E, stains, EM ); endocervix #1 ; #2 ; #3 ;
#4 ; #5 ; infoldings resemble glands ; endocervical
canal (whole mount) ; normal exocervix ;
squamocolumnar junction ; cervical myometrium #1 ;
#2 ; myometrium and adventitia ; prepubertal
squamous epithelium shows only basal and
parabasal cells with no maturation ( &
, , ); # 1 , # 2 ; # 3 , # 4 , # 5 ;
;
( ) ; ;
;
# 1 , # 2 ; ;

Virtual slides: normal cervix :

Cytology: see Cervix-cytology :
-
References: ASCCP :
Metaplasia in cervix
top
Defined as change in differentiation pathway to which the stem cell

progeny commit

Not neoplastic
Micro images: osseous and cartilaginous metaplasia
:
DD: metaplastic growth pattern, which may be neoplastic :
,
Atypical oxyphilic metaplasia of cervix

top
Very rare
Incidental finding with benign behavior

Mean age 48 years, range 41 to 62 years 48
, 41 62
Case reports: 37 year old woman ( Cesk Patol 2000;36:60 ) :
37 ( 2000; 36:60 )
Micro: large, cuboidal or polygonal epithelial cells with dense
eosinophilic, focally vacuolated cytoplasm; variable nuclear atypia in
endocervical glands due to enlarged, hyperchromatic or
multinucleated / multilobated nuclei; rarely apical snouts; no mitotic
figures, no stratification : ,
,
;
,
/ ;
, ,
References: : Int J Gynecol Pathol 1997;16:99
1997; 16:99
Epidermoid metaplasia of cervix
top
Very rare
Associated with uterine prolapse, prolonged irritation or synthetic
steroids ( Obstet Gynecol 1974;44:53 ) ,
( 1974; 44:53
)
Case reports: 44 year old woman with ectocervical lesion ( Archives
2004;128:1052 ) : 44
( 2004; 128:1052 )
Micro: epidermis, sebaceous glands and hair follicles :
,
Micro images: (1) with sebaceous glands ; (2) figure 1:
cervix covered by keratinized squamous epithelium

with prominent granular cell layer; 2: stroma has
mature sebaceous glands; 3: sebaceous cells are
surrounded by epithelial cells : (1)
, (2) 1:

; 2:
, 3:

DD: mature teratoma :
Immature squamous metaplasia of cervix

top
Micro: resembles squamous metaplasia but without cytoplasmic

glycogen; mild reactive changes include mild variation in nuclear size
and hyperchromasia; often surface maturation; when acutely inflamed
may resemble SIL, but cells are not crowded or disorganized, nuclei
are round and uniform and not hyperchromatic, background cells
have prominent nucleoli (reactive changes); often overlying mucinous
epithelium : ,
;
,
,
, ,
, ,
( ),

-
Micro images: immature squamous metaplasia ; with
mild atypia :
;
Intestinal metaplasia of cervix
top
Rare, may have mucin extravasation into stroma ,

Case reports: with HSIL ( Histopathology 1985;9:551 ), with florid
endocervical glandular hyperplasia ( Gynecol Oncol 1999;74:504 ), with
cervical dysplasia and leiomyosarcoma ( Rev Chil Obstet Ginecol
1993;58:481 ), with villous adenoma and adjacent adenocarcinoma ( Int J
Gynecol Pathol 1986;5:163 ) : ( 1985,
9:551 ), (
, 1999; 74:504 ),
( 1993; 58:481 ),
( , 1986; 5:163 )
Micro: goblet cells, occasionally Paneth cells : ,

Squamous metaplasia of cervix
top
See also immature squamous metaplasia above

Replacement of endocervical epithelium by subcolumnar reserve
cells, which differentiate into immature and then mature squamous
epithelium (see also normal histology above)
,

( )
Common response to chronic irritation in nonsquamous tissue;
present in almost every cervix
;
Centered on transformation zone
May also arise from ingrowth of squamous epithelium from ectocervix

(squamous epithelialization)
( )
Not a premalignant condition by itself
Keratosis: appearance of granular and horny epithelial layers, often

associated with prolapsed uteri (see pagetoid dyskeratosis
below) : ,
(
)
Micro: squamous epithelium overlies endocervical glands, may

replace glands; metaplastic cells may be immature, intermediate or
mature; resembles epithelium normally lining ectocervix with flat
architecture; may have cytologic atypia :
, ;
, ;

;
-
Micro images: various images ; early metaplasia ;
involving clefts ; with cytoplasmic vacuoles
: ; ;
;
Tuboendometrial metaplasia of cervix

top
Common (1/3 of women); in upper portion of endocervical canal, often

in deep glands (1 / 3 ),
,
Often seen after cervical cone biopsy; may represent response to
injury ;

Micro: tubal metaplasia - endocervix contains ciliated cells (clear
cytoplasm, abundant apical cilia and large, oval, variably
hyperchromatic nuclei), secretory cells (nonciliated with dark
eosinophilic or basophilic cytoplasm, apical cytoplasmic protrusions
but no mucin vacuoles, basal nuclei); and intercalated cells (also
called peg cells, scant cytoplasm, thin and long nuclei), as found in
normal fallopian tube; glands are regular; minimal mitotic activity, rare
crowding or atypia; also associated with endometrial type cells;
usually near squamocolumnar junction, usually no inflammation
: -
( ,
, , ),
(
,
, ) (
, , ),
; ;
, ,
,
,
May have cystic glands and periglandular stromal alterations
suggestive of premalignant conditions, or deep glands with
periglandular edema suggestive of well differentiated
adenocarcinoma, but cells are ciliated with bland cytology, no mitotic
figures, no definite desmoplastic stroma ( AJCP 1995;103:618 )

,
,
,
, ( 1995;
103:618 )
Micro images: tubal metaplasia #1 ; #2 ; #3 ; #4 ; #5

(bcl2+) : # 1 , # 2 ; # 3
, # 4 , # 5 (2 +)
Positive stains: CEA (not helpful in differential diagnosis below)
: (
)
DD: endometrioid adenocarcinoma (invasive growth pattern, marked
nuclear atypia, increased Ki-67 staining), adenocarcinoma in situ
(lesion at squamocolumnar junction involving superficial but not deep
glands; cells do not resemble fallopian tube or endometrium; have
coarse nuclei, abundant mitotic figures) :
( , ,
-67 ), (
,
; ,
, )
References: : Archives 1993;117:734 , Mod Path 2000;13:261
1993; 117:734 , 2000; 13:261
Urothelial metaplasia of cervix
top
Also called transitional cell metaplasia

An incidental microscopic finding of exocervical squamous epithelium
associated with atrophic changes in the elderly

May represent basal cell hyperplasia or atrophy associated with
androgen exposure

Case reports: with ectopic prostatic tissue in 23 year old woman with
adrenogenital syndrome ( Int J Gynecol Pathol 2004;23:182 ) :
23
( , 2004; 23:182 )
Micro: hyperplastic epithelium without maturation composed of
urothelial type cells with tapered ends, spindled nuclei with
longitudinal nuclear grooves and perinuclear halos, but minimal
nuclear atypia, low N/C ratios and rare/no mitotic activity :

,
,
, / /
-
Micro images: : urothelial metaplasia #1 ; #2 ;
#3 ; #4 (serotonin+) ; transitional metaplasia and
atrophy after androgen treatment #1 ; #2
# 1 , # 2 ; # 3 , # 4 ( +) ;

# 1 ; # 2
Positive stains: : CK13, CK17, CK18; basal cells
-calcitonin, serotonin 13, 17, 18; ,
Negative stains: CK20 (same as normal urothelium)
: 20 ( )
DD: HSIL (high N/C ratio, cellular disorganization and pleomorphism,

high mitotic rate) : ( / ,
, )
References: AJSP 1997;21:510 , Mod Path 2000;13:252 :
1997; 21:510 , 2000; 13:252
Inflammation of cervix
Inflammation of cervix-general

top
At menarche, the ovaries produce estrogen, leading to glycogen

uptake by cervix and vaginal squamous mucosa; shedding cells
promote the growth of vaginal aerobes and anaerobes, leading to a
reduced (acidic) vaginal pH, which causes metaplastic transformation
of transformation zone mucosa from columnar to squamous in
exposed endocervix; squamous epithelium overgrows columnar
epithelium, obstructing crypt openings and forming Nabothian cysts;
also produces acute and chronic inflammatory infiltrate
, ,

;
, ()
,

;
,
;

Micro images: reactive (inflammatory) atypia #1 (various
images-mainly ectocervix) ; #2-endocervix ; #3transformation zone :
() # 1 ( -
) ; # 2- ; # 3-
Actinomycosis of cervix
top
Actinomycetes normally reside in the female genital tract, so

presence does not indicate disease ( Am J Obstet Gynecol 1999;180:265 )
,
( 1999; 180:265 )
Associated with IUDs with colonization rate of 11%, increases with
duration of use ( J Reprod Med 1994;39:585 , IPPF Med Bull 1983;17:1 )
11%,
( 1994; 39:585 , , 1983; 17:1 )
Less common than pseudoactinomycotic radiate granules that form
around microorganisms or biologically inert substances

Micro: tangled clumps of gram positive filamentous organisms, often
with acute angle branching, sometimes showing irregular wooly
appearance; swollen filaments may be seen with clubs at periphery;
often cotton ball-like acute inflammatory response :
,
,
;
,
-
Amebiasis of cervix
top
May simulate or accompany carcinoma (
Am J Trop Med Hyg 1992;46:759 ,
)
( 1992; 46:759 ,
1987; 25:249 , 1985; 109:1121 )
Gross: polypoid and ulcerated mass; may engraft on pre-existing
carcinoma : ;

Micro images: various images (not cervix), figures 1-5 ;
clusters of trophozoites (liver) :
( ), 1-5 ;
Int J Gynaecol Obstet 1987;25:249 , Archives 1985;109:1121
()
Bacterial vaginosis
top
See Cervix-cytology -
Candida / fungi /
top
Chlamydia trachomatis of cervix

top
Most common sexually transmitted disease (STD) in Western world; 4

million new cases annually in US
() , 4

Affects cervix, uterus, adnexae; not vulva/vagina
, , , /
Chlamydia trachomatis is an obligate intracellular parasites with
elementary bodies (infectious but incapable of cell division) and
reticulate bodies (multiply within cytoplasm, but not infectious until
they transfer back into elementary bodies)

(, )
( ,
)
Causes infertility
Diagnose based on culture, PCR of urine or enzyme immunoassay on
cervical / urethral swab ( Archives 2000;124:840 )
,
/ ( 2000; 124:840 )
Nucleic acid amplification of urine has similar sensitivity as samples
from cervix or urethra ( Ann Intern Med 2005;142:914 )

( , 2005; 142:914 )
Does NOT cause dysplasia
Micro: lymphoid germinal centers (follicular cervicitis-sensitive but not
specific for chlamydia), plasma cells, reactive epithelial atypia
: (
, ), ,

Positive stains: immunocytochemistry can detect organisms

:
Chronic cervicitis
top
Found in almost all women (see normal histology above)

( )
Depending on etiology, may cause endometritis, salpingitis, pelvic
inflammatory disease (PID) or chorioamnionitis
, , ,
()
Organisms of concern are gonococci, Chlamydia, Mycoplasma, HSV
, , ,
Micro: affects squamocolumnar junction and endocervix; produces

intercellular edema (spongiosis), submucosal edema, mononuclear
inflammation, fibrosis :
;
(), , ,
Micro images: chronic cervicitis ; various images ;

ectocervicitis ; endocervicitis :
; ; ;
Cytology: See Cervix-cytology :

-
CMV of cervix
top
Patients are usually NOT immunocompromised ( J Clin Pathol 2004;57:691

) ( 2004; 57:691 )
Viral shedding common in HIV+ women ( Med Virol 1999;59:469 )
+ ( , 1999;
59:469 )
Micro: large, basophilic intranuclear inclusions or intracytoplasmic
eosinophilic inclusions in occasional endocervical glandular epithelial
cells; inclusions also in endothelial and stromal cells but not
squamous cells; associated with fibrin thrombi, dense acute
inflammatory infiltrate, lymphoid follicles, vacuoles in glandular cells,
reactive changes in glandular epithelial cells : ,

; ,
, ,
, ,
,

Micro images: intracytoplasmic inclusions #1
(endocervical cells) ; #2 (endothelial cells) ; CMV+
glands and stroma ; associated acute inflammatory
infiltrate ; intracytoplasmic vacuoles within
endocervical glandular cells ; fibrin thrombi within
small vessels ; not cervix - lung #1 (Giemsa stain) ; #2 ;
kidney ; pancreas ; brain :
# 1 (
) ; # 2 ( ) ; +
; ;

;
, - # 1
( ) ; # 2 , ; ;
-
Enterobius of cervix
top
-
Granuloma inguinale of cervix
top
Also called donovanosis

Due to gram negative rod, Calymmatobacterium granulomatis , which
has characteristic bipolar staining ,
,

Sexually transmitted disease which affects genital skin and mucosa
and causes inguinal lymphadenopathy; rarely becomes disseminated

,
May occur in children of infected mothers via birth canal ( AJCP

1997;108:510 )
( 1997; 108:510 )
May mimic carcinoma ( Genitourin Med 1990;66:380 )
( , 1990; 66:380 )
-
Granulomas of cervix
top
Rare
Usually foreign body-type; also diffuse ,

Associated with prior biopsy or surgery ( AJCP 2002;117:771 )
( 2002; 117:771 )
Only rarely associated with sarcoidosis or systemic conditions

Ceroid (with early lipofuscin) granulomas may be related to
endometriosis ( )

Case reports: ceroid granulomas ( Int J Gynecol Pathol 2002;21:191 ,
Histopathology 1992;21:282 ), due to pinworms ( J Trop Med Hyg 1981;84:215 )
: ( , 2002; 21:191 ,
1992; 21:282 ), ( 1981; 84:215 )
Micro images: (1) xanthogranuloma (ceroid granuloma) ;
(2) A: PAS+; B: Perls' iron stain+; C: Ziehl-Neelsen
(acid fast)+; D: Schmorl's reagent (melanin)+
: (1) ( ) , (2) :
+ : ' + : -
( ) + :
() +
-
References: ceroid granulomas ( J Clin Pathol 1995;48:1057 )
: ( 1995; 48:1057 )
Herpes simplex virus (HSV) of cervix

()
top
Relatively common; 3% (HSV1) and 8% (HSV2) of women visiting US

physicians in one study ( J Clin Virol 2005;33:25 ) ,
3% (1), 8% (2)
( , 2005; 33:25 )
Neonatal herpes may occur if infant is delivered vaginally during
maternal genital herpes

Micro: epithelial ulcers with acute and chronic inflammatory cells,
epithelial cell necrosis; multinucleate cells with intranuclear inclusions
that are smudged (ground glass) or discrete are usually at periphery
of ulcer; usually affects squamous cells, not endocervical glandular
epithelium :
, ;
(
) ;
,
-
EM: ground glass appearance is due to intranuclear viral particles;
enhancement of nuclear envelope is caused by peripheral chromatin
margination :
;

DD: inflammatory cells with multiple nuclei (lack discrete nuclear
molding) : (
)
Pseudolymphoma of cervix
top
Also called lymphoma-like lesion; a form of chronic cervicitis

;
Rare; benign reactive lesions that resemble lymphoma ;

Usually reproductive age women
Case reports: 37 year old woman with cervical polyp containing

lymphoid infiltrate resembling diffuse large B cell lymphoma ( Gynecol
Oncol 2005;99:481 ), with EBV+ tumor ( Gynecol Oncol 1992;46:69 )
: 37

( , 2005 99:481 ), + (
, 1992; 46:69 )
Gross: soft, superficial, focal erosion : , ,

Micro: clusters or sheets of large lymphoid cells, mixed with plasma
cells, neutrophils, macrophages and germinal cells; infiltrate is usually
above endocervical glands; prominent mitotic activity, often starry-sky
pattern; no deep invasion, no cellular monomorphism, no prominent
sclerosis : ,
, ,
;
; ,
, , ,

Micro images: dense lymphoid infiltrate with germinal
centers :

-
Positive stains: polyclonal :
References: Int J Gynecol Pathol 1985;4:289 , Eur J Obstet Gynecol Reprod Biol
2001;97:235 : , 1985 4:289 ,
2001; 97:235
Schistosomiasis of cervix
top
Also called bilharziasis

Diagnostic method of choice for S.
. haematobium is quantitative compressed biopsy technique ( Am J
Trop Med Hyg 2001;65:233 )
( 2001; 65:233 )
HIV patients often lack a granulomatous response and obvious ova (
Int J Gynecol Pathol 2004;23:403 ) -
(
, 2004; 23:403 )
Case reports: 27 year old from Senegal with LSIL on Pap smear (
Archives 2003;127:1637 ) : 27
( 2003; 127:1637 )
Micro images: S. : haematobium ; S.
; . mansoni in ectocervix ; figure 1/2:
calcified eggs; 3: terminal spine ; various images
(rectal mass) ; 1 / 2:
, 3: ;
( )
-
References: : Acta Trop 2001;79:193 . 2001;
79:193 .
Syphilis of cervix
top
May form primary chancre at cervix

May produce a mass suggestive of invasive carcinoma ( AJCP
1995;104:643 )
( 1995; 104:643 )
Due to Treponema pallidum infection
Micro images: #1-umbilical cord ; #2 ; dermal lesion with

abundant plasma cells ; dermal lesion with anti-T.
: # 1- , # 2 ;
;
-. pallidum immunostain
-
References: eMedicine :
Trichomonas of cervix
top
-
Tuberculosis of cervix
top
May be simultaneous cervical and endometrial infections ( J Indian Med

Assoc 1995;93:167 )
( . 1995; 93:167)
May be associated with HIV infection ( Sex Transm Infect 2002;78:62 );
associated with infertility in Iran ( Int J Gynaecol Obstet 2001;75:269 )
( , 2002; 78:62 ),
( 2001; 75:269 )
Case reports: 38 year old woman in India : 38

Gross: cervical hypertrophy or ulceration :

Micro: pseudoepitheliomatous hyperplasia, noncaseating granulomas
: ,
Micro images: various images ; granulomas with giant

cells ; acid-fast bacilli #1 ; #2 (lung) :
; ;
# 1 , # 2 ()
-
Positive stains: usually acid-fast :

Vasculitis of cervix
top
Vasculitis of any type affecting the female genital tract is usually an

isolated finding (only 10% have systemic disease, Int J Gynecol Path
2000;19:258 )
( 10%
, 2000; 19:258 )
Isolated polyarteritis nodosa of female genital tract is rare - either
giant cell type in post-menopausal women in any part of female
genital tract or PAN-type in younger women affecting cervix ( Mod
Path 1994;7:610 )
- ,
- (
1994; 7:610 )
Case reports: Case of the Week #91 : # 91

Micro images: isolated polyarteritis nodosa - image #1 ; #2 ; #3
: - # 1 ,
#2;#3
References: : Int J Gynecol Path 1998;17:193
1998; 17:193
Wuchereria bancrofti microfilariasis

top
Benign / non-neoplastic lesions of cervix

/ -
Adenomyoma of endocervical type

top
First described in 1996 ( Mod Path 1996;9:220 ), although actually very
common and often overlooked 1996 ( 1996
9:220 ),
, 21 55
Either no symptoms (usually) or abnormal vaginal bleeding
()
Recommended to not use this diagnosis unless lesion is exophytic
and does not grossly resemble a typical polyp
,

Case reports: 44 year old women ( APMIS 2001;109:546 , Pathol Int
1999;49:1019 ) : 44 ( 2001; 109:546 ,
1999; 49:1019 )
Gross: well circumscribed endocervical tumor 1 to 8 cm; may
prolapse through external os; also large mural tumors (11-23 cm);
gray-white, may have large mucin filled cysts or rarely be
hemorrhagic : 1
8 , ,
(11-23 ), -,

Micro: composed of glands and cysts lined by single layer of
endocervical-type mucosa with smooth muscle; glands are large and
irregular with papillary infolding, surrounded by smaller simple glands,
often lobular; focal tubal-type epithelium often present; rarely
endometrial-type glands and stroma; bland nuclear features,
no/minimal mitotic activity, no desmoplasia :

;
, ,
;
; ;
, / ,
-
Positive stains: PAS+ neutral mucin, Ki-67+ (up to 20%), focal CEA
: + -67 + ( 20%),

DD: minimal deviation adenocarcinoma (invasive glands, focal atypia,
desmoplastic stroma) :
( , , )
Adenosis of cervix
top
DES was given to women in 1950's to prevent miscarriages (although

it didn't actually do so) 1950
( )
In utero DES exposure is associated with adenosis of vagina and
cervix and infertility in female offspring and testicular abnormalities in
male offspring ( Cochrane Database Syst Rev 2003;(3):CD004271 , Int J Childbirth

Educ 1992;7:21 )

( 2003
(3): 004271 , 1992; 7:21 )
Tubal-type endocervical glandular proliferations resembling minimal
deviation adenocarcinoma occur in women with DES exposure, may
be a form a DES-related adenosis ( Int J Gynecol Pathol 2005;24:391 )

, - (
, 2005; 24:391 )
Micro images: various images :
-
References: Development 2004;131:1639 (role of p63 in DES-induced adenosis)
: 2004; 131:1639 ( 63 - )
Arias-Stella reaction in cervix -

top
First described in 1954 by Dr. Javier Arias-Stella ( Arch Pathol

1954;58:112 ) 1954 - (
1954; 58:112)
Nuclear changes in endocervix similar to those in endometrium

commonly seen during pregnancy (10%) or post-partum

(10%) -
Age range 19-44 years 19-44
May present as cervical polyp or be an incidental finding

Gross: no mass :
Micro: normal spatial distribution of enlarged, dilated glands
(superficial or deep) lined by large, polyhedral cells with abundant
eosinophilic or clear cytoplasm with large clear vacuoles and
enlarged, hyperchromatic, pleomorphic and smudged nuclei; usually
has hobnail cells, intraglandular tufts, delicate filiform papillae and
intranuclear pseudoinclusions; glands may have only partial
involvement; no prominent nucleoli, no invasion; no/rare mitotic
figures; may be focal :
, ( )
,

, , ;
, ,
;
,
, , / ;
Micro images: complex glands resembling late secretory

enometrium but with cervical stroma ; nuclear
enlargement and hyperchromasia :
endometrium (not cervix) - pregnant patient

( ) -
-
DD: clear cell carcinoma (forms a mass, has desmoplasia, is
infiltrative with irregular glandular distribution, uniformly marked
cytologic atypia, high N/C ratio, mitotic activity) :
( ,
,
, / , )
References: AJSP 2004;28:608 , Archives 1992;116:943 :
2004 28:608 , 1992; 116:943
Atrophy of cervix
top
May resemble SIL

Micro: pseudokoilocytosis, immature but bland epithelium; may
resemble urothelial metaplasia; may have focal nuclear enlargement
and hyperchromasia; cells have prominent intercellular bridges; nuclei
are uniform, evenly spaced, often elongated with grooves; no atypia
in upper epithelial layers, no mitotic figures :
, ;
;
; ;
, ,
, ,
-
Micro images: atrophy :
Negative stains: Ki-67 ( J Pathol 2000;190:545 ), : 67 ( 2000; 190:545 ), cyclin E, p16 , 16
DD: SIL (strong Ki-67+ and p16 staining in 75-80%, strong cyclin E+
in 31%, J Low Genit Tract Dis 2005;9:100 ), adenoid basal carcinoma
(sharply demarcated nests of tumor, may have minimal atypia) :
( -67 + 16 75-80%, + 31%,
. , 2005 9:100 ),
( ` ,
)
Atypical polypoid adenomyoma
top
Also called atypical polypoid adenomyofibroma, APA

,
Occurs in endometrium, lower uterine segment and endocervix
,
Uncommon (< 150 cases reported), associated with Turner's
syndrome (<150 ),
Mean age 40 years, range 21-73 years 40

, 21-73
Symptoms of dysfunctional uterine bleeding

May persist or recur, but does not metastasize; may have increased
risk for later carcinoma; may be contiguous with adenocarcinoma
, ;
Case reports: with hyperprolactinemia ( Int J Gynecol Cancer 2001;11:326 )

: ( , 2001; 11:326 )
Treatment: conservative polypectomy and curettage or simple
hysterectomy in peri/postmenopausal women, but with follow up
:
/ ,
Gross: resembles endometrial polyp; single, well-circumscribed,

polypoid mass up to 2 cm; usually confined to endometrium with
pushing margin; remaining endometrium is often unremarkable
: ; , ,
2 ,
;
Gross images: uterine tumor - polypoid mass (arrow)
: - ()
Micro: biphasic with hyperplastic and atypical endometrial glands
(complex architecture, often severe cytologic atypia), separated by
fascicles of bland smooth muscle and fibrous stroma; squamous
metaplasia present (90%), often extensive or with central necrosis;
minimal mitotic activity (<3 mitotic figures per 10 HPF); no
desmoplasia :
( ,
),
; (90%),
;
(< 3 10 );
low malignant potential - with features resembling well differentiated
adenocarcinoma -

Micro images: uterine tumor - atypical complex glandular
hyperplasia, smooth muscle stroma and morules #1 ;
#2 ; #3 ; #4 ; #5 ; #6 ; #7 : -
,
# 1 , # 2 ; # 3 , # 4 , # 5 , #
6;#7
-
Positive stains: trichrome (smooth muscle); low Ki-67 proliferative
activity : ( ), -67

DD: adenocarcinoma with muscular invasion (has desmoplasia, older
women, grossly invasive, large with hemorrhage and necrosis),
MMMT (older women, stromal also malignant, diffuse atypia,
increased mitotic activity) :
( , , ,
), ( ,
, , )
References: : AJSP 1996;20:1 1996; 20:1
Blue nevus of cervix

top
Present in up to 2% of cervices; may be more common in Japanese

women, particularly if step sections are obtained ( Acta Pathol Jpn
1991;41:751 ) 2% ;
, (
, 1991; 41:751 )
20% are multiple 20%

Usually an incidental finding
Case reports: endocervical location in 2 patients ( Ceska Gynekol
2004;69:411 ), incidental finding ( Appl Immunohistochem Mol Morphol
2004;12:79 ) : 2 (
2004 69:411 ), (
2004; 12:79 )
Gross: blue/black, flat, up to 3 cm; usually ill-defined in lower
endocervix : / , , 3 ,

Micro: elongated, wavy dendritic cells in clusters or individually,
below endocervical epithelium; cytoplasm has brown melanin; also
stromal macrophages : ,
, ;
,
Micro images: pigment containing nevus cells in
cervical stroma #1 ; #2 :
# 1 ;
#2
Positive stains: Fontana-Masson (melanin turns black), S100,
HMB45 : - (
), 100, 45
Negative stains: iron stains :
EM: dendritic cytoplasmic processes, electron-dense membrane
bound melanin granules, premelanosomes ( Archives 1983;107:87 ) :
, -
, ( 1983; 107:87 )
DD: melanosis (basal epithelium only, not in stroma), melanoma
(junctional change, stromal infiltration by malignant cells),
hemosiderin (coarse granules are refractile and iron+, FontanaMasson negative; pigment is in macrophages, not spindle cells) :
( ),
( ,
), ( +
- , ,
)
References: Hum Path 1985;16:79 : 1985; 16:79
Cervical pregnancy
top
Pregnancy is almost always terminated by methotrexate, uterine

artery embolization or otherwise
,
Goal is to minimize maternal morbidity (from massive hemorrhage)

and preserve the uterus ( Fertil Steril 2005;84:509 )
( )
( , 2005; 84:509 )
Case reports: pregnancy with live 1800g fetus delivered by
caesarean section ( Ginekol Pol 2005;76:304 ), live baby after
hysteroscopic resection ( Fertil Steril 2003;79:428 ), causing urinary
retention ( Am J Obstet Gynecol 2004;191:364 ), with Arias-Stella reaction (
Acta Cytol 1994;38:218 ) : 1800
( 2005 76:304 ),
( , 2003; 79:428 ),
( 2004; 191:364 ),
-( 1994; 38:218 )
Micro images: villi within cervical stroma :

Decidual nodule in cervix

top
Occurs during pregnancy

Micro: up to 4 cm, just below epithelium; uniform decidual cells with
well defined cell membranes, granular pale cytoplasm, bland nuclei;
no continuity with surface epithelium, no mitotic figures : 4
;
, ,
, ,
Micro images: decidualized stromal cells :

Negative stains: keratin :
DD: non-keratinizing squamous cell carcinoma, placental-site nodule
: - ,

Decidual reaction in cervix

top
Multiple small, yellow/red elevations of cervical mucosa ,

/
Soft, friable, bleed easily; rarely are fungating and resemble
carcinoma , , ,
Case reports: 28 year old pregnant woman with hemorrhage and

abnormal colposcopy resembling invasive cervical carcinoma ( J Low
Genit Tract Dis 2005;9:52 ), decidual change in lymph nodes mimicking
metastatic cervical carcinoma ( Archives 2005;129:e117 , Eur J Gynaecol
Oncol 2005;26:499 ) : 28

( . , 2005 9:52 ),

( 2005 129 begin_of_the_skype_highlighting 2005 129
end_of_the_skype_highlighting: 117 , 2005; 26:499 )
Micro: decidual cells with abundant pale granular cytoplasm, bland
nuclei :
,
Micro images: various images ; ectopic decidual
deposits in lymph nodes : ;

-
Positive stains: vimentin, desmin, alpha-1-antitrypsin; variable
PLAP, beta hCG : , , -1; ,
Diffuse laminar endocervical glandular hyperplasia

top
Also called nonspecific hyperplasia

First described in 1991 ( AJSP 1991;15:1123 ) 1991 (
1991; 15:1123 )
, 22 48
Non-neoplastic, incidental finding, no recurrences after surgery , ,
Case reports: 54 year old woman with 7 year history of watery
vaginal discharge ( Pathol Int 1995;45:283 ) : 54
7 (
1995; 45:283 )
Micro: diffuse proliferation of medium sized, evenly spaced, closely
packed, well differentiated mucinous glands within inner third of
cervical wall; area sharply demarcated from underlying stroma; cells
have basal nuclei; associated with chronic inflammation and stromal
edema; no significant cytologic atypia; no mitotic activity, no/rare
apoptotic activity ( Int J Gynecol Pathol 2002;21:125 ), not deeply invasive
: ,
, ,

` ; ;
,
; , /
( , 2002; 21:125 ),
Negative stains: CEA :
DD: minimal deviation adenocarcinoma (irregular stromal infiltration,
deeply invasive with desmoplastic stroma, cytologic atypia, not an
incidental finding) :
( ,
, , )
Ectopic prostate or heterotopia in cervix

top
Most common heterotopic tissue is cutaneous adnexae or mature

cartilage islands

Heterotopic tissue may be due to fetal homografts ( Obstet Gynecol
1983;61:261 )
( 1983; 61:261 )
Case reports: 38 year old woman with ectopic prostate ( Int J Gynecol
Pathol 1997;16:291 ), urothelial metaplasia with ectopic prostatic tissue in
23 year old woman with adrenogenital syndrome ( Int J Gynecol Pathol
2004;23:182 ), ectopic Darier's disease of skin ( Cytopathology 1996;7:414 )
: 38 (
1997; 16:291 ),
23
( , 2004; 23:182 ),
( 1996; 7:414 )
Positive stains: : prostate -PSA, PAP, high
molecular weight keratin (basal cells) -, ,
( )
DD: MMMT, botyroid rhabdomyosarcoma : ,
References: :
AJSP 2000;24:1224 (ectopic prostate #1) , AJSP
2006;30:209 (#2) 2000 24:1224 ( # 1) , 2006 30:209 (#

2)
Endocervical polyp
top
2-5% of adult women 2-5%

Usually multigravida age 30-59 years
30-59
Produces bleeding or mucoid discharge

Probably secondary to chronic inflammation and not neoplastic
,
Case reports: with heterologous cartilage and adipose tissue ( Pathol
Int 2001;51:305 ), 5 year old girl with multilocular cystic polyp ( Pediatr
Pathol 1993;13:415 ) :
( 2001 51:305 ), 5
( , 1993; 13:415 )
Gross: usually single, up to 1 cm; rarely mimics malignant tumor
protruding into endocervical canal : , 1 ,

Gross images: polyp #1 ; #2 ; #3 : # 1 , #
2;#3
Micro: dilated endocervical (mucus) glands in inflamed, myxoid
stroma; papillary endocervicitis if branching papillary structure;
surface epithelium may show squamous metaplasia; thick-walled
blood vessels at base of polyp; no mitotic figures :
() , ;
;
;
,
Micro images: whole mount ; various images

: ;
-
DD: superficial cervicovaginal myofibroblastoma :

Endometrial polyp of cervix

top
Either endometrial polyps that protrude through endocervical canal,

mixed endocervical and endometrial polyps or decidual polyps that
occur in pregnancy
,

Case reports: endometrial polyp with sarcomatous stroma protruding
through cervical os ( Eur J Gynaecol Oncol 2003;24:565 ), composed of
heterotopic skin with hair ( J Reprod Med 1984;29:837 ) :

( 2003; 24:565 ),
( 1984; 29:837 )
Micro images: not necessarily cervix - endometrial polyp #1 ;
#2 ; #3 : -
# 1 , # 2 ; # 3
-
Endometriosis of cervix
top
May cause abnormal uterine bleeding, post-coital bleeding

,

, 20 51
Superficial endometriosis may be due to mechanical disruption of
endometrium after D & C or cone biopsy
, &

Case reports: myxoid endometriosis simulating pseudomyxoma
peritonei ( AJSP 1994;18:849 ), 47 year old woman with superficial
cervical endometriosis with florid smooth muscle metaplasia ( Virchows
Arch 2001;438:302 ) :
( 1994; 18:849 ), 47

( 2001; 438:302 )
Gross: red/blue nodules : /
Gross images: Cervical Endometriosis #2 :
# 2
Micro: similar to endometriosis elsewhere; two of three present endometrial glands with basal nuclei, spindled stroma, hemorrhage;
usually involves superficial third of cervical wall, not deep wall; glands
are evenly spaced and without atypia, are surrounded by stroma at
least focally; inflammation and hemorrhage may obscure endometrial
stroma; may have prominent mitotic activity; no thick collagen bundles
: ,
- ,
, ;
, ;
,
;
; ,

Micro images: various images ; endometriosis
: ;
-
Positive stains: CD10; reticulin surrounds each cell ( Int J Gynecol
Pathol 2001;20:173 ) : 10;
( , 2001; 20:173 )
DD: adenocarcinoma in situ, invasive carcinoma (no endometrial
stroma, marked atypia), endocervical glandular dysplasia,
tuboendometrial metaplasia : ,
( ,
), ,
References: : Arch Gynecol Obstet 2005;272:289 , Int J Gynecol

Pathol 1999;18:198 2005 272 begin_of_the_skype_highlighting
2005 272 end_of_the_skype_highlighting:289 , , 1999; 18:198
Stromal endometriosis of cervix
top
Endometriotic stroma only with no/rare glands

/
, 29 64
Micro: well circumscribed foci within cervical superficial stroma
containing endometrial stromal cells, small blood vessels,
extravasated RBCs; usually no endometrial type glands :

, ,
;
DD: low grade endometrial stromal sarcoma, Kaposi's sarcoma (
Pathology 1997;29:426 ) :
, ( 1997; 29:426 )
References: AJSP 1990;14:449 : 1990; 14:449
Endosalpingiosis of cervix
top
Glands lined by ciliated tubal-type epithelium

Typically affects pelvic and abdominal peritoneum, usually as an
incidental microscopic finding, but may be associated with ovarian
serous neoplasms
, ,

Benign, but may have atypical epithelial changes ,

Rarely forms a cystic mass (florid cystic endosalpingiosis, Hum Path
2002;33:944 , AJSP 1999;23:166 ) (
, 2002 33:944 , 1999; 23:166 )
May have psammoma bodies ( J Reprod Med 2000;45:526 , J Reprod Med
1991;36:675 ) ( 2000; 45:526 ,
1991; 36:675 )
Micro images: not necessarily cervix - glands lined by tubal
type epithelium #1 ; #2 :
-
# 1 ; # 2
-
DD: extraovarian serous cystadenoma :
Florid deep glands of cervix

top
Usually an incidental microscopic finding

Micro: diffusely scattered endocervical glands within endocervical
stroma extending to outer third of cervical wall; less variability in size
and shape of glands than minimal deviation adenocarcinoma; no
atypia, no desmoplastic stroma, no vascular or perineural invasion
:
,

, ,
,
References: AJCP 1995;103:614 :
1995; 103:614
Glial polyp of cervix

top
Very rare; <100 cases reported ; <100

Benign, but may recur up to 5 years layer ,
5
May be due to implantation of fetal brain tissue at curettage/abortion (
Obstet Gynecol 1983;61:261 , AJCP 1980;73:718 ), overgrowth of teratoma,
ectopic glial tissue or neoplastia of mullerian origin
/ (
1983; 61:261 , 1980; 73:718 ), ,

Case reports: Case of the Week #135 : # 135
Micro: discrete polypoid lesion of endocervix; moderately cellular glia
containing bland astrocytes surround endocervical glands and invade
stroma; astrocytes are evenly spaced, have long radiating processes,
no atypia, no mitotic figures :
;
;
, , ,

Micro images: polypoid mass of glia below endocervical
surface (AFIP) :
()
case of the week - #1 ; #2 ; #3 ; #4 ; #5 ; GFAP
- # 1 , # 2 ; # 3 , # 4 , # 5 ;
Positive stains: PTAH (fibrillary processes), GFAP (astrocytic cells
and stroma, Gynecol Oncol 1985;21:385 ) :
( ), -( ,
, 1985; 21:385 )
Hemangioma of cervix
top
Capillary or cavernous
Arteriovenous malformations may also be present in cervix, due to
surgery or as part of larger pelvic vascular abnormality

,
Micro images: cavernous hemangioma #1 ; #2

: # 1 ; # 2
Inflammatory pseudotumor of cervix

top
Very rare
Case reports: 48 year old woman with bilateral parametrial

involvement causing hydroureternephrosis and invasion into vagina (
Gynecol Oncol 2005;98:325 ), 58 year old woman with pelvic pain ( Int J
Gynecol Pathol 1994;13:80 ) : 48

( , 2005
98:325 ), 58 (
, 1994; 13:80 )
Treatment: surgical excision :
Micro: fibroblast-like spindle cells, dense inflammatory infiltrate of
plasma cells and lymphocytes :
Micro images: other sites - prostate ; spleen ; breast

: - , ; ;
Negative stains: smooth muscle actin :

Inverted urothelial papilloma of cervix

top
Rare; resembles more common bladder tumor ;

Case reports: 54 year old woman ( Ann Diagn Pathol 2002;6:49 ); two
cases in young adult women ( AJSP 1995;19:1138 ) : 54
( 2002 6:49 )
( 1995; 19:1138 )
Micro: inverted epithelial nests separated by fibrovascular septa;
epithelial nests have peripheral palisading and are composed of
uniform cells containing swirling oval nuclei with longitudinal
grooves; nests contain cystitis glandularis-type areas; no significant
atypia; no/rare mitotic activity :
;
""
;
; ; /

Micro images: bladder - inverted papilloma #1 ; #2 ; #3 ;
basaloid appearance ; with squamous metaplasia
: - # 1 , # 2 ; # 3 ,
;
Leiomyoma of cervix
top
Uncommon; only 8% of uterine leiomyomas occur in cervix

, 8%
Clinically may mimic an endocervical polyp

Case reports: pedunculated leiomyoma with superficial squamous
cell carcinoma ( Gynecol Oncol 2005;97:253 ), large leiomyoma causing
heavy hemorrhage ( Clin Exp Obstet Gynecol 2003;30:144 ); associated with
fatal intraperitoneal dissemination ( Gynecol Oncol 1996;62:119 )
:
( , 2005 97:253 ),
( 2003 30:144 )
( , 1996; 62:119 )
Gross: firm, whorled cut surface similar to uterine leiomyoma; usually
1 cm or less : ,
; 1
Gross images: leiomyoma (arrows at tumor) :
( )
Micro: resembles uterine leiomyoma; often prominent thick walled
blood vessels; may have mitotic figures below ulcerated areas
: ,
;
Micro images: spindled cells ; spindled cells in

streaming pattern : ;

-
Lipoleiomyoma of cervix
top
Micro images: contributed by Dr. Asmaa Gaber Abdou, Menofiya

University , Egypt - image #1 ; #2 ; #3 ; #4 :
,
, - # 1 , # 2 ; # 3 ; # 4
Lobular endocervical glandular hyperplasia of cervix,

NOS
,
top
Rare; first described in 1999 ( AJSP 1999;23:886 ) ,

1999 ( 1999; 23:886 )
Resembles pyloric gland metaplasia ( AJSP 2000;24:325 )
( 2000; 24:325 )
, 37 71
Usually an incidental finding, but 37% have a visible gross
abnormality or clinical symptoms , 37%

Benign, does not recur, but may progress to endocervical
adenocarcinoma ( Mod Path 2005;18:1199 ) , ,
( 2005;
18:1199 )
Micro: noninvasive proliferation of endocervical glandular cells
without any obvious adenocarcinoma component; usually confined to
inner half of cervical wall; lobular arrangement of hyperplastic
small/medium sized, rounded endocervical glands lined mostly by
single layer of columnar, mucin-rich epithelium that surround large,
cystically dilated central glands; may have mild reactive nuclear
atypia; non invasive, no desmoplasia, no mitotic figures, no
squamous differentiation :

;

/ ,
,
,
; ;
, , ,

Cytology: see Cervix-Cytology :
-
Positive stains: PAS (neutral mucin), pyloric gland mucin (HIK1083)
: ( ),
(1083)
Negative stains: CEA, p53 : , 53
Molecular: HPV negative ( Int J Gynecol Pathol 2005;24:296 )
: ( , 2005; 24:296 )
deep invasion, desmoplastic stroma response, focally malignant
cytologic features, Pathol Int 2005;55:412 ) :

( ,
, ,
, 2005; 55:412 )
Melanosis of cervix
top
Case reports: after cryotherapy for dysplasia ( AJCP 1990;93:802 )

: ( 1990; 93:802 )
Gross: flat, dark lesion up to 3 cm : , 3
,
Micro: benign pigmented melanocytes in basal layer of epithelium; no
thickening of epithelium; melanocytes are densely pigmented and
dendritic, but do not involve the stroma :
,
;
,
DD: blue nevus :
Mesonephric papilloma of cervix

top
Also called mullerian papilloma
Rare, benign, polypoid lesion of cervix or vagina of young girls to

adult women , ,

May recur, but good prognosis ,
Treatment: local excision :
Case reports: recurrent cervical tumor ( J Pediatr Adolesc Gynecol
1998;11:29 ), 18 month girl with mullerian papilloma and multiple renal
cysts ( Urology 2005;65:388 ), borderline malignant change in vaginal
tumor ( J Clin Pathol 1998;51:875 ) :
( . , 1998; 11:29 ), 18
(
2005 65:388 ), (
1998; 51 : 875 )
Micro: superficially located, composed of papillary stalks covered by
mucinous epithelium with focal squamous metaplasia; stroma is
highly cellular fibrous tissue; no atypia, minimal mitotic activity
: ,

; ,
,
Micro images: various images and immunostains ;
: ;
borderline vaginal tumor in above case history - papillary
tumor with various epithelial types ; focal atypia due
to stratification, pleomorphism and atypical mitotic

figure
-
;
,
Positive stains: CK7, CA125, EMA : 7,

125,
Negative stains: CK20, CEA, smooth muscle actin

: 20, ,
DD: botyroid rhabdomyosarcoma :
References: : Ultrastruct Pathol 2005;29:209 (EM findings)
, 2005; 29:209 ( )
Mesonephric rests / remnants of cervix

/
top
Remnants of mesonephric (Wolffian) ducts which form the epididymis

and vas deferens in males, present in 1/3 of women
()
, 1 / 3
Unrelated to symptoms that cause excision of tissue; usually no
clinical mass ( AJSP 1990;14:1100 , Archives 1991;115:1059 )
;
( 1990; 14:1100 , 1991; 115:1059 )
Case reports: : involvement by squamous CIS from
cervix ( AJSP 1994;18:1265 , Cesk Patol 2004;40:109 ), atypical
mesonephric rests associated with cervical osteosarcoma ( Cancer
1988;62:1594 ) ( 1994;
18:1265 , 2004 40:109 ),
( , 1988; 62:1594 )
Micro: dilated tubules of cuboidal cells with eosinophilic secretions,
surrounded by endocervical stroma; may undergo atypical
hyperplastic changes or malignant change :
,
;

Micro images: clusters of mesonephric tubules
surround a branching duct ; mesonephric remnants
with hyaline secretion ; cells are cuboidal with a
distinct basement membrane ; complex and deep duct
with focal squamous metaplasia ; CD10+ :

; ;

;
; 10 +
-
Positive stains: CD10, vimentin : 10,
Negative stains: CEA, p53, Ki-67, mucicarmine, PAS

: , 53, -67, ,
DD: adenocarcinoma (involves overlying endocervical mucosa,
invasive, has stromal response and cytologic atypia, no lobular
pattern, no intraluminal eosinophilic material) :
( , ,
,
, )
References: : Histopathology 2003;43:144 (CD10) , AJSP
2003;27:178 (CD10) 2003 43:144 (10) , 2003 27:178 (10)
Mesonephric hyperplasia of cervix

top
Rare; usually an incidental finding ;
Mean age 38 to 47 years, range 21 to 81 years
38 47 , 21 81
Benign
Micro: prominent increase in number of tubules with increase in
lobule size and extensive involvement of cervix; either lobular, diffuse
(bland glands, no stromal reaction) or ductal patterns (large, dilated or
irregular ducts in wall of cervix with micropapillary budding of
pseudostratified epithelial cells without atypia); small round
mesonephric tubules are often deep within cervical wall and extend to
cervical surface; may appear infiltrative; often has intraglandular
colloid-like material; no back to back glandular crowding, no nuclear
atypia, no angiolymphatic invasion, no perineural invasion :

; ,
( , )
(,

);

;
,
, ,
, ,
Micro images: marked tubular proliferation but with
lobular architecture ; more nuclear variation than in
mesonephric rests ; bland glands deep in cervical
stroma #1 ; #2 ; large ducts deep in stroma with tufting
: ,
;
;
# 1 , # 2 ;

-
Positive stains: CD10 : 10
Negative stains: CEA, p53, Ki-67 : , 53, 67
DD: mesonephric adenocarcinoma, well-differentiated endocervical
adenocarcinoma, clear cell carcinoma :
,
,
References: Gynecol Oncol 1993;49:41 , : , 1993;
49:41 , AJSP 1990;14:1100 , Mod Path 2000;13:261 1990; 14:1100 ,
2000; 13:261
Microglandular hyperplasia of cervix

top
Also called microglandular adenosis, microglandular change

,
Common cervical lesion associated with birth control pills or
pregnancy in young women, although also in post-menopausal
women
,
Usually incidental, may grow as a polypoid mass ,

Gross: polypoid, single or multiple; early lesions are sessile :
, ;
Micro: complex proliferation of small back to back glands lined by
cuboidal, columnar or flattened cells with prominent vacuoles
above/below vesicular nuclei; indistinct nucleoli, usually no atypia;
may be associated with immature or mature squamous metaplasia;
may have areas of solid growth, mucin pools (resembling colloid
carcinoma), pseudoinfiltrative pattern, signet ring cells, focal atypia,
occasional mitotic figures, acute and chronic inflammation, hobnail
cells :
,
/ ;
, ;
;
, (
), , ,
, ,
,
Micro images: dense glands but no atypia ; solid pattern
#1 ; #2 ; possible involvement by HSIL :
; # 1 ,
# 2 ;
-
Positive stains: mucin (vacuoles and lumina) :
( )
Negative stains: CEA (usually), CD10, vimentin :
(), 10,
DD: endocervical adenocarcinoma (atypia, infiltrative, CEA+), clear
cell carcinoma (papillary processes, open glands and tubules with
diffuse atypia, hobnail cells and marked mitotic activity, minimal
inflammation, no vacuoles), microglandular hyperplasia-like mucinous
endometrial adenocarcinoma (usually older women, mature but not
immature squamous metaplasia, diffuse nuclear atypia, stromal foam
cells, mitotic activity and Ki-67+, no vacuoles, AJSP 1992;16:1092 , Int
J Gynecol Pathol 2003;22:261 ), microglandular carcinoma of uterus
(neutrophils and dirty lumina, endometrioid-type single glands,
vimentin+, Ann Diagn Pathol 2003;7:180 ) :
(, , +),
( ,
, ,
, ),
(
, , ,
, ,
-67 +, , 1992; 16:1092 ,
, 2003; 22:261 ),
( "" ,
, + 2003; 7:180 )
References: : AJSP 1989;13:50 (worrisome patterns) , Mod Path
2000;13:261 (cervical glandular lesions) 1989 13:50 (
) , 2000 13:261 ( )
Myofibroblastoma of cervix
top

55 58 , 23 80
Often vaginal or vulvar, may be cervical
,
Benign behavior, but may recur after excision ,

May be neoplastic proliferation of hormonally responsive
mesenchymal cells native to subepithelial stroma of endocervix and
vulva of adult women

Gross: well circumscribed, polypoid or nodular mass, mean 3 cm
(range 1 to 6 cm) arising in the superficial lamina propria of cervix and
vagina : , ,
3 ( 1 6 )

Micro: well circumscribed cellular tumor composed of bland spindled
and stellate mesenchymal cells in collagenous stroma with myxoid
and edematous foci; often lacelike pattern in hypocellular area, vague
fascicular growth pattern in cellular area; minimal mitotic activity; no
atypical mitotic figures :

,
,
; ,

Micro images - breast : (1) epithelioid type #1 ; #2 ; #3 ;
CD34+ ; (5) figure 1: sharply circumscribed tumor with
fibrous pseudocapsule; 2: composed of bland spindle

cells in collagenous or myxoid stroma; 3A: CD34+;
3B: bcl2+; 4: desmin+ (focal) - : (1)
# 1 , # 2 ; # 3 , 34 + , (5) 1:

, 2:
; 3:
34 + ; 3: 2 + 4: + ()
Positive stains: vimentin, ER, PR, desmin, CD34, CD99, bcl2,
calponin; also alpha smooth muscle actin (45%), muscle specific actin
(25%) : , , , 34, 99,
2, , (45%),
(25%)
Negative stains: S100, EMA, keratin, h-caldesmon, CD117
: 100, , , - 117,
DD: fibroepithelial stromal polyp, angiomyofibroblastoma, aggressive
angiomyxoma : ,
,
References: Hum Path 2001;32:715 , Pathology 2005;37:144 , Histopathology
2005;46:137 : 2001 32:715 , 2005 37:144 ,
2005; 46:137
Nabothian cysts
top
A normal finding; no treatment needed ,

Due to obstruction of crypt openings containing mucus by squamous
epithelium, causing acute and chronic cervicitis; also form after
subtotal hysterectomy due to ablation of cervical canal ( J Reprod Med

1999;44:567 )
, ,

( 1999; 44:567 )
Associated with endocervical tunnel clusters ( AJSP 1990;14:895 )
( 1990; 14:895 )
Deep cysts may resemble malignancy by imaging studies

Gross: single or multiple, up to 1.5 cm : ,

1,5
Gross images: in situ #1 ; #2 ; Nabothian cysts #1
(arrows) ; #2 ; #3 ; various images :
# 1 , # 2 ; # 1 () ; # 2
, # 3 ;
Micro: uniform architecture; dilated mucin filled cyst lined by flattened
mucinous epithelium without atypia; may rupture with extravasation of
mucin into stroma and reactive changes; may penetrate deep into
wall; no stratification, no mitotic figures :
;
;

; , ,

Micro images: cyst with flattened epithelium #1 ; #2
: # 1 ; # 2
Positive stains: mucin :
DD: well differentiated or minimal deviation adenocarcinoma (atypical
nuclear features, invasive, Int J Gynecol Pathol 1989;8:340 ) :

( , ,
, 1989; 8:340 )
Necrobiotic granulomas of cervix

top
Resembles tuberculosis or rheumatic nodules

Seen after cervical surgery ( AJSP 1984;8:841 )
( 1984; 8:841 )
Micro: resembles rheumatoid nodules :

Neurofibroma of cervix
top
Very rare in cervix
Case reports: 39 year old woman with multiple cutaneous
neurofibromas and plexiform neurofibroma of cervix ( Archives
2005;129:783 ), diffuse involvement of female genital tract ( Obstet Gynecol
1996;88:699 , AJSP 1989;13:873 ) : 39
(
2005 129 begin_of_the_skype_highlighting 2005 129
),
( 1996 88:699 , 1989; 13:873 )
end_of_the_skype_highlighting:783
Treatment: wide excision recommended due to high recurrence rate (

Int Braz J Urol 2005;31:153 ) :
( , 2005; 31:153 )
Micro images: plexiform neurofibroma ; figure 2
: ; 2
Pagetoid dyskeratosis of cervix

top
Reactive process in which some keratinocytes are induced to
proliferate

Also found in intertriginous areas - may be due to friction
-
In cervix, associated with uterine prolapse ( AJSP 2000;24:1518 )

, ( 2000; 24:1518 )
Micro: small numbers of large cells with central pyknotic nuclei,
perinuclear halos and abundant cytoplasm; no mucin; resembles
Paget's disease :
, ,
;
Positive stains: high molecular weight keratin :

Negative stains: low molecular weight keratin, EMA, CEA
: , ,
,
Molecular: negative for HPV :
DD: artifact (signet ring morphology with eccentric pyknotic nuclei),
glycogen-rich cells (large, vacuolated, pale-staining squamous cells
with regular nuclei and basket-weave pattern), koilocytes (large cells
with perinuclear clearing, cytoplasmic margination giving sharp edge
to halo; large, irregular, hyperchromatic nuclei, often with
binucleation; usually in midzone of superficial layer), extramammary
Paget's disease, pagetoid spread of carcinoma :
( ),
(, , -
"-" ),
( ,
; , ,
, ;
), - ,

Papillary adenofibroma of cervix

top
Uncommon in cervix, more common in endometrium
,
Usually post-menopausal women
Case reports: 55 year old woman with mass containing multiple
cystic components ( Ultrasound Obstet Gynecol 2005;26:186 ), 46 year old
woman with clinical endocervical polyp ( Pathologica 1996;88:135 )
: 55
( 2005 26:186 ), 46
( 1996;
88:135 )
Gross: protrudes into endocervical canal; papillary or sessile, may be

5 cm or larger; firm, rubbery, tan-brown with focal hemorrhage; may
have small cysts on cut surface; no invasion of underlying stroma
: ; ,
5 ; , , -
; ,

Micro: lobulated papillary configuration; blunt edged and branching
papillae covered by bland endocervical epithelium with stromal
proliferation; may have focal squamous differentiation; stromal cells
are small, uniform, bland; no/rare mitotic figures; no increased
cellularity around entrapped glands :
;
;
; ,
, ; / ,

Micro images: glandular epithelium and connective
tissue proliferation ; adenofibroma-not necessarily
from cervix :
;

DD: endocervical polyps (not branching, no stromal proliferation),
adenosarcoma (increased mitotic figures in stroma and stromal
atypia) : ( ,
), (
)
Papillary endocervicitis
top
Endocervical inflammatory process with papillary growth pattern

Micro: chronic cervicitis with papillary architecture at surface; papillae
are short and edematous, often with lymphoid aggregates, covered by
simple columnar epithelium with reactive nuclear changes; cells have
finely stippled chromatin and prominent nucleoli; mitotic figures may
be present but no atypia; no infiltrative pattern; often mast cells ( Indian
J Pathol Microbiol 2004;47:178 ) :
;
, ,

;
; , ;
, (
, 2004; 47:178 )
Placental site nodule of cervix

top
Ages 27 to 45 years 27 45
Incidental finding; benign ( AJSP 1990;14:1001 ) ;
( 1990; 14:1001 )
Gross: may be visible but usually small; single or multiple :
, ;
Micro: well defined hyalinized lesion, variably cellular, immediately
below mucosa, composed of extravillous (intermediate) trophoblast
cells with abundant amphophilic, glycogen rich or eosinophilic
cytoplasm with vacuoles, irregular nuclei with degenerative features
and possible atypia; occasional inflammatory cells, rare/no mitotic
figures; resembles trophoblasts in chorion lavae :

, ,
, ()
,
,
;
, / ;

Micro images: nodule just below surface with sparsely
cellular stroma ; cytoplasmic vacuoles and nuclear
enlargement ; HLA-G+ (not necessarily cervix)
:
;
; + ( )
Positive stains: keratin, PLAP, inhibin alpha, CK18, HLA-G, p63;
variable HPL : , ,
18, - 63;
Negative stains: Ki-67 (<8% positivity) : -67
(<8% )
DD: placental site trophoblastic tumor (larger, has mitotic activity, not
degenerative), hyalinizing squamous cell carcinoma (definite
squamous cells, atypia, HPL negative), cartilaginous tumors :
(,
, ),
( , , ),

Post-operative spindle cell nodule of cervix

top
Associated with prior biopsy or curettage

More common in vulva/vagina ( Histopathology 1995;26:571 ); also in
bladder ( J Urol 1990;143:824 ) / (
1995; 26:571 ), ( , 1990; 143:824 )
May recur after excision
Micro: resembles nodular fasciitis and granulation tissue; bundles or
fascicles of proliferative spindle cells with infiltrative margins; nuclei
are oval to spindled with mild hyperchromasia and pleomorphism;
frequent mitotic figures; often edematous stroma, delicate capillary
network, neutrophils and red blood cells :
;

;
; ,
, ,

Micro images: bladder tumor :
Pseudosarcomatous fibroepithelial stromal polyps of

cervix

top
Median age 32 years, range 16 to 75 years 32
, 16 75
Often in pregnant patients or post-operative

-
May recur locally; no metastases ;
Positive margin status, which is common, apparently is not associated

with recurrence , ,

Gross: often multiple lesions, particularly in pregnant women; tender,
skin-colored, sac-like : ,
, , , -
Micro: resemble fibroepithelial stromal polyps of vagina and vulva,
but with bizarre morphology, frequent mitoses (>10/10 HPF), atypical
mitotic figures or hypercellularity; clues to diagnosis are characteristic
stellate cells and multinucleate stromal cells, and extension of lesions
up to mucosal-submucosal interface :
,
, (> 10/10 ),
;
,
-
Positive stains: desmin, ER, PR : , ,
DD: aggressive angiomyxoma : deep, prominent vascular pattern

cuffed by myoid bundles : : ,

angiomyofibroblastoma : well circumscribed subserosal nodule, no
atypia, stromal cells cluster around vessels, which usually have
delicate walls :
, ,
,
botyroid embryonal rhabdomyosarcoma : early childhood,
submucosal hypercellular zone/cambium layer, rhabdomyoblasts,
myoglobin+, myogenin+
: ,
/ , ,
+ +
cellular angiofibroma : well circumscribed, less polypoid, diffusely
vascular with hyalinized walls, no atypical stromal cells, desmin : , ,
,
, leiomyosarcoma : clear boundary of tumor cells with epithelium,
smooth muscle differentiation :
,
low grade endometrial stromal sarcoma : vessels resemble spiral
arterioles, no central vascular core, thick bands of collagen in
starburst pattern, dot like staining of desmin or keratin
:
, ,
,
malignant peripheral nerve sheath tumor : perivascular accentuation,

50% are S100+ :
, 50% 100 +
References: AJSP 2000;24:231 , Cancer 1983;51:1148 (vaginal) :
2000 24:231 , , 1983; 51:1148 ()
Pyogenic granuloma of cervix
top
Gross: red-brown-blue-black, due to excessive capillary growth
: ---,
Micro: lobulated collection of inflammatory cells, with neutrophils

confined to surface of ulcerated lesions; prominent small vessels
: ,
,

Rhabdomyoma of cervix
top
Also in vagina and vulva
Micro: undifferentiated spindle shape cells and scattered muscle
fibers within myxoid matrix, beneath intact squamous epithelium
:
,
adult type - abundant eosinophilic cytoplasm

fetal type - small cells and cells resembling fetal muscle
-
juvenile type - intermediate between adult and fetal types
-
Micro images: various images and stains ; kidney #1 ;
#2 ; various cardiac tumors :
; # 1 , # 2 ;
Positive stains: desmin, myoglobin, myoD1, myogenin
: , , 1,
DD: rhabdomyosarcoma :
Squamous papilloma of cervix
top
Also called fibroepithelial polyp, fibroepithelial stromal polyp,
mesodermal stromal polyp
, ,

Benign lesion of lower genital tract (vagina, vulva, less commonly in
cervix), usually in women of reproductive age
(, , ),

15%+ occur during pregnancy; these cases are often multiple with
more pleomorphism and atypia 15% + ,

May contain atypical stromal cells (see pseudosarcomatous
fibroepithelial stromal polyp )
(
)
May regress spontaneously after delivery; may recur
;
May be a reactive hyperplastic process of myxoid stroma of lower
female genital tract, because (a) no clearly defined margin, (b)
stromal cells also present in normal vulva, vagina and cervix, (c)
similar lesions at other sites, (d) ER+/PR+ suggests hormonal
influence
, ()
, ()
, , ()
, ( ) + / +
May represent condyloma without koilocytosis

Treatment: excisional biopsy :
Gross: usually 5 mm or less, solitary : 5
,
Micro: fibrovascular stalk covered by mature squamous epithelium,
or acanthotic stellate shaped cells growing in a chaotic manner; often
no distinct boundary between stroma and epithelium; may have
multinucleated stromal cells near epithelial-stromal interface or
edematous stroma with occasional enlarged multinucleated
fibroblasts; no arborizing pattern, no koilocytotic changes, no
cambium layer, no rhabdomyoblasts, no/rare mitotic figures :
,
,
;
-

, ,
, , ,
/
Micro images: squamous epithelium overlying
fibrovascular papillae ; not cervix - respiratory
squamous papilloma ; GE junction :

, -
;
-
Positive stains: vimentin, ER, PR, strong smooth muscle actin, weak
desmin : , , ,
,
DD: sarcoma (including rhabdomyosarcoma), condyloma
(koilocytosis, marked arborization; Ki-67 and HPV tests may be
helpful, AJSP 2000;24:1393 ), verrucous carcinoma, well differentiated
squamous cell carcinoma, papillary SIL, papillary immature
metaplasia, vaginal polyp (contains atypical stromal cells) :
( ),
(, ; -67 -
, 2000 24:1393 ), ,
,
, , (
)
Traumatic neuroma of cervix
top
Reparative lesion at site of traumatic injury of peripheral nerves

Interruption in continuity of nerve causes wallerian degeneration (loss

of axons in proximal stump and retraction of axons in distal segment),
then exuberant regeneration of nerve and formation of mass of

Schwann cells, axons and fibrous cells
(
),

,
Rare complication of cone biopsy ( Archives 1989;113:945 )
( 1989; 113:945 )
Microneuromas present in 55% of hysterectomy patients, associated
with childbirth ( Histopathology 1996;28:153 )
55% , (
1996; 28:153 )
Gross: irregular gray area up to 2 cm near cone biopsy margin or
scar : 2

Micro: haphazard nerves within mature collagenous scar with
entrapped smooth muscle :

Micro images: oral cavity :
Positive stains: S100 : 100
Tunnel clusters of cervix

top
Incidental finding with no associated gross abnormality

Benign, does not recur ,
80% have had 3+ prior pregnancies 80% 3 +
Micro: lobular proliferation of endocervical glands (clefts) with side
channels growing out of them; close to endocervical canal; may be
dilated due to inspissated eosinophilic secretions; low power
appearance is lobular with one or more discrete foci of cystically
dilated endocervical glands; may extend deep into cervical wall;
usually well circumscribed but may have pseudoinvasive appearance;
benign nuclear features; minimal atypia; no stromal desmoplasia
:
(), ,
;
;

; ;
,
; ; ,

Type A glands: smaller; noncystic tubules that resemble mucosal
folds cut in various planes; may have florid glandular proliferation, and
mild nuclear atypia, but are still lobular and have minimal mitotic
activity : ;
;
, ,

Type B glands: cystic or dilated tubules arranged in lobular units;
often multifocal, up to 2 mm in diameter individually; lined by bland
cells with no mitoses, no/minimal nuclear atypia :

, , 2
; ,
/
Micro images: tunnel
clusters (type B) with sharp

circumscription #1 ; #2 with dense secretion
: ( )
# 1 ; # 2
Negative stains: intracytoplasmic CEA, Ki-67 (or low)
: , -67 ( )
DD: minimal deviation adenocarcinoma (not lobular,
moderate/marked nuclear atypia) :
( , /
)
References: AJSP 1996;20:1312 (type A with atypia) , AJSP 1990;14:895 (early
study) , Mod Path 2000;13:261 (cervical glandular lesions) :
1996 20:1312 ( ) , 1990; 14:895 ( ) , 2000
13:261 ( )
Premalignant / preinvasive lesions of cervix

/
Human papilloma virus (HPV) of cervix

()
top
Causes spectrum of changes ranging from condyloma accuminatum

(flat, spiked and inverted condyloma and warty atypia) to invasive
squamous cell carcinoma ,
(,
)
Family of 60+ viral types; nonenveloped viruses, 55 nm in diameter
60 + ; , 55
Transmitted sexually; has predilection for metaplastic squamous

epithelium ;

Koilocytosis / koilocytotic atypia: related to expression of viral E4
protein and disruption that this causes in cytoplasmic keratin matrix
/ :
4

Koilocyte is superficial or immature squamous cell with sharply
outlined perinuclear vacuoles, dense and irregular staining peripheral
cytoplasm, enlarged nucleus with undulating (raisin-like) nuclear
membrane and rope-like chromatin; often bi- or multinucleation and
variation in nuclear size
,
,
( -)
, -

Nuclear changes are required for diagnosis of koilocytosis since
glycogen accumulation is otherwise common ( Archives 1990;114:1038 ),
and perinuclear halos can be prominent in postmenopausal cervix
without HPV
(
1990; 114:1038 ),
HPV E6 protein interacts with p53; HPV E7 protein interacts with Rb
(retinoblastoma) protein; both induce genetic instability, which
promotes selection of a malignant phenotype ( J Clin Virol 2005;32 Suppl
) -6 53; -7
() ,
,
( , 2005, 32 1: 25 )
Low risk HPV subtypes (associated with genital condyloma and low
grade SIL): 6, 11, 40, 42, 43, 44, 54, 61, 70, 72, 81, CP6108
(
): 6, 11, 40, 42, 43, 44, 54, 61, 70, 72, 81, 6108
High risk HPV subtypes (associated with high grade SIL and
invasive carcinoma): 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68,
73, 82; subtypes 26, 53 and 66 are probably high-risk ( Low Genit Tract
Dis 2005;9:154 ) (
): 16, 18, 31, 33, 35, 39, 45, 51,
52, 56, 58, 59, 68, 73, 82; 26, 53 66 "
" ( , 2005; 9:154 )
HPV 18: associated with lesions of glandular origin and small cell
neuroendocrine carcinoma; recommended that patients with HPV18+
cervical smears have endocervical curettage, even if normal
morphology ( Best Pract Res Clin Obstet Gynaecol 2006;20:253 ) -18:

; 18 +
,
( 2006;
20:253 )
Presence of HPV 16 or 18 confers a 200x relative risk for HSIL for 2
years after first detected ( Eur J Obstet Gynecol Reprod Biol 2006;125:114 )
- 16 18 200
2 ( 2006;
125:114 )
Note: report presence of HPV associated changes, even if SIL is also
present : - ,

Uses: to triage ASCUS cases (HPV+ are more likely to have HSIL at
followup), to confirm cervical origin of squamous cell or
adenocarcinoma :
( + ),

Micro: normal basal cell layer, expanded parabasal cell layer, orderly
maturation, mitotic figures (normal), koilocytosis :
, ,
, (),
1:S25
-
Micro images: :
HPV immunostains - normal cervix has some HPV
background staining ; cervical condyloma is HPV+ ;
LSIL/CIN1 ; HSIL/CIN2 ; HSIL/CIN3 ; carcinoma
- -
;
+ ; /1 ; /2 ; /3 ;
Positive stains: Ki-67 (higher in HPV+ epithelium than inflamed or

metaplastic squamous epithelium; very high with high risk HPV types)
: -67 ( - +
,
)
Molecular: usually detected by Southern blot hybridization (gold

standard) or in situ hybridization; HPV DNA may be detected by PCR
in lesions without koilocytotic atypia ( AJSP 1990;14:643 )
:
(" ") ;
( 1990; 14:643 )
Molecular images: various HPV detection schemes
: -
EM: intranuclear crystalline or filamentous inclusions :

z References: Archives 2003;127:935 (HPV biology) , HPV genome
organization : 2003; 127:935 ( ) , -

Condyloma acuminatum of cervix

top
Common sexually transmitted, HPV-associated lesion
,
Usually associated with HPV 6 or 11; HPV16 is associated with high
grade atypia - 6 11; 16

Benign
May enlarge dramatically during pregnancy and regress
spontaneously

Treatment: excisional biopsy, cryosurgery or laser vaporization
: ,
Gross: polypoid lesion with spiked or cauliflower appearance; only

8% are multiple :
, 8%
Micro: papillomatosis, acanthosis, koilocytosis in middle and upper
epithelium, inflammation; undulating epithelium on low power; minor
atypia is common; if more severe, grade as HSIL (high grade
squamous intraepithelial lesion) or LSIL (low grade) :
, ,
, ; ;
, , (
) ( )
Micro images: various images #1 ; #2 ; #3 ; spiked
excrescences ; cervical condyloma is HPV+
: # 1 , # 2 ; # 3 ,
;
+
-
Molecular: HPV 6 or 11 in 70-90% of cases, HPV 16 is occasionally
seen and associated with high grade cytologic atypia :
6 11 70-90% , -16

Immature condyloma of cervix
top
Also called papillary immature metaplasia

Considered a variant of LSIL

May be a variant of condyloma
May be due to HPV 6 or 11 ( Mod Path 1992;5:391 )
-6 11 ( 1992; 5:391 )
Gross: exophytic; involves proximal transformation zone and
endocervix : ;

Micro: filiform papillae composed of proliferation of immature
squamous cells with mild atypia, often associated with mature areas
of condyloma; variable cytologic atypia, frequent extension into
endocervical canal with preservation of surface endocervical
epithelium; usually no koilocytotic atypia, no/rare mitotic figures
:
,
; ,

; , /

Micro images: papillary immature metaplasia ; p16
negative (page 2) :
; 16 ( 2)
-
Negative stains: marked reduction in Ki-67 staining in superficial cell
layers vs. condyloma, HSIL or papillary carcinoma; p16
: -67
, ; 16
Molecular: HPV 6 and 11 are present in areas of koilocytotic atypia
and immature metaplasia; high grade types not found, but rarely
coexist with separate high grade lesion ( J Korean Med Sci 2001;16:762 )
: 6 11
;
,
( . , 2001; 16:762 )
DD: reactive metaplasia, HSIL (nuclear overlap, no discrete
chromocenters, high mitotic activity and Ki-67 index), papillary
squamous cell carcinoma (marked atypia, mitotic activity) :
, ( ,
, -67
), ( ,
)
References: Hum Path 1998;29:641 , Mod Path 2000;13:252 :
1998; 29:641 , 2000; 13:252
Atypical squamous lesion of cervix

top
May be neoplastic (HPV related, LSIL, HSIL) or reactive
( , , )
In cervical smears, often related to SIL ,

Features suggestive of neoplastic (5 or more) vs. Nonneoplastic (0-2)
are: mitotic figures, vertical nuclear growth pattern, no perinuclear
halo, indistinct cytoplasmic border, primitive cells in upper 1/3 of
squamous layer, p16+ cells in upper 2/3 of squamous layer, Ki-67+
cells in upper 2/3 of squamous layer ( AJCP 2005;123:699 )
(5 )
(0-2) : ,
, , ,
1 / 3 , 16 +
2 / 3 , -67 + 2 / 3
( 2005; 123:699 )
Reactive changes are present in 2-3% of cervical smears, include
normal N/C ratio, intercellular bridges, regular nuclear membrane,
finely granular chromatin and prominent nucleoli, but no organization
disruption, no/rare mitotic figures, no abnormal mitotic figures; may be
occasional binucleated cells or neutrophils in epithelium
2-3% ,
/ , ,
, ,
, / ,
;

Micro: reactive atypia - normal architecture and polarity ;
prominent nucleoli : -
;
-
Atypical immature metaplasia of cervix

top
Squamous proliferation of transformation zone and endocervical
glands associated with abnormal Pap smears and a colposcopically
visible abnormality

Poorly understood - heterogeneous group of lesions including HSIL
and reactive metaplasia - ,

May be HPV infection of immature squamous metaplasia, but
histologic appearance doesn't predict HPV status
,
-
HPV+ cases are associated with future diagnosis of HSIL +

Cytologically, are a subgroup (<10%) of ASC-H (atypical squamous
cells, cannot exclude high grade lesion)
(<10%) - ( ,
)
Treatment: based on size and distribution of lesion ( Cancer
1983;51:2214 ) :
( , 1983; 51:2214 )
Micro: not papillary; metaplastic squamous epithelium shows nuclear
atypia; basal layer of uniform cells with a uniform chromatin pattern
and variable hyperchromasia; overlying squamous cells are
monomorphic with prominent chromocenters and regular nuclear
membranes; normal cell polarity, rare/no cell crowding and mitoses; if
present, mitoses are normal and confined to the lower third of the
epithelium; occasional higher mitotic rates, multinucleation, nuclear
enlargement and perinuclear halos : ;
;

;

; , /
; ,
;
, ,

Micro images: image1 ; image2 : 1 ;
2
Positive stains: Ki-67 staining similar to LSIL, higher than normal
cervix : -67 ,

Molecular: 2/3 have intermediate or high risk HPV; none have low
risk HPV : 2 / 3
-; -
DD: HSIL, papillary immature metaplasia (papillary architecture) :
, ( )
References: Hum Path 1999;30:345 , Hum Path 1999;30:1161 , Mod Path
2000;13:252 : 1999; 30:345 , 1999; 30:1161 ,
2000; 13:252
Squamous intraepithelial lesions (SIL) of cervixgeneral ()

top
Invasive carcinoma is usually preceded by SIL, which may exist for 20
years before tumor becomes invasive
, 20

Often occurs in teenagers and young women (mean age 26 years in
one study) (
26 )
Risk factors are similar as squamous cell carcinoma (sexual activity
before age 17 years, multiple sexual partners, most likely related to
HPV infection)
( 17 ,
, )
SIL cells are usually detected by cytologic examination (Pap smear or
liquid based cytology), have similar histology as invasive cells,
including nuclear enlargement and hyperchromasia, alteration of
maturation, increased mitotic activity; also reduction in cytoplasmic
glycogen (less iodine staining with Lugol or Schiller's iodine test)

( ),
,
, ,
, (
)
SIL morphologic abnormalities correlate with cytogenetics, ploidy, cell
proliferation and molecular changes
, ,

SIL usually affects transformation zone near endocervical epithelium;
may have abrupt borders, may extend up endocervical canal

; ,

Changes in pregnant women and post-radiation dysplasia may NOT
regress -

Postradiation dysplasia within 3 years of treatment is a poor

prognostic factor 3

Dysplastic cells from cervix may cause vulvar/vagina dysplasia also (
J Natl Cancer Inst 2005;97:1816 )
/ (
, 2005; 97:1816 )
Low grade SIL (LSIL): usually euploid or polypoid, 2/3 regress, 1/6
are unchanged, 1/6 progress ():
, 2 / 3 , 1 / 6 , 1 /
6
High grade SIL (HSIL): usually aneuploid, less regression; 1/3
become invasive at 9 years; associated with HPV types 16, 18, 31,
33; peaks during ages 30-39 years; 0.2% develop invasive carcinoma
even after treatment; distinction between high grade dysplasia (HSIL)
and carcinoma in situ is not reproducible between pathologists and is
not usually made anymore ():
, , 1 / 3 9 ,
16, 18, 31, 33; 30-39 ;
0,2% ;
()

Classification systems: (a) mild, moderate or severe dysplasia or

carcinoma in situ; (b) cervical intraepithelial neoplasia (CIN) - CIN I,
CIN II, CIN III; (c) low grade SIL (LSIL) or high grade SIL (HSIL) - SIL
terminology is currently recommended : ()
, , , ()
() - ,
, -, () ()
( ) -
Treatment for LSIL: controversial since most lesions regress
:
Treatment for HSIL: cone, LEEP, electrodiathermy, cryosurgery,
laser; long term followup is necessary : ,
, , , ;

Note: treatment of HIV+ patients must be more aggressive ( Eur J
Obstet Gynecol Reprod Biol 2005;121:226 ) : +
( 2005;
121:226 )
Features to report: LSIL or HSIL (or use terminology at institution),
presence of endocervical glandular involvement, presence in multiple
quadrants, presence of HPV related changes, margin involvement
(including endocervical margin), involvement of endocervical clefts
: (
), ,
,
( ),

Prognostic factors for recurrence after LEEP: positive margins,
positive glandular involvement, multiple quadrant disease ( Mod Path
1999;12:233 ) :
, ,
( 1999; 12:233 )
Gross: identified best with colposcopic examination after application
of acetic acid; more common on anterior lip of cervix than posterior
lip; rarely occurs laterally :

;
;
Micro: squamous intraepithelial lesions with abnormal proliferation

and abnormal maturation, nuclear enlargement and nuclear atypia;
abnormal proliferation begins at basal and parabasal layers with an
increased number of immature parabasal type cells in intermediate
and superficial epithelium; abnormal maturation is due to loss of
polarity and cellular disorganization; also increased number of mitotic
figures and abnormal mitotic figures, particularly in HSIL :

,
;

;

,
,
-
Drawings/micro images: SIL diagram #1; #2 ; classification
systems / : # 1 # 2 ;

Positive stains: Ki-67/MIB : -67/
MIB-1 staining of cluster of 2 nearby nuclei in upper 2/3 of epithelial
thickness may distinguish SIL from reactive lesions ( AJSP 2002;26:1501
); MIB-1 staining is a strong indicator of HSIL, less reliable for
immature LSIL ( AJSP 2001;25:884 ); MIB-1 staining may be helpful in
equivocal cases ( AJSP 2002;26:70 ) -1 2.
2 / 3
( 2002; 26:1501 ) -1
,
( 2001; 25:884 ) -1
( 2002; 26:70 )
LSIL / CIN I / low grade dysplasia of cervix /

/
top
Slightly raised (condylomas) or flat; thickened (acanthotic) epithelium
with koilocytotic atypia (viral cytopathic effect) in middle or upper
epithelium () ,
() (
)
Most flat LSILs are associated with high risk HPV; use caution if
diagnosing LSIL on any flat immature lesion
-;

HPV negative LSIL: not a distinct biologic entity; often false positive
LSIL or false negative HPV ( Cancer 2005;105:253 )
: ,
- ( , 2005; 105:253 )
HPV16+ LSIL or ASC have higher risk for HSIL than HPV16LSIL/ASC ( J Natl Cancer Inst 2005;97:1066 ) 16 +
16- / ( ,
2005; 97:1066 )
Micro: :
Sternberg's approach to diagnosis: -

:
(a) low power epithelial disorganization compared to surrounding
epithelium, due in alterations in thickness, absence of mucin droplets
and metaplastic changes, hyperchromasia in upper layers or other
changes in nuclear density, cell arrangement or halo contour ()
,
,
,
,
(b) at high power, should be 3x difference in size of nuclei compared

to normal intermediate cells, although often not present; combination
of nuclear and cytoplasmic changes and growth pattern alterations
may be sufficient () , 3
,
;

(c) subtle features include binucleation (2+ binucleated cells per high
power field is supportive, particularly if enlarged or hyperchromatic);
also small densely hyperkeratotic binucleated cells; binucleation
occasionally is found in reactive changes; irregular cytoplasmic halos
are useful, if a rim of dense cytoplasm forms a basket weave in the
superficial epidermis; however may be non-specific ()
(2 +
,
),
;
; ,

,
Diagnosis is often subjective, with interobserver variation
,
Koilocytotic changes are present in HPV negative squamous
component of endometrioid carcinoma of endometrium or ovary; are
not present in HPV+ cervical adenocarcinoma
-
;
+
Presence of meganuclei in superficial epithelial layers is associated
with high risk HPV ( Hum Path 1998;29:1068 )

- ( 1998; 29:1068 )
Koilocytotic atypia (koilocytosis): nuclear pleomorphism, wrinkled
nuclei, hyperchromasia, binucleation (almost always present, Mod Path
1993;6:313 ), perinuclear halos with distinct clear zone around nucleus
and condensation of denser cytoplasm around the periphery; few/no
mitotic figures, particularly in lower half of epithelium, no atypical
mitotic figures; prominent nucleoli suggests reactive changes
():
, , ,
( , 1993 6:313 ),

; / ,
,
;
Micro images: various images ; LSIL merging into HSIL ;

koilocytosis #1 ; #2 ; #3 with markedly enlarged
bizarre nuclei ; #4 ; Cdc6 and MIB-1 (figures C, D)
: ; ;
# 1 , # 2 ; # 3
; # 4 ; 6 -1 ( , )
Positive stains: Ki-67 throughout epithelium : 67
EM: perinuclear cytoplasmic necrosis with cytoplasmic fibrils
condensed along cell periphery; viral particles are present in nuclear
crystalline array :
;

DD of LSIL: :
(a) vaginal papillomatosis : papillary epithelium is normal in vagina;
may have cytoplasmic halos; usually no prominent acanthosis, no
nuclear atypia, no atypical parakeratosis ()
: ,
; ,
,
(b) reactive epithelial changes : cytoplasmic halos are associated with
glycogenated cells, mild atypia associated with inflammation, but no
pleomorphism is present; small binucleated cells may be seen in a
background of metaplasia; reactive changes usually have regular
nuclear spacing, distinct nucleoli, no nuclear atypia in upper layers,
superficial maturation () :
,
, ;
;
,
, ,

(c) postmenopausal squamous atypia : pseudokoilocytosis with
uniform/round halos with central nuclei, slightly hyperchromatic,
occasional grooves, occasional binucleation; associated with
urothelial metaplasia and atrophy; NOT associated with HPV ( Mod
Path 1995;8:408 () :
/
, ,
, ;
, - ( 1995; 8:408
(d) HSIL : nuclear enlargement and atypia throughout full thickness of
epithelium () :

(e) cytoplasmic vacuolization due to glycogen of normal squamous
epithelium : usually diffuse, normal epithelial maturation, no nuclear
atypia ()
: ,
,
References: AJSP 2002;26:1389 (p16) : 2002; 26:1389 (16)
HSIL / CIN II / moderate dysplasia of cervix /

/
top
Micro: persistent abnormal differentiation towards prickle and
keratinizing layers with at least focal maturation; atypical basal cells
involve between 1/3 and 2/3 of epithelial thickness or less with
disproportionate atypia; increased N/C ratio, pleomorphic nuclei with
hyperchromasia, loss of polarity, increased mitotic activity :

;
1 / 3 2 / 3
, / ,
, ,

-
Micro images: various images ; H&E #1 ; #2 ; #3
: ; & # 1 , # 2 ; # 3
HSIL / CIN III / severe dysplasia of cervix /
/
top
1-7% are associated with early invasive disease; 10-20% are
estimated to progress to carcinoma if untreated 1-7%
; 10-20%

Poor prognostic factors include extensive involvement of surface
epithelium and deep endocervical clefts, luminal necrosis,
intraepithelial squamous maturation

, ,

Case reports: HSIL involving deep mesonephric remnants ( AJSP
1994;18:1265 ) :
( 1994; 18:1265 )
Gross images: colposcopic image #1 ; #2 :
# 1 ; # 2
Micro: epithelium is totally replaced by atypical cells in at least part of
the lesion with loss of maturation; koilocytes often have smaller and
more concentric halos and denser hyperchromasia; may have less
pleomorphism than low grade lesions, although nuclei are uniformly
enlarged, crowded or irregularly spaced; hyperchromatic or
binucleated; increased mitotic activity is present; may have surface
parakeratotic cells with abnormal nuclei; nuclear abnormalities are
often more prominent in basal/parabasal cells :

;
;
,
, ;
;
;
;
/
Note: LSIL and HSIL often coexist :
Micro images: various images #1 ; #2 ; #3 ; #4 ; #5 ; #6 ; #7

; #8 ; #9 ; involvement of endocervical glands ; at
squamocolumnar junction ; LSIL merging into HSIL ;
Cdc6, MIB-1 (figures E, F) : # 1
, # 2 ; # 3 , # 4 , # 5 , # 6 , # 7 , # 8 , # 9 ,
;
; ; 6, - 1
( , )
Virtual slides: high
grade SIL #1 ; #2 :
# 1 ; # 2
-
Positive stains: MIB-1; also MUC4 ( Hum Path 2001;32:1197 )
: -1, 4 ( 2001; 32:1197 )
EM: loss of intercellular cohesion due to marked reduction in
desmosomes, presence of extremely complex cell surface, loss of
surface pseudopodia :
,
,
DD of HSIL: :
(a) reactive/reparative changes : intercellular edema (spongiosis),
evenly spaced nuclei, minimal variation in nuclear size, prominent
nucleoli, neutrophils, superficial maturation of epithelium, no
hyperchromasia; binucleation may be present () /
: (),
,
, , ,
, ;

(b) immature squamous metaplasia : mucin droplets, neutrophilic
infiltration, often overlying mucinous epithelium, minimal variation in
nuclear size, no hyperchromasia ()
: , ,
,
,
(c) atrophy : hyperchromatic but uniform nuclei, elongated and
grooved nuclei, minimal atypia in superficial epithelium, no mitotic
activity, even spacing of nuclei, conspicuous intracellular bridges,
MIB-1 negative; Ki-67/MIB1 and p16 negative are helpful in diagnosis
in postmenopausal women ( J Low Genit Tract Dis 2005;9:100 ); in older
women, can apply estrogen to induce maturation and rebiopsy ()
: ,
, ,
, ,
, -1 , -67/1 16
( .
, 2005 9:100 ), ,

(d) adenoid cystic carcinoma ()
(e) radiation changes : abundant cytoplasm with vacuoles, nuclear
enlargement and hyperchromasia with smudged chromatin,
prominent nucleoli, uniform nuclear spacing, normal N/C ratio,
minimal mitotic activity () :
,
, , ,
/ ,
(f) placental site nodule : (strongly keratin and PLAP positive) ()
: (
)
(g) sheets of macrophages ()
(h) urothelial hyperplasia ()
(i) iodine effect: can induce shrinkage, cytoplasmic eosinophilia,
vacuolization and epithelial pyknosis () :
, ,

DD (clinical): hyperkeratosis and metaplastic squamous epithelium

():
SIL Variants of cervix
Keratinizing SIL of cervix
top
HSIL with immature metaplastic differentiation of cervix

top
Immature flat lesions with uniform population of small, metaplastictype cells, reduced superficial cell maturation, high nuclear density on
surface with hyperchromasia
, ,
,
DD: papillary immature metaplasia (papillary not flat, less nuclear

pleomorphism and atypia), air drying artifact :
( ,
),
HSIL with eosinophilic dysplasia of cervix

top
Present in 10% of HSIL lesions 10%
Associated with HPV infection and classic HSIL in adjacent areas

May arise from metaplastic cervical squamous epithelium that has

become infected with high risk HPV

-
Micro: lack of normal maturation; compared to classic HSIL, cells
have distinct cell borders and abundant eosinophilic cytoplasm,
increased N/C ratio and focal dysplastic nuclei with nuclear
enlargement, hyperchromasia, variable nuclear membrane
abnormalities and distinct nucleoli; associated with classic SIL and
squamous metaplasia : ;
,
, /
,
, ,
;

Positive stains: p16, MIB1 expression, HPV :
16, 1 , -
DD: glassy cell carcinoma :
References: : AJSP 2004;28:1474 2004; 28:1474
Endocervical glandular atypia / dysplasia

/
top
More severe cases are called endocervical glandular dysplasia
(atypical hyperplasia)
( )
In United Kingdom, use terminology of CGIN - cervical glandular
intraepithelial neoplasia ,
Not a reproducibly defined entity with a specific cause or outcome

Patients with diagnosis based on cervicovaginal smears often have

squamous dysplasia ( Obstet Gynecol 1992;79:101 )

( 1992; 79:101 )
Appears to NOT be a precursor to adenocarcinoma in situ ( Hum Path
2000;31:656 , AJCP 1998;110:200 )
( 2000 31:656 , 1998; 110:200 )
Atypical oxyphilic metaplasia: incidental finding of endocervical
glands lined by large cuboidal or polygonal epithelial cells with dense,
eosinophilic, focally vacuolated cytoplasm and variable nuclear
enlargement, hyperchromatism, multiple lobes or multinucleation; no
mitotic activity or stratification; benign behavior ( Int J Gynecol Pathol
1997;16:99 ) :

, ,

, ,
, ;
( 1997; 16:99 )
Micro: glandular atypia - glandular cells with hyperchromatic nuclei
with only occasional mitotic figures and minimal pseudostratification;
no cribriform areas, no papillary projections, no crowding, no mitotic
figures; alternatively there is marked atypia involving only a single
gland; normal N/C ratio : -

,
, , ,
;
; /
glandular dysplasia - resembles
adenocarcinoma in situ but nuclei are not malignant and have fewer
mitotic figures, OR malignant involvement of only one gland ,
,

-
Micro images: reactive glandular atypia #1 ; #2 ; low
grade intraepithelial neoplasia/dysplasia ; glandular
dysplasia-various images ; glandular dysplasia #1 ; #2
: # 1 , # 2 ;
/
; - ;
# 1 ; # 2
Positive stains: p16 (in dysplasia, Hum Path 2004;35:689 , but
not atypia or reactive lesions, AJSP 2003;27:187 )
: 16 ( , 2004 35:689 ,
, 2003; 27:187 )
Negative stains: HPV (usually) : ()
DD: inflammation, radiation, Arias-Stella reaction, tamoxifen or oral
contraceptives, microglandular hyperplasia, metaplasia :
, , -,
, ,
References: AJSP 2003;27:452 (scoring system) , Mod Path 2000;13:261

: 2003 27:452 ( ) , 2000; 13:261
Adenocarcinoma in situ (AIS) of cervix

()
top
In United Kingdom, overlaps with high grade CGIN (cervical glandular
intraepithelial neoplasia) ,
(
)
May be increasing in incidence
Average age 35 to 40 years at presentation, range 27 to 74 years
35 40 , 27
74
30-60% have associated SIL 30-60%
HPV 16 or 18 are risk factors ( Br J Cancer 2006;94:171 ); are present in
50-90% of cases -16 18 ( , 2006;
94:171 ) 50-90%
Precursor to most cases of invasive adenocarcinoma of cervix; may
progress to invasive adenocarcinoma or be adjacent to microinvasive
disease
;

Arises from reserve cells with capacity to undergo columnar
differentiation, or from columnar epithelium
,

Case reports: with HSIL in pregnant patient ( Arch Gynecol Obstet
2004;270:116 ), 30 year old woman with HSIL on pap smear ( Case of
Week #202 ) : (
), 30
( # 202 )
Treatment: cone biopsy or hysterectomy (cold knife with negative
margins may still lead to invasive, residual or recurrent disease);
follow up with cytology and HPV testing :
(
,
);
Gross: no distinctive gross appearance; often multifocal involving
multiple quadrants of cervix; often superior to squamocolumnar
junction : ,
,

Micro: low power diagnosis; normal glandular architecture with
malignant, darkened glands at squamocolumnar junction involving
part or all of epithelium lining glands or forming the surface,
composed of hyperchromatic, enlarged, crowded nuclei with coarse
chromatin, small single or multiple nucleoli, frequent mitotic figures
(mean 18/10 HPF); apoptotic bodies common (mean 16/10 HPF);
may have abrupt transition to normal epithelium; endocervical type
most common; also endometrioid (no mucin production, no goblet
cells, no cells with clear or light-staining cytoplasm, cells have scanty
cytoplasm with marked nuclear stratification), intestinal types; may
have periglandular inflammation; presence of glands close to thick
walled vessels (within diameter of vessel) is suggestive of invasion (

Int J Gynecol Pathol 2005;24:125 ); no extension below normal glands, no
infiltration of stroma, no desmoplasia : ;
,

,
, ,
, ,
( 18/10 ); (
16/10 ); ;
, (
, ,
- ,
), ;
;
( )
( , 2005; 24:125 );
, ,
-
Micro images: various images #1 ; #2 ; endocervical type
#1 ; #2 ; #3 ; #4 ; #5 ; #6 ; : # 1 , #
2 ; # 1 , # 2 ; # 3 , # 4 , # 5 , # 6 ;
endometrioid type #1 ; #2 ; #3 ; #4 ; #5 ; intestinal type ;
adenosquamous type #1 ; #2 ; with HSIL-#1 ; #2 ; #3 ;
Cdc6, MIB-1 (figures A, B) ; adenocarcinoma in situ ;
#2 ; #3 ; #4 - with HSIL ; #5 - with HSIL ; biopsy
# 1 , # 2 ; # 3 , # 4 , # 5 ;
; # 1 , # 2 ;
-# 1 , # 2 ; # 3 , 6, -1 ( , , ) ;
; # 2 , # 3 , # 4 -
; # 5 - ;
Positive stains: CEA (specific if strongly positive), Cdc6 and MIB1
(Cdc6 stains only scattered cells, Archives 2002;126:1164 ), p16 (non
specific, Hum Path 2004;35:689 , AJSP 2003;27:187 ), keratin (50%)
: ( ),
6 1 (6 , 2002 126
begin_of_the_skype_highlighting 2002 126 end_of_the_skype_highlighting:1164 ),
16 ( , 2004 35:689 , 2003 27:187 ),
(50%)
Negative stains: ER and PR, vimentin, bcl2 :
, 2,
Molecular: HPV (70% by in situ hybridization) :
(70% )
DD: tubal or tuboendometrial hyperplasia (involves only a single
gland or portion of a gland, no significant nuclear atypia), nonspecific
glandular atypia or dysplasia, invasive adenocarcinoma (infiltrating
glands with budding, desmoplasia, extension of glands beyond
normal glandular depth), Arias-Stella reaction (usually focal glands or
focal portion of glands, hobnail type cells, no/rare mitotic activity),
microglandular hyperplasia (polypoid, smaller and more uniform
glands, bland nuclei, no mitotic activity), endometriosis (endometrialtype cells with basal nuclei but no atypia; surrounded by endometrialtype stroma which is CD10+), mesonephric remnants (deep in
stroma, bland nuclei, have intraluminal secretions), viral induced
changes (inflammation present, viral nuclear inclusions) :
(
, ),
,
( ,
,
), - (
, , /
), (,
, , ),
( ,
; 10 +),
( , ,
), (
, )
References: AJSP 1998;22:434 (apoptotic bodies) , Mod Path 2000;13:261
: 1998; 22:434 ( ) , 2000; 13:261
Radiation atypia of cervix

top
Can involve endocervical cells or squamous epithelial cells

Gross: fibrosis, induration, stenosis of endocervix, surface irregularity

or no abnormality : , ,
,
Micro: similar to changes in other organs; hyalinized stroma or
reactive changes with ectatic vessels; sparse, well-spaced tubular or
dilated glands in endocervix; abundant cytoplasm with vacuoles;
uniformly dispersed nuclei with minimal crowding, but marked nuclear
atypia of endocervical glandular cells with enlarged, pleomorphic and
smudged nuclei, prominent nucleoli; chromatin is fine and
degenerated; no/rare mitotic figures, low N/C ratio :
;
; ,
;
; ,

, ,
; , /
, /
-
Micro images: radiation atypia #1 ; #2 ; #3 :
# 1 , # 2 ; # 3
Positive stains: scattered CEA :
References: : Int J Gynecol Pathol 1996;15:242
, 1996; 15:242
Stratified Mucin producing Intraepithelial Lesions

(SMILE) of cervix
()
top
Rare cervical intraepithelial lesion that is a variant of endocervical
columnar cell neoplasia, consistent with neoplasm arising in reserve
cells in transformation zone
,

Associated with SIL and invasive carcinoma

May be a marker of phenotype instability

Micro: multilayered epithelium resembling SIL with conspicuous
cytoplasmic clearing or vacuoles in lesions otherwise resembling
HSIL due to more extreme nuclear pleomorphism and
hyperchromasia and higher proliferation index; mucin present
throughout the epithelium; usually associated SIL or AIS; usually no

;
; ;

Micro images: resembles HSIL but with abundant mucin
:
Positive stains: high MIB-1 index, mucin :

-1
Negative stains: keratin 14, p63 : 14,
63
DD: adenocarcinoma in situ, atypical immature squamous metaplasia
: ,
References: AJSP 2000;24:1414 : 2000; 24:1414
Carcinoma of cervix
WHO classification of cervical tumors

top
Epithelial tumors
Squamous lesions and precursors
Squamous cell carcinoma, not otherwise specified

,
Keratinizing
Nonkeratinizing
Basaloid
Verrucous
Warty (condylomatous) ()
Papillary (transitional) ()
Lymphoepithelioma-like
Squamotransitional
Early invasive (microinvasive) squamous cell carcinoma
()
Squamous intraepithelial neoplasia / lesions (SIL)
/ ()
High grade (usually lumped with carcinoma in situ) or low grade
( ),

Cervical intraepithelial neoplasia (CIN) - different terminology than
SIL ()
CIN 1 (mild dysplasia, low grade SIL) 1 ( ,

)
CIN 2 (moderate dysplasia, high grade SIL) 2 (
, )
CIN 3 (severe dysplasia, carcinoma in situ, high grade SIL) 3
( , , )
Benign squamous cell lesions
Condyloma acuminatum
Squamous papilloma
Fibroepithelial polyp
Glandular tumors and precursors
Adenocarcinoma
Mucinous adenocarcinoma (endocervical, intestinal, signet ring,
minimal deviation, villoglandular subtypes)
(, , ,
, )
Endometrioid adenocarcinoma (may have squamous metaplasia)
(
)
Clear cell adenocarcinoma
Serous adenocarcinoma
Mesonephric adenocarcinoma
Early invasive adenocarcinoma
Adenocarcinoma in situ
Glandular dysplasia
Benign glandular lesions
Mullerian papilloma
Endocervical polyp
Other epithelial tumors
Adenosquamous carcinoma
Glassy cell carcinoma variant
Adenoid cystic carcinoma
Adenoid basal carcinoma
Neuroendocrine tumors
Carcinoid tumor
Atypical carcinoid tumor
High grade neuroendocrine carcinoma - small cell or large cell types
-

Undifferentiated carcinoma
Mesenchymal tumors and tumor like conditions

Leiomyosarcoma
Endometrioid stromal sarcoma, low grade
,
Undifferentiated endocervical sarcoma

Embryonal rhabdomyosarcoma (sarcoma botyroides)
( )
Alveolar soft parts sarcoma
Angiosarcoma
Malignant peripheral nerve sheath tumor

Leiomyoma
Genital rhabdomyoma
Postoperative spindle cell nodule
Mixed epithelial and mesenchymal tumors

Carcinosarcoma (malignant mullerian mixed tumor)
( )
Adenosarcoma
Wilms tumor
Adenofibroma
Adenomyoma
Melanocytic tumors
Malignant melanoma
Blue nevus
Miscellaneous tumors
Germ cell tumors (yolk sac tumor, dermoid cyst, mature cystic
teratoma) ( ,
, )
Lymphoid and hematopoietic
Malignant lymphoma (specify type) (
)
Leukemia (specify type) ( )
Secondary tumors
References: IARC/WHO : /
Squamous cell carcinoma of cervix

top
4,500 deaths/year in US, #8 cause of cancer death in women in US
(was #1 in 1940's); still #1 in other countries 4.500 /
, # 8 ( # 1
1940), # 1
Reduction due to Papanicolaou smear test to detect premalignant
lesions (1 million cases of SIL detected per year in US, 13,000 new
invasive carcinomas, Cancer 2004;100:1035 )
(1
-, 13.000
, 2004; 100:1035 )
Mean age 51 years, uncommon before age 30 years but most are
ages 45-55 years 51 , 30
, 45-55
Risk factors: early age at first intercourse, multiple sexual partners (
Br J Cancer 2003;89:2078 ), male partner with multiple prior sexual
partners, history of HSIL; HLA associations in Mexican women ( Hum
Path 1999;30:626 ) : ,
( , 2003; 89:2078 ),
, ;
( 1999; 30:626 )
Also: oral contraceptives (some studies), cigarette smoking ( Int J
Cancer 2006;118:1481 ), parity, family history, associated genital
infections, no circumcision in male partner :
( ), ( , 2006; 118:1481
), , , ,

Human papillomavirus (HPV): causes vulvar condyloma
acuminatum (sexually transmitted), found in DNA of 95% of cervical
cancers, 90% of condylomas and premalignant lesions
():
( ), 95%
, 90%
High risk HPV types for cervical carcinoma: 16, 18, 31, 33, 35, 39,
45, 51, 52, 56, 58, 59, 68 and others
: 16, 18, 31, 33, 35, 39, 45, 51, 52,
56, 58, 59, 68
Low risk HPV types for cervical carcinoma: 6, 11, 42, 44
(associated with condyloma) -
: 6, 11, 42, 44 ( )
HPV acts via E6 and E7 genes, which differ in high vs. low risk HPV
types; HPV is integrated in premalignant lesions with tumor DNA vs.
present in episomes (not integrated) in condylomas; in HPV 16 and
18, E6 binds to p53, causing its proteolytic degradation; E7 binds to
retinoblastoma gene (Rb) and displaces transcription factors normally
bound by Rb - 6 7 ,
-;
(
) , 16 18, 6 53 ,
; 7
()

Other co-factors are important, because (a) most with HPV don't get
cervical cancer, (b) 10-15% of cervical cancer is NOT associated with
HPV - , () -
() 10-15%
-
HIV or HTLV-1 infection adversely affect the prognosis, may be
associated with rapidly progressive course - -1
,

Detect clinically via white patches after application of acetic acid to
cervix; cervix also has mosaic vascular patterns at colposcopy

;

Prognostic factors: clinical stage, nodal status, size of largest node
and number of involved nodes, tumor size, depth of invasion,
endometrial extension, parametrial involvement, angiolymphatic
invasion; HPV negative patients do poorer; possibly S phase fraction;
possibly tissue associated eosinophilia (poorer survival in one study,
Hum Path 1996;27:904 ); also squamous cell carcinoma antigen serum
level in patients with advanced disease ( Anticancer Res 2005;25:1663 )
: , ,
,
, , ,
, ; -
; ;
( ,
1996; 27:904 ),
(
2005; 25:1663 )
Not relevant: microscopic tumor grade, tumor type, angiogenesis

: , ,
Spreads usually through cervical lymphatics in sequential manner; via

direct extension to vagina, uterus, parametrium, lower urinary tract,
uterosacral ligaments; distant metastases to aortic and mediastinal
lymph nodes, lung, bones, ovary (1%)
;
, , ,
, ;
, , ,
(1%)
2/3 are stage I or II when diagnosed 2 / 3 ,
Case reports: after amebiasis ( Archives 1985;109:1121 ), with

endometrial tuberculosis in India ( Arch Gynecol Obstet 2004;269:221 ), with
granulocytosis ( Obstet Gynecol 2004;104:1086 , Korean J Intern Med 2005;20:247
), decidua in pelvic lymph nodes of pregnant patient may mimic
metastases ( Eur J Gynaecol Oncol 2005;26:499 ), with coexisting HPV
negative clear cell carcinoma ( Gynecol Oncol 2005;97:976 ), with CLL/SLL
( Gynecol Oncol 2004;92:974 ), : ( 1985
109 begin_of_the_skype_highlighting 1985 109 end_of_the_skype_highlighting:1121
), ( 2004
269 begin_of_the_skype_highlighting 2004 269 end_of_the_skype_highlighting:221 ),
( 2004 104 begin_of_the_skype_highlighting 2004
104 end_of_the_skype_highlighting:1086 , 2005; 20:247 ),

( 2005;
26:499 ), - (
, 2005 97:976 ), / ( , 2004 ; 92:974 ),
on surface of pedunculated cervical leiomyoma ( Gynecol Oncol
2005;97:253 )
( , 2005; 97:253 )
metastases - to pulmonary capillaries causing cor pulmonale (
Archives 1992;116:187 ), to lung presenting as lymphangitis
carcinomatosis ( Gynecol Oncol 2004;94:825 ), causing right ventricular
mass ( Jpn J Thorac Cardiovasc Surg 2005;53:645 ), to cerebellum confirmed
using PCR ( Hum Path 1999;30:587 ), to cerebrum ( MedGenMed 2005;7:26 ),
to ovarian Brenner tumor ( Mod Path 1995;8:307 ), to incisional scar ( Int J
Gynecol Cancer 2005;15:1183 ), to scalp ( Clin Exp Dermatol 2003;28:28 , Int J
Gynecol Cancer 2001;11:244 ), extensive subcutaneous metastases in
HIV+ patient ( Int J Gynecol Cancer 2001;11:78 ), to spleen ( South Med J
2004;97:301 , Eur J Gynaecol Oncol 2004;25:742 ), to psoas muscle ( Cancer
Radiother 2003;7:187 ) -
( 1992; 116:187 ),
( , 2004 94:825 ),
( 2005 53:645 ),
( 1999; 30:587 ), (
2005 7:26 ), ( 1995 8:307
), ( , 2005; 15:1183 ), (
, 2003 28:28 , , 2001; 11:244 ),
+ ( , 2001
11:78 ), ( , 2004; 97:301 , 2004
25:742 ), ( , 2003; 7:187 )
Treatment: surgery (note: trachelectomy means cervicectomy),

radiation therapy, radioactive implants (for early lesions), pelvic
extenteration (for post-radiation therapy relapse; 5 year survival is
23%; frozen section may be necessary to rule out extra-pelvic spread)
: (:
), , (
), ( -
; 5 23%;
- )
5 year survival of patients treated 1993-1995 by stage: Ia1-Ib1: >
95%, Ib2-IIb: 80-90%, III: 50%, IV: 25-35% 5
1993-1995 : 1-1:> 95%, 2: 80-90%, : 50%, 25-35%
Gross: polypoid or deeply invasive :
Gross images: barrel shaped cervix ; ulcerative tumor ;

stage I tumor ; tumor extending to vagina ; stage IV
tumor with bladder extension #1 ; #2 ; invading lower
uterine segment ; squamous tumor :
; ;
; ;
# 1 , # 2
; ;

Micro: see subtypes below; invasion characterized by desmoplastic
stroma, focal conspicuous maturation of tumor cells with prominent
nucleoli, blurred or scalloped epithelial-stromal interface, loss of
nuclear polarity; may have pseudoglandular pattern due to
acantholysis and central necrosis; rare findings are amyloid ( Archives
1993;117:199 ), signet-ring cells ( Int J Gynecol Cancer 1992;2:152 ), melanin
granules ( Int J Gynecol Pathol 2003;22:285 ) :
; ,
,
- ,
;
; (
1993; 117:199 ), - ( , , 1992; 2:152
), ( , 2003; 22:285 )
May have HSIL / CIN3 like growth pattern ( Int J Gynecol Cancer 2000;10:95
) / 3 ( , ,
2000; 10:95 )
Grading does not correlate with prognosis and is optional

Well differentiated: predominantly mature squamous cells with
abundant keratin pearls, occasional well-developed intercellular
bridges, minimal pleomorphism, minimal mitotic activity
:
,
, ,
Moderately differentiated: less distinct cell borders and less

cytoplasm than well differentiated tumors; also more nuclear
pleomorphism and more mitotic activity :

,

Poorly differentiated: small primitive appearing cells with scant

cytoplasm, hyperchromatic nuclei and marked mitotic activity; no/rare
keratinization; resembles HSIL :
,
; /
;
-
Drawings: evolution of invasive carcinoma from SIL ;
lymphatic pathways of spread :
,
Micro images: various images ; invasive tumor #1 ; #2 ;

#3 ; central keratinization ; resembling clear cell
carcinoma ; margin involvement ; Cdc6, MIB-1 (figures
G, H) ; : ;
# 1 , # 2 ; # 3 , ;
; ; 6, -1
( , ) ;
Images contributed by Frank Melgoza MD and Mai Gui MD PhD,
UC Irvine, California (USA) : squamous cell carcinoma #1 ;
#2
, , ():
# 1 ; # 2
Grading: well differentiated with prominent keratin
pearl ; moderately differentiated with invasion by
nests and single cells ; poorly differentiated spindled
tumor with focal keratinization ; poorly differentiated
with markedly pleomorphic nuclei :
;

;
;

Virtual slides: squamous cell carcinoma #1 ; #2 ; #3

: # 1 , #
2;#3
Positive stains: keratin (almost 100%), CEA (90%), progesterone
receptor, mucicarmine (some, but does not make them
adenocarcinomas), p63 ( Hum Path 2001;32:479 ), thrombomodulin,
involucrin : ( 100%), , (90%),
, (,
), 63 ( 2001 32:479 ), ,
Negative stains: p53 (usually), MDM2 gene, EBV (usually, Archives

1999;123:1098 ) : 53 (), 2 ,
(, 1999; 123:1098 )
EM: well developed intracytoplasmic tonofilaments, desmoplastictonofilament complexes and intercellular microvilli in well
differentiated tumors, lost with decreasing differentiation :
,
EM images: tumor cell in intratumoral vessel :

Molecular: aneuploid, but tumor may exhibit heterogeneity; HPV16 is
associated with 3q amplification : ,
; 16 3
DD: immature squamous metaplasia (uniform cell size and shape, no

significant nuclear atypia), squamous metaplasia with extensive
glandular involvement or marked decidual reaction (no atypia, no/rare
mitotic figures; decidua is keratin-), placental site nodule (well
circumscribed nodules of intermediate trophoblast cells, no/rare
mitotic activity, HPL+), clear cell carcinoma (papillary and tubulocystic
areas, hobnail cells, no squamous differentiation, may be associated
with DES exposure), small cell neuroendocrine carcinoma (diffuse
infiltration of small cells with scant cytoplasm and hyperchromatic
nuclei; often rosettes, trabeculae or ribbons; often crush artifact;
immunoreactive for neuroendocrine markers) :
( ,
),

( , / ; -),
(
, / , +),
( ,
, ,
),
(
, , ,
;
)
References: EMedicine , Molecular Cancer 2005; 4: 38 (epigenetics)
: , 2005, 4: 38 ()
Large cell keratinizing squamous cell carcinoma of cervix

top
Rare, locally aggressive; spreads by direct extension ,
;
More radioresistant than nonkeratinizing carcinomas (5 year survival
for stage I is 54%)
(5 54%)
Not associated with HPV or SIL; not associated with sexual risk
factors - ,

Often normal Pap smear, but may be large and high stage at
diagnosis ,

Histologically similar to HPV negative vulvar and penile cancers

Gross: usually large :
Micro: must have keratin pearls and intercellular bridges to be
keratinizing; keratin pearl is rounded nest of squamous epithelium
with circles of squamous cells surrounding a central focus of acellular
keratin; cells are large with abundant eosinophilic cytoplasm; nuclei
may be enlarged or pyknotic; extensive parakeratosis and
hyperkeratosis without atypia in non-malignant portion of cervix,
marked hyperkeratosis in invasive area with keratin pearls,

intercellular bridges, >25 cells per nest, extensive infiltration of
adjacent tissues, relatively low mitotic activity, no vascular invasion
:
;

;
; ;
-
,
, ,> 25
, ,
,
Micro images: central cystic degeneration ; multiple
keratin pearls :
;
Molecular: HPV negative by PCR :
References: AJSP 2001;25:1310 : 2001; 25:1310

Large cell nonkeratinizing squamous cell carcinoma of cervix

top
More radiosensitive than large cell keratinizing (5 year survival for
stage I is 84%)
(5 84%)
Gross images: #1 : # 1
Micro: rounded nests of neoplastic squamous cells with no keratin
pearls, but may have individual cell keratinization or clear cells;
relatively uniform cells with indistinct cell borders and numerous
mitotic figures :
,
;

Micro images: nonkeratinizing tumor #1 ; #2 ; #3 ; #4
: # 1 , # 2 ; # 3 ; #
4
Papillary squamourothelial carcinoma of cervix

top
Rare, resembles urothelial carcinoma, but lacks true urothelial
differentiation ( J Low Genit Tract Dis 2005;9:149 ) ,
,
( . , 2005; 9:149 )
May behave aggressively with late metastases and local recurrence

Usually postmenopausal women who present at advanced stage ( Eur
J Gynaecol Oncol 1998;19:455 )
( , 1998; 19:455 )
Superficial biopsies with this pattern should be considered invasive
until proven otherwise

Micro: papillary architecture with fibrovascular cores lined by
multilayered, basaloid/urothelial-type epithelium with mitotic activity
and without maturation, resembling HSIL; stromal invasion is usually
at base of tumor but may be within fibrovascular core :

, /
, ;
,

Micro images: papillae covered by atypical basal cells
#1 ; #2 ; focal squamous differentiation ; infiltration of
stroma :
# 1 , # 2 ;
;
Positive stains: CK7, CK5/6 : 7, 5 / 6
Negative stains: CK20 (usually) : 20 ()
Molecular: often HPV16+ ( Cancer 1998;83:521 ) :
16 + ( , 1998; 83:521 )
References: AJSP 1997;21:915 : 1997; 21:915
DD: verrucous carcinoma (bland epithelium, broadly invasive front),
condyloma (maturation, koilocytosis) : (
, ), (,
)
Small cell squamous cell carcinoma of cervix

top
Mean age 50 years 50
Lower rate of nodal metastases and recurrence than small cell
neuroendocrine carcinoma

5 year survival for stage I is 42% 5
42%
Micro: well-defined nests of basaloid-type cells resembling small cell
neuroendocrine carcinoma, but with more cytoplasm, coarser
chromatin and prominent nucleoli; 60% also have SIL :

, ,
, 60%
Positive stains: keratin :
Negative stains: neuroendocrine markers :

DD: small cell neuroendocrine (undifferentiated) carcinoma :
()
References: Mod Path 1991;4:586 : 1991; 4:586
Microinvasive squamous cell carcinoma of cervix

top
3 mm or 5 mm (varies by author) or less of stromal invasion 3
5 ( )
Also known as early invasive carcinoma (WHO), early stromal
invasion or superficially invasive "
" (), " "
" "
Approximately 20% of invasive carcinoma cases in US (higher figure
than in the past; lower rate where patients typically present with
advanced disease, Bull Soc Pathol Exot 2005;98:183 ) 20%
(
,
, 2005; 98:183 )
Note: FIGO stage Ia is lesion with maximum depth of invasion of 5
mm and maximum horizontal spread of 7 mm; is subdivided into Ia1
(invasive depth of 3 mm or less; no wider than 7 mm) and Ia2
(invasive depth of more than 3 mm but not more than 5 mm; no wider
than 7 mm), IARC :
5
7 1 (
3 ; 7 ) 2 (
3 , 5 , 7 )
1% with 3 mm of invasive disease have nodal metastases (more if

angiolymphatic invasion) vs. 13% with 3-5 mm of invasive disease
1% 3 (
) 13% 3-5
In recent study, recurrence in 6% with up to 3 mm vs. 13% with up to
5 mm of invasive disease ( Eur J Gynaecol Oncol 2003;24:513 )
, 6% 3 13% 5
( 2003; 24:513 )
Almost always arises from SIL, usually in anterior lip of cervix;
associated with delayed screening ( BJOG 2005;112:807 )
, ;
( 2005; 112:807 )
Prognostic factors: lymph node metastases; recurrence associated
with angiolymphatic invasion, depth of invasion and distance between
tumor margin and apex of cone ( Int J Gynecol Cancer 2005;15:88 ); also
positive margins :
; ,

( , 2005 15:88 )
Report depth of invasion (measure from most superficial epithelialstromal interface of adjacent intraepithelial process - image ), length
of entire lesion, whether length is composed of one or multiple
lesions, presence of vascular invasion (DD: retraction artifact,
displacement of tumor into vascular spaces during biopsy or
anesthetic injection), margins, presence of SIL, presence of glandular
differentiation (ie adenocarcinoma) (
-
- ), ,
,
(: ,

), , ,
(. )
Obtain levels as needed to confirm invasion

Case reports: superficial spread through endometrial cavity ( J Obstet
Gynaecol Res 2004;30:363 ), disseminated recurrence although initial
disease < 1 mm deep and 1 mm wide ( Gynecol Oncol 2003;90:443 )
: (
, 2004; 30:363 ), <1
1 ( , 2003; 90:443 )
Treatment: clinical course resembles HSIL, so treat with cone biopsy
or simple hysterectomy (versus radical hysterectomy with pelvic
lymph node dissection for more invasive disease) :
,
(

)
Gross: resembles HSIL; often abnormal vessels at colposcopy
: ,
Micro: irregularly shaped tongues of epithelium projecting into
stroma; invasive cells exhibit individual cell keratinization, loss of
polarity, pleomorphism, cellular differentiation, prominent nucleoli,
desmoplastic stroma rich in acid mucosubstances with metachromatic
staining properties, breach of basement membrane by reticulin stains
(also type IV collagen or laminin); may also see scalloped margins at
epithelial-stromal interface, duplication of neoplastic epithelium or
pseudoglands :
;
, , ,
, ,

,
( );
- ,

-
Micro images: various images #1 ; #2 ; irregularly shaped
tongues of squamous epithelium with loose
fibroblastic stroma #1 ; #2 with differentiated
overlying squamous epithelium ; #3 ; #4 ; small
invasive bud ; individual cell keratinization of invasive
cells ; measuring depth of invasion ; suggestive of
angiolymphatic invasion ; angiolymphatic invasion
confirmed by factor VIII related antigen immunostain ;
HSIL with focal necrosis and nearby angiolymphatic
invasion : # 1 , # 2 ;

# 1 ; # 2
; #
3 , # 4 ; ;
;
;
;
;

Virtual slides: early invasive carcinoma
:
DD: crypt involvement of SIL with tangential sectioning (each nest is
discrete and separate from its neighbors), cautery/crush artifact due
to prior biopsy, pseudoepitheliomatous hyperplasia or other reactive
changes, blurring of epithelial-stromal border by inflammation,
placental implantation site :
(
), /
,
, -
,
Adenocarcinoma of cervix and variants

top
5-15% of invasive cervical carcinomas, higher percentage in Jewish
women 5-15% ,

Incidence increasing in US, now up to 25% of cervical cancers, due to
decreasing rates of squamous cell carcinoma and difficulty in
diagnosis using current screening methods; increased frequency in
young women ( Cancer 2004;100:1035 ) ,
25% ,

,
( , 2004; 100:1035 )
Usually associated with in-situ adenocarcinoma (mean 5 year interval,
which is less than for SIL) -
( 5 ,
)
Suspected but still unproven association with oral contraceptives

Endocervical adenocarcinoma is associated with ovarian mucinous

adenocarcinoma and ovarian endometrioid adenocarcinoma

30-50% false negative reports by cytology 30-50%

p16 may be sensitive/specific for diagnosing adenocarcinoma
(invasive or in-situ) by histology or Thin-Prep ( AJSP 2003;27:187 , but
see Hum Path 2002;33:899 ) 16 /
( ),
( 2003 27:187 ,
2002; 33:899 )
Often vaginal bleeding, pelvic pain ,

Spreads first to pelvic structures, then pelvic lymph nodes;
metastases to ovaries, upper abdomen, distant organs
, ;
, ,
Usually EBV negative ( Archives 1999;123:1098 )
( 1999; 123:1098 )
Mixed if there is 10% or more of a second component
10%
Survival by stage: I-79%, II-37%, III/IV-less than 9%
: -79%, -37%, / - 9%
Poor prognostic factors: high stage (including depth > 5 mm, Int J
Gynecol Cancer 2004;14:104 ), angiolymphatic invasion, high grade (
Gynecol Oncol 2004;92:262 ); also HER2 overexpression, elevated serum
CA125 : (
> 5 , 2004; 14:104 ),
, ( , 2004; 92:262 ), 2
, 125
Case reports: ovarian recurrence after radical trachelectomy ( Am J
Obstet Gynecol 2005;193:1382 ), mixed with urothelial carcinoma ( Pathol Int
2004;54:63 , Int J Gynecol Pathol 2003;22:220) :
( 2005 193
begin_of_the_skype_highlighting 2005 193 end_of_the_skype_highlighting:1382
),
( 2004 54:63 ,
, 2003; 22:220)
metastases - choriocarcinomatous metastases to lung ( Gynecol Oncol

2006;101:346 ), to brain ( Int J Gynecol Cancer 2005;15:561 ), vaginal
metastasis associated with traumatic vaginal tear ( Gynecol Oncol
2005;96:857 ) -
( , 2006; 101:346 ), ( , 2005
15:561 ),
( , 2005; 96:857 )
Treatment: surgery (simple or radical hysterectomy or fertility sparing
surgery), radiation therapy, cisplatin or other chemotherapy ( Curr Treat
Options Oncol 2004;5:119 ) : (
),
, (
2004; 5:119 )
Gross: exophytic mass, ulcerated plaque or barrel-shaped cervix
(diffuse enlargement) : ,
( )
Micro: often well differentiated with endocrine morphology and mucin
that may leak into stroma; may also be poorly differentiated, papillary,
endometrioid or have psammoma bodies :

; ,
,
microscopic invasion: individual cells or incomplete glands lined by
malignant cells at a stromal interface or malignant glands surrounded
by a desmoplastic host response; other evidence of invasion is
architecturally complex, branching, or small glands, which grow
confluently or in a labyrinthine pattern; cribriform growth pattern of
malignant epithelium devoid of stroma within a single gland profile;
and the presence of glands below the deep margin of normal glands;
rare findings are focal cilia ( Acta Cytol 2005;49:187 )
:

;
, , ,
;

; ( 2005; 49:187 )
Tumor grade of adenocarcinoma (for classical adenocarcinoma,
not variants; not universally accepted):
( , ,
):
Grade 1: well-differentiated (10% or less solid growth); tumor contains
well-formed regular glands with papillae; cells are elongate and
columnar with uniform oval nuclei; minimal stratification (fewer than
three cell layers in thickness); infrequent mitotic figures 1:
(10% );
;
;
( ),

Grade 2: moderately differentiated (11% to 50% solid growth); tumor
contains complex glands with frequent bridging and cribriform
formation; solid areas up to 50% of tumor; nuclei more rounded and

irregular; small nucleoli present; mitoses more frequent 2:
(11% 50% ),

; 50%
; ; ;

Grade 3: poorly differentiated (over 50% solid growth); sheets of
malignant cells; few glands are discernible; cells are large and
irregular with pleomorphic nuclei; occasional signet cells are present;
mitoses are abundant with abnormal forms; marked desmoplasia;
necrosis is common 3: ( 50%
), ;
; ;
;
; ;
-
Micro images: various images ; poorly defined glands
lined by malignant cells ; malignant glands with
necrotic debris #1 ; #2 ; #3 ; poorly differentiated tumor
#1 ; #2 : ;
;
# 1 , # 2 ; #
3 ; # 1 ; # 2
Positive stains: Alcian blue, mucicarmine, CEA, keratin, EMA, p16,
ER and PR in 25%, p53 : ,
, , , , 16, 25%, 53
Negative stains: CD10 (positive only in mesonephric
adenocarcinomas), p63 ( Hum Path 2001;32:479 ), vimentin (usually)
: 10 (
), 63 ( 2001 32:479 ), ()
Molecular: associated with HPV 16 and 18 in 85-95% of cases ( AJCP
1996;106:52 , Br J Cancer 2005;93:1301 ) : -16
18 85-95% ( 1996 106 begin_of_the_skype_highlighting
1996 106 end_of_the_skype_highlighting:52 , , 2005; 93:1301 )
DD: endometrioid adenocarcinoma extending to cervix (no in situ
cervical adenocarcinoma, continuity between cervix and endometrial
tumors, usually myometrial invasion, often bland squamous
differentiation; stains may be helpful - negative or focal/superficial for
CEA and mucin; positive for vimentin, ER and PR, negative for HPV
by PCR, AJSP 2002;26:998 , AJSP 2003;27:1080 ), metastatic
adenocarcinoma (usually clinical evidence of widespread disease,
angiolymphatic invasion, no surface involvement), adenocarcinoma in
situ (no glands below deep margin of normal endocervical glands),
microglandular hyperplasia (does not extend below deep margin of
normal endocervical glands, usually young women taking oral
contraceptives or pregnant, few mitotic figures), mesonephric
remnants (deep, don't extend to surface, contain eosinophilic
secretions, CD10+, no mitotic activity, no atypia) :
(
,
,
, ;
- /
; , ,
, 2002 26:998 , 2003 27:1080 ),
(
, , ),
(
),
(
,
, ),
(, ,
, 10 +, ,
)
Endocervical (mucinous) type of adenocarcinoma of cervix
()
top
70-90% of all adenocarcinomas 70-90%
Micro: tumor cells resemble endocervical mucosa; cells are arranged
in simple or branching glands; often glands are close to thick-walled
vessels (within thickness of vessel wall, Int J Gynecol Pathol 2005;24:125 );
usually brisk mitotic activity :
;
,
( , ,
2005; 24:125 )
Micro images: well differentiated tumor composed of
endocervical type cells ; colloid type with clusters of
tumor cells floating in mucin :

;

DD: endocervicosis (often in outer cervix, zone of normal stroma
between lesion and endocervical glands, no atypia, no mitotic figures,
Int J Gynecol Pathol 2000;19:322 ) : (
,
, ,
, , 2000; 19:322 )
Endocervical microcystic adenocarcinoma of cervix

top
, 34 78
Presents with abnormal Pap smears or vaginal bleeding

Micro: cysts occupy 50-90% of tumor, 1-8 mm in diameter; lined by
flat to low cuboidal to pseudostratified epithelium; luminal mucin is
common, resembles contents of mesonephric tubules; variable
desmoplastic stroma : 50-90% , 1-8
;
; ,
;

DD: tunnel clusters, deep Nabothian cysts, lobular endocervical gland
hyperplasia, mesonephric hyperplasia (no foci of atypia or
architecturally abnormal glands, usually low mitotic rate) :
, ,
, (
,
)
References: AJSP 2000;24:369 : 2000; 24:369
Endometrioid adenocarcinoma of cervix

See below
Intestinal type of adenocarcinoma of cervix

top
Rare
Micro: mimics colonic epithelium; glands lined by pseudostratified,
malignant appearing cells with intracytoplasmic mucin vacuoles;
goblet cells, occasionally Paneth cells ( Archives 1990;114:731 ) :
;
,
; ,
( 1990; 114:731 )
Micro images: intestinal type cells #1 ; #2 ; #3 ; A: H&E;
B: CDX2-; C: CK7+; D: CEA+; E: CK20- ; metastatic
colonic adenocarcinoma is CDX2+ :
# 1 , # 2 ; # 3 , &; :
2-: 7 + : + : 20- ;
2 +
Positive stains: CEA, CK7 : , 7
Negative stains: CDX2, CK20 : 2, 20
DD: metastatic colorectal adenocarcinoma (very rare; CDX2+, CK7-,
CK20+, Archives 2003;127:1586 , Jpn J Clin Oncol 1999;29:640 ) :
( ; 2
+ 7-, 20 + 2003 127 begin_of_the_skype_highlighting 2003 127
end_of_the_skype_highlighting:1586 , , . 1999; 29:640 )
Signet ring adenocarcinoma of cervix

top
Rare to be pure; usually is mixture with other subtypes
;
Case reports: with glassy cell carcinoma ( Pathol Int 2004;54:787 ), with
neuroendocrine differentiation ( Int J Gynecol Cancer 1999;9:433 )
: ( 2004 54:787 ),
( , , 1999; 9:433 )
Micro: solid cell nests surrounded by pools of mucin :

-
Micro images: signet-ring type tumor cells ; A: H&E, B:
CDX2-, C: CK7+, D: CEA+, E: CK20- :
; : & , -2, :
7 + : + : 20Positive stains: CEA, CK7 : , 7
DD: metastatic adenocarcinoma from breast ( Gynecol Oncol 1998;71:461 )
or stomach ( Cancer 1993;71:3472 , Acta Cytol 1997;41:291 ) :
( , 1998; 71:461 )
( , 1993; 71:3472 , 1997; 41:291 )
Microinvasive adenocarcinoma of cervix

top
Usually defined as stromal invasion up to 3-5 mm in depth
3-5
Excellent prognosis ( Obstet Gynecol 2001;97:701 ) (
2001; 97:701 )
Associated with minimal metastases to nodes ( Int J Gynecol Cancer
2004;14:104 ) (
, 2004; 14:104 )
May have associated SIL
Report: depth of invasion measured from surface, horizontal extent,
margin involvement, infiltrative vs. expansile invasion, degree of cell
differentiation, presence of angiolymphatic invasion :
, ,
, ,
,
Case reports: 62 year old woman with FIGO stage IA1 disease and
bilateral pelvic nodal metastases ( Gynecol Oncol 2000;77:467 ),
metastasis to episiotomy scar and subsequent death from disease (
Gynecol Oncol 1995;59:297 ) : 62
1
( , 2000 77:467 ),
( , 1995; 59:297 )
Treatment: depends on horizontal extent and nodal involvement;
simple hysterectomy is usually adequate ( Gynecol Oncol 2002;85:327 )
:
;
( , 2002; 85:327 )
Micro: up to 5 mm of invasive disease as measured from surface;
budding of cells from adenocarcinoma in situ gland; vesicular nuclei
with prominent nucleoli (similar to invasive squamous cell carcinoma);
desmoplastic stroma; glands deeper than normal endocervical glands
or invasive growth pattern; in some cases, unequivocal invasion may
be difficult to identify : 5
;
; (
); ;

, ,

-
Micro images: various images ; malignant gland with
desmoplasia ; complex / labyrinthine pattern of
malignant epithelium ; buds of early stromal invasion
: ;
; /
;
Positive stains: CEA, keratin (50%) : ,

(50%)
References: AJSP 2003;27:187 (p16) , AJSP 2002;26:1389 (p16) , IARC/WHO
definition : 2003 27:187 (16) , 2002 26:1389 (16) ,
/
Adenoid basal carcinoma of cervix

top
Uncommon, <100 cases reported, occurs in elderly (mean age 60 to
71 years, range 30 to 91 years), often blacks , <100
, ( 60 71
, 30 91 ),
May derive from cervical reserve cells, since similar
immunophenotype ( Jpn J Clin Oncol 1997;27:437 )
, (
1997; 27:437 )
Often an incidental finding; associated with HSIL and HPV 16
; 16
Excellent prognosis; slow growing, usually indolent with favorable
prognosis, mean depth of tumor invasion 4 mm (range 2 to 10 mm);
no nodal metastases, no tumor recurrence, no/rare distant
metastases ; ,
, 4 (
2 10 ) , , /

Some recommend calling adenoid basal epithelioma due to indolent
behavior ( AJSP 1998;22:965 )
( 1998;
22:965 )
May also have an invasive carcinoma component that requires
aggressive treatment ( Hum Path 2005;36:82 ); may represent the
epithelial component of carcinosarcoma/MMMT ( AJSP 2001;25:338 , Int J
Gynecol Pathol 1998;17:211 )
( 2005 36:82 )
/
( 2001 25:338 , , 1998; 17:211 )
Case reports: 79 year old black woman with HSIL on pap test (
Archives 2004;128:485 ), with carcinosarcoma ( Int J Gynecol Pathol 2002;21:186
) : 79 (
), (
)
Treatment: hysterectomy; cone biopsies may not completely excise
these lesions : ;

Gross: usually no mass identified; may have vague nodular distortion
: ;

Gross images: small polypoid lesion (arrow) :
, 2002; 21:186
()
Micro: basaloid islands of small cells with peripheral nuclear
palisading (similar to basal cell carcinoma) and microcyst formation,
occasional central squamous or glandular differentiation or acinar
arrangement; ulcerated infiltrating growth pattern; cells are uniform,
round/oval with scant cytoplasm and hyperchromatic nuclei; no
stromal reaction; associated with SIL (usually HSIL) :

( )
,
;
; , /
,
; ( )
-
Micro images: tumor lower right corner, also HSIL ; topmicrocysts with peripheral palisading and squamous
differentiation of small basaloid cells with scant
cytoplasm and hyperchromatic nuclei, bottom-true
lumina may be present ; top-CK17+, bottom-CK18+ ;
figure 1: nests of basaloid cells with overlying HSIL;
2: central squamous differentiation with microcysts,
plus nests of small basaloid cells with scant
cytoplasm and hyperchromatic nuclei ; various
images (figures 1-4) ; nests of basaloid cells
infiltrating the stroma ; squamous differentiation and
microcyst formation ; squamous differentiation
: , ;

, -
; 17 + 18 + ; 1:
, 2:
,

; (
1-4) ;
;
;
Negative stains: CK7 : 7
Molecular: usually HPV16+ ( Int J Gynecol Pathol 1997;16:301 )
: 16 + ( 1997; 16:301 )
EM: cribriform patterns with gland-like structures covered by basal
lamina; cells have scant cytoplasm, irregular nuclei; no myoepithelial
features ( Med Electron Microsc 2000;33:241 ) :
;
, ,
( , 2000; 33:241 )
DD: adenoid cystic carcinoma (larger tumors, extensively involves
surface, has glands with cylindromatous pattern, usually type IV
collagen+ and laminin+), small cell carcinoma, carcinoid tumor,
basaloid squamous cell carcinoma (larger neoplastic cells with
nuclear pleomorphism, central comedonecrosis, CK7+, Pathol Int
2005;55:445 ), pseudoepitheliomatous hyperplasia (nests are connected
with or close to surface, usually associated inflammation) :
( ,
, ,
+ +) ,
, (
,
, 7 + , 2005 55:445 ),
(
, )
References: AJSP 1980;4:235 , Hum Path 2000;31:740 :
1980; 4:235 , 2000; 31:740
Adenoid cystic carcinoma of cervix

top
Uncommon (1% of primary cervical adenocarcinomas), occurs in
elderly, black women with multiple pregnancies (1%
),
,
Rarely occurs in women under 40 years ( Gynecol Oncol 1989;32:26 )
40 ( , 1989; 32:26
)
Poor prognosis due to frequent local recurrences and distant
metastases

May be epithelial component of carcinosarcoma ( AJSP 2001;25:338 , Eur
( 2001; 25:338 , , 2000; 21:292 )
Case reports: 83 year old white woman with cervical mass ( Archives
2004;128:817 ) : 83
( 2004; 128:817 )
Treatment: radiotherapy and chemotherapy in elderly, surgery
: ,
Gross: irregular, polypoid, friable cervical mass : ,
,
Gross images: contributed by Dr. Ihab Hosny, Ohio - image
#1 ; #2 : , # 1 ; # 2
Micro: nests of cells in cribriform pattern with eosinophilic / hyaline
cores, resembling adenoid cystic carcinoma of salivary glands but
without myoepithelial cells; may resemble adenoid basal carcinoma
but has more nuclear atypia, expansile growth pattern, distinct
stromal reaction and necrosis; mitotic figures, angiolymphatic invasion
and hyalinized stroma are common; may have focal solid growth or
squamoid pattern :
/ ,
, ;
, ,
, ;
,

Micro images: cribriform architecture and basement

membrane material #1 ; #2 ; #3 ; figure 1: friable and
ulcerated cervical mass, 2: cribriform islands of

basaloid cells with peripheral palisading, high N/C
ratio and scant mitotic activity; 3: focal solid pattern;
4: infiltrating cords of cells within basement
membrane-like material :
# 1 , #
2 ; # 3 , 1:
, 2:
, /
; 3:
, 4:

contributed by Dr. Ihab Hosny, Ohio : image #1 ; #2 ; #3 ; #4 ;
#5 ; #6 ; vascular invasion ; actin #1 ; #2 ; CEA #1 ; #2 ;
EMA ; high molecular weight keratin #1 ; #2 ; S100
, : # 1 , # 2 ; # 3 , # 4 ,
# 5 , # 6 , ; # 1 , # 2 ; ,
# 1 , # 2 ; ; #
1 , # 2 ; 100
other sites: esophagus ; salivary gland-various images
as part of case history : ;
-

-
Positive stains: keratin, type IV collagen, laminin (extracellular
basement membrane), HHF45, focal CEA and EMA
: , , (
), 45,
Negative stains: usually S100 and actin :
100
Molecular: HPV16+ ( J Clin Pathol 1996;49:805 ) : 16
+ ( 1996; 49:805 )
EM: redundant basal lamina forming pseudocysts, intercellular
spaces, and occasional true lumens with microvilli ( AJCP 1982;77:494 )
: ,
,
( 1982; 77:494 )
DD: adenoid basal carcinoma (no intraluminal hyaline material,
smaller and less pleomorphic nuclei, usually no type IV collagen or
laminin, AJSP 1999;23:448 ) : (
,
, , 1999; 23:448 )
References: AJSP 1988;12:134 , Int J Gynecol Pathol 1992;11:2 (solid variant)
: 1988; 12:134 , , 1992; 11:2 (
)
Adenosquamous carcinoma of cervix

top
May arise from subcolumnar reserve cells in basal layer of endocervix

More common during pregnancy

Same prognosis as other cervical carcinomas when stratified by
grade and stage, but most cases are high grade

,
Most undifferentiated cervical carcinomas have ultrastructural
features of squamous or glandular differentiation

Case reports: with vaginal and endometrial extension ( Int J Gynecol
Cancer 2004;14:625 ), myometrial recurrence during pregnancy ( Gynecol
Oncol 2000;76:409 ), metastasis to port site ( Gynecol Oncol 1999;74:130 )
: (
, 2004; 14:625 ), (
, 2000 76:409 ), ( ,
1999; 74:130 )
Micro: usually defined as biphasic pattern of well defined malignant
glandular and squamous components clearly identifiable without
special stains; glandular component usually endocervical and poorly
differentiated with cytoplasmic vacuoles or luminal mucin; squamous
component also is poorly differentiated; if endometrioid call
endometrioid carcinoma with squamous differentiation :

;

;
,

-
Micro images: various images ; poorly formed glands
and squamous components #1 (arrows) ; #2 ; #3
: ;
# 1 () ; # 2 ; # 3
Positive stains: p63 (squamous component), CK7
: 63 ( ), 7
EM: glandular features include mucous secretory vacuoles, true
lumen formation and scattered glycogen; also tonofilaments and
secretory products :
,
,
DD: squamous cell carcinoma with focal mucin droplets, adenoid
basal carcinoma ( Pathol Int 2005;55:445 ), extension of endometrial
adenocarcinoma (bulk of tumor is in endometrium), adenocarcinoma
with coexisting SIL (usually no mixing of tumor elements) :
,
( 2005 55:445 ),
(
), (
)
Basaloid squamous cell carcinoma of cervix

top
Aggressive behavior
Micro: squamous cell carcinoma with well defined nests of small,
oval-shaped basaloid cells with scant cytoplasm; prominent peripheral
palisading, infiltrative growth, minimal stromal reaction; resembles
tumors of same name at other sites ( Adv Anat Pathol 2002;9:290 ); often
necrosis or focal keratinization but no keratin pearls :
,
;
, ,

( , 2002; 9:290 ) ,

Micro images: oral cavity ; skin :
;
DD: adenoid basal carcinoma, adenoid cystic carcinoma :

,
Carcinoid tumor of cervix
top
Rare; very aggressive with 3 year survival of 12-33% ( World J Surg
2005;29:92 ) , 3 12-33% (
2005; 29:92 )
Neuroendocrine tumors of cervix are classified as carcinoid, atypical
carcinoid and neuroendocrine carcinoma (small cell or large cell)

,
( )
Survival may be similar between carcinoid tumors (classic and
atypical) and neuroendocrine carcinoma ( J Exp Clin Cancer Res
2001;20:327 )
( ) (
2001; 20:327 )
Case reports: with local spread and liver metastases ( Arch Anat Cytol
Pathol 1989;37:88 ), with brain metastases ( Gynecol Oncol 1988;30:114 ),
associated with microinvasive adenocarcinoma ( Acta Pathol Jpn
1987;37:1183 ) : (
, 1989; 37:88 ), (
, 1988; 30:114 ), (
1987; 37:1183 )
Micro: resembles carcinoid tumors elsewhere :

Micro images: ribbons of tumor cells ; glandular features
; cords and glands of tumor cells :
; ;

other sites - kidney ; small intestine ;
Positive stains: neuroendocrine stains show intracytoplasmic
endocrine granules; may also represent adenocarcinoma with
carcinoid features :
;

EM: secretory granules :
Atypical carcinoid of cervix
top
Carcinoid tumor with cytologic atypia and increased mitotic activity

Case reports: 46 year old woman with atypical carcinoid and

carcinoid syndrome ( J Clin Endocrinol Metab 1999;84:4209 ) : 46

( 1999; 84:4209 )
Micro images: various images and stains ; atypical
carcinoid tumor ; chromogranin+ atypical carcinoid
tumor : ;
; +

DD: adenocarcinoma :
Clear cell carcinoma (adenocarcinoma) of cervix

()
top
Formerly called (incorrectly) mesonephric carcinoma of cervix actually of mullerian origin ( Cancer 1978;42:2435 )
() -
( , 1978; 42:2435 )
4% of cervical adenocarcinomas; less common in cervix than ovary
and endometrium 4% ,

Most common form of cervical carcinoma in young women

Associated with in utero DES exposure (women born in 1950's, N Engl
J Med 1987;316:514 ); also older women without DES exposure; rare in
children - (
1950, 1987; 316:514 ),
;
Good survival - 55% at 5 years and 40% at 10 years
- 55% 5 40% 10
Case reports: with squamous cell carcinoma ( Gynecol Oncol 2005;97:976
), associated with GU malformation ( Obstet Gynecol 2000;96:834 )
: ( , 2005 97:976
), ( 2000; 96:834 )
Treatment: radical hysterectomy and pelvic lymphadenectomy;
trachelectomy to preserve fertility ( Gynecol Oncol 2005;97:296 ) :
;
( , 2005; 97:296 )
Gross: involvement of ectocervix (if DES exposure) or endocervical
canal (no DES exposure); may resemble cervical polyp :
( )
( );
Micro: tubulocystic, solid, papillary or microcystic patterns of cells
with abundant clear or eosinophilic cytoplasm, large irregular nuclei;
hobnailing of cells (nuclei protrude into lumina); intraglandular
papillary projections; in situ changes at squamocolumnar junction;
may have hyalinized stroma or papillary cores, may have eosinophilic
material within tubules or cysts : , ,

, ;
( );
,
;
,

-
Micro images: various images ; clear cell carcinoma #1 ;
#2 ; #3 ; tubulocystic pattern ; approaching
mesonephric remnants ; vaginal tumor :
; # 1 , # 2 ; # 3 ,
;
;
EM: continuous lamina densa, numerous mitochondria and rough
endoplasmic reticulum, abundant glycogen and blunt microvilli; also
vesicular aggregates in nucleoplasm, perinuclear cytoplasm or
between membranes of nuclear envelope ( Acta Cytol 1976;20:262 ) :

,
,
, ,

( 1976; 20:262 )
EM images: clear cell carcinoma :
DD: microglandular hyperplasia (polypoid, focal or no atypia, usually

also squamous metaplasia), mesonephric hyperplasia (no significant
atypia, glands are deep in cervix), Arias-Stella reaction (history of
pregnancy or birth control pills, no infiltration, atypia is focal, no
mitotic figures), squamous cell carcinoma (no areas resembling clear
cell carcinoma although cells may have cytoplasmic clearing due to
glycogen), metastatic renal cell carcinoma (rare, history important),
yolk sac tumor (rare, children), alveolar soft parts sarcoma (rare) :
(,
, ),
( ,
), -(
, , ,
), (
,
),
(, ), (, ),
()
References: Centers for Disease Control :


top
Second most common type of cervical adenocarcinoma after
endocervical type

Incidence rates may be increasing ( Cancer 2000;89:1291 )
( , 2000; 89:1291 )
May be associated with synchronous (existing at same time) or
metachronous (existing at different time) ovarian tumor
( )
( )
Micro: resembles tumor in uterine corpus and ovary; often well

differentiated; complex branching of glands lined by pseudostratified
cells with scant cytoplasm and no mucin vacuoles present on H&E;
crowded and stratified nuclei; often accompanied by adenocarcinoma
in situ : ,
;

&; ,

Micro images: branching glands whose cells lack
mucin ; stratified epithelium, cells have scant granular
cytoplasm and no mucin #1 ; #2 ; uterus, not necessarily
cervix - endometrioid adenocarcinoma #1 ; #2 ; #3
(invasive patterns ) :
; ,
#
1 , # 2 , , # 1 , # 2 ; # 3
( )
Positive stains: HPV, CEA (usually, Hum Path 1996;27:172 )
: , (, 1996; 27:172 )
Negative stains: vimentin (usually) :
()
DD: primary endometrial adenocarcinoma spreading into cervix
(endometrial hyperplasia present, no adenocarcinoma in situ in
cervix, no involvement of endocervical stroma, vimentin+, ER+, PR+,
CEA-, HPV-, AJSP 2003;27:1080 ), endocervical type adenocarcinoma
with minimal intracellular mucin :
(
,
, , +
+, +, -, , 2003 27:1080 ),

References: minimal deviation endometrioid adenocarcinoma AJSP 1993;17:660 and Histopathology 1992;20:351 :
-
1993; 17:660 1992; 20:351

Epithelioid trophoblastic tumor of cervix

top
Rare tumor (100 cases reported) in women of reproductive age with
abnormal vaginal bleeding (100 )

Associated with a gestational event, mean 6 years prior
, 6
Usually elevated serum hCG -
In uterine fundus, lower uterine segment or endocervix
,
Neoplastic counterpart to placental site nodule, with malignant
intermediate trophoblast ,

Metastases in 25%, death in 10%; similar behavior as placental site
trophoblastic tumor; less aggressive than choriocarcinoma
25%, 10%;
;
Case reports: 36 year old with clinical squamous cell carcinoma of
cervix and high beta hCG ( Gynecol Oncol 2002;87:219 ), 53 year old
woman with gestational event 25 years prior ( Int J Gynecol Cancer
2003;13:551 ) : 36
- ( , 2002;
87:219 ), 53 25
( , 2003; 13:551 )
Gross images: expansile mass with fleshy cut surface
:
Micro: resembles placental site trophoblastic tumor; invasive nodules

of monomorphic intermediate-sized intermediate trophoblast cells with
abundant eosinophilic or clear cytoplasm, medium/large irregular
nuclei with distinct nucleoli; occasional multinucleated cells; tumor

cells surround extensive necrosis and hyaline-like matrix; 2+ mitotic
figures/10 HPF; at periphery, tumors infiltrate normal tissue in small
round nests or cords, including focal replacement of surface or
glandular epithelium with stratified neoplastic cells; often decidualized
stroma nearby; usually no definite SIL :
;

, /
;
;
, 2 + /10 ;
,
,

, ;

Micro images: various images ; uterine tumor with
coexisting choriocarcinoma : ;
Positive stains: MIB-1 (18%), AE1/AE3, CK18, HLA-G, EMA, Ecadherin, p63, inhibin-alpha ( Int J Gynecol Pathol 1999;18:144 ), focal HPL,
focal hCG : -1 (18%), 1/3, 18, -
-, 63, - ( , 1999;
18:144 ), , Negative stains: PLAP, MEL-CAM : ,
DD: placental site trophoblastic tumor (larger cells, more nuclear
pleomorphism, infiltrative pattern), invasive squamous cell carcinoma,
lymphoepithelioma-like carcinoma with hCG production ( Int J Gynecol
Pathol 2000;19:179 ) : (
, ,
), ,
(
, 2000; 19:179 )
References: AJSP 1998;22:1393 , Mod Path 2006;19:75 ) :
1998; 22:1393 , 2006; 19:75 )
Glassy cell carcinoma of cervix

top
Distinct type of poorly differentiated adenosquamous carcinoma

1-2% of cervical carcinomas 1-2%

Younger age group (mean 41 years), associated with pregnancy,
HPV 18 and 16 ( 41 ),
, - 18 16
Historically considered more aggressive with poorer prognosis than
ordinary adenosquamous carcinoma or adenocarcinoma ( APMIS Suppl
1991;23:119 ), although recent studies show less or no difference ( Am J
Obstet Gynecol 2004;190:67 , Gynecol Oncol 2002;85:274 )

( , 1991;
23:119 ), (
)
May have peripheral blood eosinophilia

Cytokeratin expression is similar to that of reserve cells or immature
squamous cells of cervix ( Int J Gynecol Pathol 2002;21:134 )

( , 2002; 21:134 )
Poor prognostic factors: angiolymphatic invasion, deep stromal
invasion, large tumor size :
, ,

Treatment: radical hysterectomy and adjuvant radiation :

Case reports: 33 year old woman ; combined with signet ring
cell carcinoma ( Pathol Int 2004;54:787 ) : 33
; (
2004; 54:787 )
Gross: exophytic mass or barrel shaped cervix :

Gross images: bulky exophytic mass :
end_of_the_skype_highlighting:67 , , 2002; 85:274

Micro: solid nests of markedly pleomorphic, polygonal tumor cells
with prominent cell membrane, glassy and eosinophilic cytoplasm,
large eosinophilic nuclei, prominent nucleoli, surrounded by heavy
inflammatory infiltrate containing eosinophils; frequent mitotic figures;
pure cases have no histologic evidence of glandular or squamous
differentiation (ie no intracellular bridges, no dyskeratosis, no
intracellular glycogen), which is detectable only by EM; often less
invasion than is suspected :
,
, ,
, ,
;
;
(.
, , ),
,

-
Micro images: various images ; sheets of cells with
abundant lightly stained cytoplasm ; cells have
distinct cell border and prominent nucleoli ; nests of
glassy cells separated by eosinophil laden stroma ;
eosinophils infiltrating into nests ; focal glandular
differentiation : ;
;

;
;
;
Positive stains: PAS+ cell wall, vimentin, focal mucin, focal CEA
: + , ,
,
Negative stains: p63, HMB45, ER and PR (usually)

: 63, 45, ()
EM: glassy features may be due to cytoplasmic polyribosomes,
abundant tonofilaments and abundant dilated rough endoplasmic
reticulum ( AJCP 1991;96:520 ); adenosquamous features include well
developed desmosomal complexes and microvilli; occasional
intracellular lumina ( Cancer 1983;51:2255 ) :
,

( 1991; 96:520 )
;
( , 1983; 51:2255 )
DD: large cell nonkeratinizing squamous cell carcinoma (cell
membrane is less well defined, cytoplasm is less finely granular,
coarser chromatin distributed along nuclear membrane; also poor
staining or fixation makes it resemble glassy cell carcinoma) :

( ,
,
,
)
References: Archives 1982;106:250 : 1982; 106:250
Large cell neuroendocrine carcinoma of cervix

top
Rare (<1% of cervical carcinomas) (<1%
)
, 21 62
Presents with abnormal Pap smear or vaginal bleeding

Aggressive behavior, similar to lung counterpart, with early
metastases to regional lymph nodes and liver, lung, bone and brain (
Int J Gynecol Pathol 2003;22:226 ) ,

, , ( , 2003; 22:226 )
Median survival < 2 years <2
Case reports: Japanese woman with 3q amplification in tumor ( Hum
Path 2005;36:1096 ), with HSIL ( Pathology 1999;31:158 ), with small cell
component ( Gynecol Oncol 1998;68:69 ), presenting as
carcinomatous meningitis , with well differentiated
adenocarcinoma : 3
( 2005 36:1096 ), ( 1999, 31:158 ),
( , 1998; 68:69 ),
,

Micro: defined as moderate to severe nuclear atypia, neuroendocrine
differentiation with cells larger than typical small cell carcinoma;
insular, trabecular, glandular and solid growth patterns; usually
eosinophilic cytoplasmic granules, >10 MF/10 HPF and extensive
necrosis; angiolymphatic invasion; often with adjacent
adenocarcinoma in situ :
,
; ,
, ;
,> 10 /10
; ,

Micro images: trabecular pattern with mitotic activity ;
with adenocarcinoma in situ ; metastatic to bone
marrow ; keratin+ (MNF116) in paranuclear dot-like
pattern ; synaptophysin+ :
;
; ;
+ (116) ;
+
Positive stains: keratin (MNF116) in paranuclear dot-like pattern;
chromogranin or synaptophysin, vascular endothelial growth factor (
Int J Gynecol Cancer 2005;15:646 ), HepPar1 ( J Clin Pathol 2004;57:48 ), alpha
fetoprotein ( Acta Cytol 2003;47:799 ) :
(116) ;
, (
, 2005 15:646 ), 1 ( 2004; 57:48 ), (
2003; 47:799 )
Negative stains: HER2 (usually), ER and PR (usually)
: 2 (), ()
Molecular: HPV16 and HPV18 are usually present ( J Clin Pathol
2002;55:108 ) : 16 18 (
2002; 55:108 )
Molecular images: HPV16+ by ISH :
16 +
EM images: pseudorosette :
DD: atypical carcinoid tumor, poorly differentiated carcinoma :
,
References: AJSP 1997;21:905 : 1997; 21:905
Lymphoepithelioma-like carcinoma of cervix

top
Resembles nasopharyngeal counterpart
Usually younger patients than squamous cell carcinoma of cervix

Uncommon, usually EBV+ in Asian patients ( Cancer 1997;80:91 ); EBVin non-Asian patients ( Archives 2002;126:1501 ) ,
+ ( , 1997; 80:91 ) - -
( 2002; 126:1501 )
Usually low stage at diagnosis; better outcome than usual squamous
cell carcinoma of cervix ;

Case reports: 21 year old black woman, EBV- ( AJCP 1993;99:195 ), 44

year old white woman in Netherlands, EBV- but HPV+ ( Gynecol Oncol
2005;97:716 ), EBV- but HPV+ cases ( Hum Path 2001;32:135 ), positive for
beta-hCG ( Int J Gynecol Pathol 2000;19:179 ) : 21
, -( 1993 99:195 ), 44
, - - + ( , 2005 97:716 ), -
+ ( 2001 32:135 ), (
, 2000; 19:179 )
Gross: usually exophytic :

Micro: syncytium of large tumor cells with eosinophilic cytoplasm,
vesicular nuclei, prominent nucleoli; prominent lymphoplasmacytic
infiltration with T lymphocytes; pushing margins; no glandular or
, ,
;
; ,
-
Micro images: syncytial pattern of cells with prominent
nucleoli, atypical mitotic figure ; H&E and stains ;
CD45+ infiltrating lymphocytes :

, ; &
; 45 +
vagina - well circumscribed tumor ; large epithelioid
cells with prominent nucleoli in inflammatory
background - ;

bladder - image#1 ; #2 ; AE1-AE3 positive -
# 1 , # 2 ; 1-3
lung - various images -
Positive stains: AE1-AE3, EMA, HPV, p63, p53, MIB-1; variable
beta-hCG, focal HER2 : 1-3, , -,
63, 53, -1; , 2
Negative stains: lymphoid markers (stain infiltrating lymphocytes
only), bcl2, ER, PR : (
), 2, ,
Molecular: may have EBV false positives due to EBV+ lymphocytes (
Neoplasma 2003;50:8 ); HPV negative, SV40 negative :
+ ( 2003;
50:8 ) , 40
DD: glassy cell carcinoma with lymphocytic infiltrate, poorly
differentiated squamous cell carcinoma :
,

1985 9:883 , 2000; 124:746
Mesonephric adenocarcinoma of cervix

top
Arise from remnants of mesonephric (Wolffian) ducts, which form
epididymis and vas deferens in males and persist in females as rete
ovarii, paraoophoron and Gartner's duct
() ,
,

, 35 72
Usually presents with abnormal vaginal bleeding, stage IB disease;

some are higher stage and aggressive
, ,

Adjacent to areas of mesonephric hyperplasia

Appears to arise from lower zone of Wolffian system, in contrast to
female adnexal tumors of probable Wolffian origin (upper zone)
" " ,
( )
Immunophenotype resembles mesonephric remnants of cervix and
vagina (EMA+, CK7+, ER-, PR-, AJSP 2001;25:379 )
( +
7 + --, 2001; 25:379 )
May have better prognosis than mullerian counterparts ( AJSP
2004;28:601 ) (
2004; 28:601 )
Case reports: 47 year old woman with pelvic pain ( Archives
2004;128:1179 ), 18 month old girl ( Int J Gynaecol Obstet 1988;26:137 ), 55
year old with postmenopausal bleeding : 47
( 2004 128
begin_of_the_skype_highlighting 2004 128 end_of_the_skype_highlighting:1179 ), 18
( 1988; 26:137 ), 55

Gross: often along lateral cervix within fibromuscular stroma :

Micro: small tubules or ducts (most common), also retiform, solid,
sex-cord like and spindled; glands may be endometrioid; may have
eosinophilic secretions seen in mesonephric rests; often lined by
cuboidal or low columnar cells with malignant nuclei but no
intracytoplasmic mucin; mild to moderate nuclear atypia; usually
adjacent hyperplastic mesonephric remnants; surface epithelium is
not involved; desmoplastic stroma is not prominent :
(), , , ; ;
,

, ;
;
; ;

Micro images: figure 1: 3 cm polypoid mass; 2:
prominent tubule formation; 3: stroma shows minimal

desmoplasia; 4: CD10+ : 1: 3 ,
, 2: ,
3: , 4:
10 +
Positive stains: AE1/AE3, CAM5.2, CK1, CK7, EMA (100%),
calretinin (88%), vimentin (70%), CD10 ( AJSP 2003;27:178 ), androgen
receptor (33%), inhibin (30%, focal), Ki-67 (15%) :
1/3, 5.2, 1, 7, (100%), (88%),
(70%), 10 ( 2003 27:178 ),
(33%), (30%, ), -67 (15%)
Negative stains: CK20, ER, PR, CEA : 20, ,
, ,
DD: :
mesonephric hyperplasia - usually incidental finding with lobular and
noninfiltrative patterns, minimal atypia, minimal mitotic activity, no
solid/ductal patterns, no angiolymphatic invasion, no necrotic luminal
debris -
, ,
, / ,
,
endometrioid adenocarcinoma - usually high grade, involves surface
epithelium and deep cervical stroma, no mesonephric hyperplasia,
ER+, PR+, CEA+, vimentin- ,
, , +,
+, + malignant mixed mullerian tumor - high grade atypia, distinct
demarcation between glandular and stromal components
- ,

clear cell carcinoma of mullerian origin - often associated with DES
exposure; tubulocytic or papillary pattern with clear and hobnail cells
-
;

References: AJSP 1995;19:1158 : 1995; 19:1158
Metastases to cervix
top
Extragenital tumors more commonly metastasize to ovary and vagina
than cervix

Usually from ovary, breast, colon ( Archives 2003;127:1586 ), stomach,
kidney; evidence of widespread disease is usually present
, , ( 2003; 127:1586 ), ,
,
Direct extension from endometrial primary tumor is also common
(particularly poorly differentiated adenocarcinoma)

( )
Often involves cervical stroma and NOT surface epithelium or
endocervical glands

Rarely due to metastatic mucinous carcinoma of appendix

Case reports: 19 year old girl with renal cell carcinoma metastasis (
Gynecol Oncol 2005;99:232 ), gastric carcinoma ( Int J Gynecol Cancer
2003;13:555 ), breast carcinoma patients on tamoxifen ( Eur J Gynaecol
Oncol 1999;20:416 , Eur J Obstet Gynecol Reprod Biol 1999;83:57 ), signet ring
breast metastases ( Gynecol Oncol 1998;71:461 ) : 19 ( ,
2005 99:232 ), ( , 2003; 13:555 ),
( 1999; 20: 416 ,
1999; 83:57 ), (
, 1998; 71:461 )
Micro: usually no in situ component; extensive angiolymphatic
invasion is present, even in small and superficial lesions :
;
,
-
Micro images: breast carcinoma metastatic to cervix
(AFIP) :
()
contributed by Dr. Mowafak Hamodat, Eastern Health of
Newfoundland and Labrador, St. John's, Canada - #1 ; #2 ; #3 ;
#4 ; ER ; PR ; GCDFP-15 ,
,
, - # 1 , # 2 ; # 3 , # 4 , , , -15
Minimal deviation adenocarcinoma of cervix

top
Also called adenoma malignum
1% of endocervical adenocarcinomas 1%
Usually sporadic, but also associated with Peutz-Jeghers syndrome

(rare, autosomal dominant disorder of hamartomatous polyposis in GI
tract, mucocutaneous pigmentation and predisposition to benign and
malignant GI, breast, ovary, cervix and testicular tumors; due to
STK11 gene) , (,
,
, , ,
; 11 )
Usually HPV negative ( Mod Path 1998;11:11 , Mod Path 2005;18:528 , Int J
Gynecol Pathol 2005;24:296 ) ( 1998
11:11 , 2005 18:528 , , 2005; 24:296 )
Often missed by small cervical biopsies; lack of diagnostic consensus
between pathologists ( Pathol Int 2003;53:440 )
,
( 2003; 53:440 )
May be identified during endometrial ablation ( J Am Assoc Gynecol
Laparosc 2003;10:119 )
( , 2003; 10:119 )
Ages 34 to 42 years in one study 34 42
May have worse prognosis due to difficulty of diagnosis / discovery at

higher stage with nodal involvement ,
/
Case reports: patient with Peutz-Jeghers syndrome ( Gynecol Oncol

2004;92:337 ), with cystic lesions >10 cm causing bladder obstruction (
Gynecol Oncol 2002;84:339 ) : -
( , 2004 92:337 ), > 10 ,
( , 2002; 84:339 )
Gross: barrel-shaped cervix (diffusely enlarged) :
( )
Micro: very well differentiated glands (usually endocervical-type) with
cystic dilation; glands are variable in shape or size with irregular or
claw-shaped outlines; malignant due to distorted glands with irregular
outlines deep in cervix, focal stromal response; 50% have small foci
with a moderate/poorly differentiated focus; often has cilia or apical

snouts; often has mitotic figures; often glands are close to thickwalled vessels (within thickness of vessel wall, Int J Gynecol Pathol
2005;24:125 ); may have vascular or perineural invasion; rarely has
endometrioid histology :
( -) ;

;
,
, 50% /
, ,
,
( , ,
2005; 24:125 ) ;

-
Micro images: endocervical type ; malignant cells
merging with normal endocervical cells ; nonspecific
type #1 ; #2 ; endometrioid-type glands deep in cervix
#1 ; #2 ; #3 ; various images :
;
;
# 1 , # 2 ;
# 1 , # 2 ; # 3 ;

Positive stains: PAS-Alcian blue 2.5 (red/neutral mucin), HIK1073
(GI phenotype, 75%, Mod Path 2004;17:962 ), periglandular smooth
muscle actin+ stroma ( Histopathology 2005;46:130 ), CEA (variable)
: - 2.5 ( /
), 1073 ( , 75%, 2004 17:962 ),
+ (
2005 46:130 ), ()
Negative stains: high iron diamine-Alcian blue 2.5 (acid mucin), p53,
CD10, calretinin : -
2.5 ( ), 53, 10,
Molecular: often mutations in STK11 gene ( Lab Invest 2003;83:35 )
: 11 ( 2003; 83:35 )
EM: may have gastric phenotypes ( Ultrastruct Pathol 1999;23:375 ) :
( , 1999; 23:375 )
DD: adenofibroma (may extend throughout cervix and into upper
vagina wall; has dense periglandular fibrosis, Int J Gynecol Cancer
1995;5:236 ), diffuse laminar endocervical glandular hyperplasia ( AJSP
1991;15:1123 ), endocervical type adenomyoma ( APMIS 2001;109:546 ),
endocervicosis (outer cervix and paracervical connective tissue,
presence of uninvolved zone of cervical wall between endocervicosis
and normal endocervical glands, Int J Gynecol Pathol 2000;19:322 ),
endosalpingiosis (rarely presents as a mass, AJSP 1999;23:166 ), florid
deep glands (bland inactive appearing cells), lobular endocervical
glandular hyperplasia (noninvasive proliferation of endocervical
glandular cells in lobular arrangement without any irregular stromal
infiltration, desmoplasia or focal malignant features, Pathol Int
2005;55:412 , AJSP 1999;23:886 ), microglandular hyperplasia (different
morphology; CEA negative), pseudoinfiltrative tubal metaplasia of the
endocervix associated with in utero DES exposure ( Int J Gynecol Pathol
), tunnel clusters (little variation in size, shape and depth of

glands) : (
; ,
, 1995 5:236 ),
( 1991; 15:1123 ),
( 2001 ; 109:546 ), (
,

, , 2000 19:322 ),
( , 1999 ; 23:166 ),
( ),
(

,
,
2005; 55:412 , 1999; 23:886 ),
( ; ),
( , 2005 24:391 ), (
, )
References: AJSP 1993;17:660 (early study) , : 1993; 17:660
2005;24:391
( ) , AJSP 2000;24:559 (mucin stains) , AJSP 1989;13:717 (analysis of 26

cases) , Mod Path 2000;13:261 2000 24:559 ( ) , 1989
13:717 ( 26 ) , 2000; 13:261
Mixed carcinoma of cervix

top
At least 10% of two components - adenosquamous carcinoma is
described above ; MMMT is described below 10%
- ;

Includes squamous, adenocarcinoma and urothelial carcinoma
,
References and case reports are listed separately under each
component

Serous papillary adenocarcinoma of cervix

top
Rare, resembles serous papillary carcinoma of ovary or endometrium
,
Metastasizes to pelvic and periaortic lymph nodes

Stage 1 tumors have similar outcome as other cervical
adenocarcinomas; aggressive behavior if supradiaphragmatic
metastases 1
;

In young women, may be focal component of conventional
adenocarcinoma; HPV positive ,
; -
In menopausal women, may be drop metastasis from endometrial or

upper genital tract tumor; HPV negative ,

; -
Case reports: familial tumors of cervix, ovary and peritoneum (
Gynecol Oncol 1998;70:289 ) :
, ( , 1998; 70:289 )
Gross: resembles endocervical adenocarcinoma :

Micro: papillary proliferation of pleomorphic epithelial cells with
complex papillary architecture on fibrovascular cores, exhibiting
epithelial stratification and tufting; cells have protruding apical
cytoplasm, moderate/severe nuclear atypia and nuclear
pleomorphism; frequent mitotic activity; papillary cores often have
intense inflammatory infiltrate; often mixed with another
adenocarcinoma, frequently low grade villoglandular; psammoma
bodies common :

, ;
, /
;
;
,
, ;

-
Micro images: H&E and p53 ; uterus, not necessarily cervix image : & 53 ; ,
-
Positive stains: CA-125 (75%), CEA (50%), p53 (40%)
: -125 (75%), , (50%), 53 (40%)
DD: extension / metastatic ovarian or uterine tumors : /

References: AJSP 1998;22:113 , Mod Path 1992;5:426 :
1998; 22:113 , 1992; 5:426
Small cell (neuroendocrine / undifferentiated)

carcinoma of cervix ( /
)
top
Rare (2-5% of invasive cervical carcinomas); clinically aggressive with
rapid metastases; frequently presents with parametrial invasion and
pelvic lymph node metastases (2-5%
), ;

Similar age as squamous cell carcinoma (mean 43 years, range 23 to
63 years) (
43 , 23 63 )
Associated with HPV-18 ( AJSP 1991;15:28 , Int J Gynecol Pathol 2004;23:366 );
occasionally associated with Cushing syndrome or symptoms of other
peptide hormones 18 ( 1991; 15:28 ,
, 2004; 23:366 ),

Coexisting SIL is rare; endocrine cell hyperplasia may be a precursor
lesion ;

5 year survival is 30-40%; relapse in 2/3 at median 8 months ( Gynecol

Oncol 2004;93:27 ), poor prognostic factors are smoking and high stage (
Cancer 2003;97:568 ), focal glandular differentiation does not affect
prognosis 5 30-40%; 2 / 3
8 ( , 2004 93:27 ),
( , 2003; 97:568 ),

Case reports: with syndrome of inappropriate antidiuretic syndrome (
Mod Path 1996;9:397 ), 27 year old woman ( AJCP 1992;97:516 ), cervical
polyp with rapid growth during pregnancy ( Gynecol Oncol 2001;81:117 ),
G-CSF producing tumor ( Diagn Cytopathol 2000;23:269 ) :
(
1996 9:397 ), 27 ( 1992 97:516 ),
( , 2001; 81:117 ),
( 2000; 23:269 )
Amphicrine carcinoma: small cell carcinoma combined with
squamous cell carcinoma or adenocarcinoma
:

Treatment: radical hysterectomy with bilateral lymphadenectomy,
radiation therapy and chemotherapy :
,

Gross: may be ulcerative and infiltrative; often barrel shaped cervix
: ,

Micro: loose aggregates of uniform small cells with indistinct cell
borders, scant cytoplasm, hyperchromatic nuclei with fine granular
chromatin, nuclear molding, indistinct nucleoli, extensive mitotic
activity, single cell necrosis; may form sheets with small acini
resembling rosettes; necrosis common; vascular invasion in 9%;
resembles counterpart in lung; patterns include insular (solid nests /
islands of cells with peripheral palisading and retraction of stroma),
perivascular and thick trabeculae with serpiginous (wavy) growth;
variable amyloid deposition; may have minor (<10%) component of
glandular or squamous differentiation; often no associated
inflammation :
, ,
, ,
, ,
;
; 9%,
; ( /
),

() ; ;
(<10 %)
,
well differentiated pattern : organoid arrangement with insular,
trabecular, glandular or spindle patterns
: ,

-
Micro images: sheets of small cells with scant
cytoplasm and hyperchromatic nuclei #1 ; #2 ; H&E

# 1 , # 2 ; &
Positive stains: note - small cell carcinoma is a morphologic
diagnosis regardless of stain results ; NSE (80%), chromogranin
(60%), synaptophysin (70%), serotonin, CEA, p16 ( AJSP 2004;28:901 ;
Hum Path 2003;34:778 ), S100, keratin (variable); CD56 is sensitive but
not specific ( Int J Gynecol Pathol 2005;24:113 ); variable TTF1
: -
, ; (80%),
(60%), (70%), , , 16
( 2004 28:901 ; 2003 34:778 ), 100, ();
56 , ( , 2005;
24:113 ) 1
Negative stains: CK20, Rb, p53, p63, CD117/c-kit ( Mod Path
2004;17:732 ) : 20, , 53, 63, 117/- (
2004; 17:732 )
Molecular: frequent loss of heterozygosity at 3p and 11p
: 3 11
EM: cells are tightly packed with close apposition of cell membranes;
dense core secretory granules :
;
DD: small cell squamous cell carcinoma (well defined nests similar to
large cell nonkeratinizing squamous cell carcinoma), carcinoid tumor,
metastatic carcinoma (lung or other sites) :
(
),
, ( )
References: AJSP 1988;12:684 , Mod Path 1991;4:586 , Int J Gynecol Cancer
2005;15:295 , Ann Diagn Pathol 2002;6:345 : 1988; 12:684 ,
1991; 4:586 , , 2005; 15:295 , 2002;
6:345
Spindle cell carcinoma of cervix

top
Also called sarcomatoid carcinoma
Similar to upper aerodigestive tract counterpart

, 29 76
Aggressive; tumors often recur and cause death ( Gynecol Oncol
2003;90:23 ) ; (
, 2003; 90:23 )
Case reports: death after stage I disease ( Eur J Gynaecol Oncol
2000;21:287 ), : (
2000; 21:287 ),
Micro: poorly differentiated squamous cell carcinoma with spindleshaped cells; often osteoclast-like giant cells :

,
Micro images: bladder #1 ; #2 : # 1 ; #
Positive stains: keratin, p63, vimentin; often HPV, smooth muscle

actin : , 63, , -,

DD: MMMT (spindle cell component is malignant) :
( )
Urothelial carcinoma of cervix

top
Also called transitional cell carcinoma
Rare; resembles counterpart in bladder ( AJSP 1995;19:1138 ) ;

( 1995; 19:1138 )
Often presents at advanced clinical stage

May represent subgroup of squamous cell carcinoma

Case reports: complicated by pyometra (pus in uterine cavity, Indian J
Pathol Microbiol 2004;47:71 ), mixed with adenocarcinoma ( Pathol Int
2004;54:63 , Int J Gynecol Pathol 2003;22:220 ) :
( , , 2004
47:71 ), ( 2004 54:63 ,
, 2003; 22:220 )
Micro: often exophytic, may have inverted pattern :
,
-
Micro images: renal pelvis ; bladder :
;
Positive stains: CK7 : 7
Molecular: often HPV16+ ( Gynecol Oncol 1999;74:361 , Cancer 1998;83:521 )
: 16 + ( , 1999; 74:361 , ,
1998; 83:521 )
DD: papillary lesions of cervix, inverted urothelial papilloma :
,
References: AJSP 1995;19:1138 : 1995; 19:1138
Verrucous carcinoma of cervix

top
Rare; diagnosis of exclusion ;
More common in vulva
Diagnosis is difficult with superficial biopsies

Invades locally (may extend into endometrial cavity), and up to 50%
recur, but metastases are unlikely (
), 50% ,

One paper claims that HPV+ cases are better classified as SIL, giant
condyloma or invasive squamous cell carcinoma ( Can J Surg 1993;36:147
) +
,
( 1993; 36:147 )
Case reports: tumors in cervix and vagina ( Gynecol Oncol 2003;90:478 ),

multiple small recurrent tumors 13 years later in retroperitoneal space
( Oncol Rep 2000;7:1079 ), 32 year old woman with endometrial
involvement, hysterectomy and brachytherapy ( Eur J Gynaecol Oncol
1999;20:35 ), with pelvic abscess and abdominal wall fistula ( Gynecol
Oncol 1999;74:115 ) : (
, 2003; 90:478 ), 13
( 2000 7:1079 ), 32
,
( 1999; 20:35 ),
( , 1999; 74:115 )
Treatment: usually hysterectomy; radiation may induce anaplastic
transformation : ;

Gross: large, warty lesion resembling condyloma; cut surface shows
sharply circumscribed deep margin : ,
;

Micro: well differentiated squamous cell carcinoma with a polypoid
growth pattern (but no fibrovascular cores) expanding the underlying
stroma instead of involving crypts; blunt pattern of invasion, with
minimal nuclear atypia at epithelial-stromal interface; may be
exophytic and endophytic; may have intense inflammatory infiltrate;
no/rare mitotic figures; no koilocytosis :

( )
; ,
-
; ;
, /
,
-
Micro images: various images ; squamous cells with
central keratinization but no fibrovascular cores ;
bland epithelium with at most mild atypia ; pushing
margin ; other sites - penis #1 ; #2 ; vulva :
;
;
; ;
- # 1 , # 2 ;
DD: condyloma accuminatum (more delicate architecture, distinct
fibrovascular cores), squamous cell carcinoma with papillary growth
pattern (usually has finger-like invasive tongues, marked nuclear
atypia), warty / condylomatous carcinoma (prominent cytoplasmic
halos around tumor cells) :
( , ),
(
, ),
/ (
)
Villoglandular papillary adenocarcinoma of cervix

top
Rare
Excellent prognosis only if pure; must examine carefully for squamous

differentiation or other growth patterns ( Eur J Obstet Gynecol Reprod Biol
1999;87:183 ); limit diagnosis to cases with minimal atypia and no other
types of carcinoma ;

( 1999; 87:183 )

Metastases reported only rarely
Often in women age 40 years or less 40

Case reports: recurrent tumor and metastases ( Tohoku J Exp Med
2004;202:305 ), with nodal metastases ( Gynecol Oncol 2004;92:64 )
: ( 2004 202
( , 2004; 92:64 )
Treatment: surgery (conservative to allow future pregnancy, Gynecol
Oncol 2006;101:168 , Gynecol Oncol 2001;81:310 ), chemotherapy :
( , ,
2006; 101:168 , , 2001 81:310 ),
Gross: exophytic polypoid lesion :
Micro: very well differentiated papillary adenocarcinoma; surface

papillae with complex branching lined by endocervical, endometrial or
intestinal type epithelium with mild to moderate atypia; may resemble
villous adenoma of colon; mean 43 mitotic figures/10 HPF, often
angiolymphatic invasion; no desmoplasia; usually associated with
adenocarcinoma in situ or SIL; may be deeply invasive and extend to
endometrium :
;
, ,
;
; 43 /10
, , ;
;

-
Micro images: tumor extends throughout most of
cervix ; papillary fibrovascular cores lined by mildly
atypical epithelium #1 ; #2 ; #3 ; adjacent area of higher
grade adenocarcinoma :
;

# 1 , # 2 ; # 3 ,

Positive stains: HPV : DD: implant from endometrial tumor ( Int J Gynecol Cancer 2002;12:308 ),
other papillary carcinomas (smaller and thinner papillae, form a more
complex lattice), hyperplastic and reactive glands (no invasion, cells
not cytologically malignant) :
( , 2002; 12:308 ),
( , ),
( ,
)
References: Cancer 1989;63:1773 , Mod Path 2000;13:261 :
1989; 63:1773 , 2000; 13:261
Warty (condylomatous) carcinoma of cervix

()
top
Very rare variant of invasive squamous cell carcinoma; more common
in vulva
,
May be less aggressive than well differentiated squamous carcinoma

Gross: often feathery and thin surface ( Pathol Res Pract 1998;194:713 )
: ( 1998;
194:713 )
Micro: striking condylomatous or warty appearance, although deep
margin is similar to classic squamous cell carcinoma; often
koilocytotic atypia :
,
,
-
Molecular : HPV+ (often different HPVs) : +
( )
Sarcoma/lymphoma/other / /
Adenosarcoma of cervix
top
Also called Mullerian adenosarcoma
More common in endometrium

Often in adolescents
Good prognosis if no myometrial invasion, bland histology and no
sarcomatous overgrowth ( Oncol Rep 1998;5:939 )
,
( 1998; 5:939 )
Median survival is 4 years; 40% recur 4
, 40%
Case reports: involving cervix, ovary and pelvic peritoneum ( Philipp J
Obstet Gynecol 1998;22:87 ), with heterologous elements ( Gynecol Oncol
2002;84:161 ), presenting as 6 cm cervical polyp ( Pathol Int 1998;48:649 ),
with ovarian sex cord-like differentiation ( Cancer 1986;57:1197 ),
rhabdomyomatous variant ( Int J Gynecol Pathol 1985;4:146 ), resembling
embryonal rhabdomyosarcoma ( Cancer 1976;37:1725 ) :
, (
. 1998 22:87 ), (
, 2002; 84:161 ), 6 ,
( 1998; 48:649 ) ,
( , 1986; 57:1197 ), (
, 1985 4:146 ),
( , 1976; 37:1725 )
Treatment: hysterectomy :
Gross: broad based or sessile polypoid mass :

Micro: biphasic; papillary stromal fronds lined by epithelium form leaflike processes that protrude into cysts and cleft-like spaces distributed
within the stroma, similar to breast phyllodes tumors; malignant
stroma resembles stromal sarcoma, or less often, has
rhabdomyoblasts or heterologous elements (bone, cartilage, skeletal
muscle, fat, occasionally smooth muscle); usually stroma has 2+
MF/10 HPF; periglandular accentuation or cuffing of stroma; may
have sex cord differentiation; glandular component may be
endocervical, ciliated, eosinophilic or endometrioid :
;

,
; , ,
(,
, , ,
); 2 + /10 ;
;
; ,
,
Micro images: phyllodes tumor-like pattern #1 ; #2 (more
cellular than adenofibroma) ; uterus, not necessarily cervix
- with dilated glands :
# 1 , # 2 (
) ; ,
Positive stains: muscle specific actin, desmin, ER
: , ,
EM: stromal cells resemble endometrial stromal cells :

With sarcomatous overgrowth
top
Rare aggressive variant
Case reports: 37 year old with clinical endocervical polyp ( Int J
Gynecol Cancer 2004;14:1024 ) : 37-
( , 2004; 14:1024 )
Micro: obvious high grade sarcoma in addition to low grade stroma
:
Aggressive angiomyxoma of cervix

top
First described in female pelvis in 1983 ( AJSP 1983;7:463 )
1983 ( 1983; 7:463 )
Very rarely reported in cervix
Usually large, bulky mass of deep soft tissue of pelvicoperineal region

of young adult women and men ,

High risk of local recurrence, but only rare metastases ( Hum Path
2003;34:1072 ) ,
( 2003; 34:1072 )
Gross: gelatinous, up to 60 x 20 cm, locally infiltrative :
, 60 20 ,
Micro: bland-appearing myofibroblastic tumor composed of scanty
spindled and stellate cells in loose stromal matrix with collagen fibrils,
prominent vasculature including thick walled vessels; may infiltrate
locally; no/rare mitotic figures, no atypia : -

,
; ; /
,
Micro images: not necessarily cervix - bland hypocellular
mesenchymal tumor #1 ; #2 ; #3 ; vulva :
-
# 1 , # 2 ; # 3 ;
Positive stains: vimentin, desmin, muscle-specific actin, smooth
muscle actin; variable CD13, factor XIIIa, ER and PR
: , , ,
; 13, ,
Negative stains: keratin, S100 : , 100
Molecular: rearrangement of HMGIC gene :

EM: myofibroblastic features :
DD: myxoma, myxoid liposarcoma, botyroid rhabdomyosarcoma,

myxoid MFH, nerve sheath myxoma : ,
, , ,

Alveolar soft parts sarcoma of cervix

top
Very rare
Usually ages 30 to 40 years 30 40
Associated with abnormal uterine bleeding

Patients often do well, but may die of metastatic disease
,
Case reports: 35 year old woman ( Archives 1989;113:1179 ), incidental
tumor in 39 year old woman ( Int J Gynecol Pathol 2005;24:131 ), 8 year old
girl ( Acta Pathol Jpn 1993;43:204 ) : 35 (
1989; 113:1179 ), 39 (
, 2005 24:131 ), 8 ( 1993; 43:204 )
Gross: solid, mean 4 cm (range 1-10 cm); irregular, circumscribed,
friable nodule : , 4 ( 1-10 ),
, ,
Micro: well circumscribed tumor with loss of central cohesion causing
a pseudoalveolar pattern; nests are separated by thin-walled,
sinusoidal vascular spaces; cells are large with distinct cell borders,
resembling gemistocytic astrocytes; contain PAS+ diastase resistant
intracytoplasmic crystals; small nuclei with prominent nucleoli :

;
, ;
,
; +
;
Micro images: nests of tumor cells with PAS+ crystals
#1 ; #2 : + # 1 ; # 2
Positive stains: neuron-specific enolase, S100, TFE3 (nuclear
staining); reticulin highlights alveolar pattern; also desmin, myoglobin,
HHF35 : - , 100,
3 ( );
, , , 35
Negative stains: GFAP, S100 (usually) : ,
100 ()
Molecular: t(X;17)(p11;q25) - TFE3-ASPL fusion transcript
: (, 17) (. 11; 25) - 3-
EM: rhomboid, rod-shaped or spicular crystals with a regular lattice

pattern and electron dense secretory granules; crystals consist of
filaments 6 nm in diameter, arranged in parallel arrays with periodicity
of 10 nm; basal lamina surrounds groups of tumor cells with
prominent mitochondria, glycogen and lipid : ,

;
6 ,
10 ,
,
DD: metastatic renal cell carcinoma, clear cell carcinoma (often
papillary or cystic with hobnail cells, cytoplasm is more clear, may
have focal PAS+ areas in cytoplasm, but diastase sensitive),
paraganglia (solid nests of neuroendocrine cells surrounded by
S100+ sustentacular cells; negative for muscle markers, no PAS+
diastase resistant crystals) :
, (
, , +
, ),
( 100 +
; , +
)
Ewing sarcoma / PNET of cervix /
top
Extremely rare, <20 cases reported , <20
May present as abnormal uterine bleeding

May have similar prognostic factors as other sites (5 year survival of
70% with chemotherapy), although limited number of cases
(5
70% ),

Case reports: presenting with abnormal uterine bleeding ( Archives
2001;125:1389 ), 21 year old woman ( Gynecol Oncol 2005;98:516 ), 36 year
old woman with necrotic and hemorrhagic mass ( Int J Gynecol Pathol
1998;17:83 ) :
), 21 (
), 36
( , 1998; 17:83 )
Treatment: surgery and chemotherapy :
Gross: may be necrotic and hemorrhagic :

Micro: diffuse sheets of small round cells with scant cytoplasm,
hyperchromatic and vesicular nuclei, indistinct nucleoli :
,
,
, 2005 98:516
-
Micro image: H&E ; not necessarily cervix - PAS+ glycogen ;
CD99+ : & , + ; 99 +
Positive stains: CD99, PAS, neuron-specific enolase
: 99, , -
Negative stains: keratin, CD45, chromogranin, synaptophysin
: , 45, ,
Molecular: t(11:22)(q24,q12) - EWS/FLI1 fusion transcript
: (11:22) (24, 12) - /1
EM: large glycogen pools in cytoplasm, few cytoplasmic organelles,

rare neurosecretory granules, no cell projections :
, ,
,
DD: neuroendocrine neoplasms, endometrial carcinoma, melanoma,
lymphoma, endometrial stromal sarcoma, metastatic carcinoma :
, , ,
, ,
Granulocytic sarcoma of cervix

top
Also called chloroma (due to green appearance)
( )
Soft tissue masses of AML blasts
Rare, must consider possibility of this diagnosis to arrive at correct
diagnosis ,

Usually presents with vaginal bleeding; rarely is initial manifestation of
AML ( Cancer 1977;40:3030 , J Obstet Gynaecol Res 1997;23:261 )
,
( , 1977; 40:3030 ,
, 1997; 23:261 )
Two year survival is 6% for all sites, no patients live 5 years
6% ,
5
Case reports: 33 year old woman with large cervical mass ( Gynecol
Oncol 2005;98:493 ); relapses in cervix - after bone marrow
transplantation ( Int J Gynecol Cancer 2004;14:553 ), after remission ( Acta
Cytol 1999;43:1124 ); in a child ( J Pediatr Hematol Oncol 1996;18:311 ),
relapse with abdominal tumor : 33
( , 2005; 98:493 )
-
( , 2004; 14:553 ), ( 1999,
43: 1124 ), ( 1996 18:311 ),

Micro: diffuse, cords or pseudoacinar growth patterns; often
sclerosis; composed of primitive myeloid blasts : ,
, ;

Micro images: various images (uterus, not necessarily
cervix ); H&E ; (a) left - alpha-1-antitrypsin+; (b) right chloroacetate esterase+ ; thoracic lesion-various
images : (,
); & ; () - -1-
+ () -
+ ; -
Positive stains: chloroacetate esterase, lysozyme, myeloperoxidase,
CD68, CD43, CD45 : ,
, , 68, 43, 45
EM images: P-early promyelocyte, L-late stage
granulocyte, MY-myofibroblast ; detail of
promyelocyte - A is primary or azurophilic granule;

other granules have irregular or partially extracted
contents : - -
, - ;
-
,

DD: diffuse large B cell lymphoma, inflammatory conditions :
,
References: AJSP 1997;21:1156 , Gynecol Oncol 1992;46:128 ; J Clin Pathol
1989;42:483 : 1997; 21:1156 , , 1992; 46:128 ;
1989; 42:483
Leiomyosarcoma of cervix
top
Rare; <100 cases reported; but most common primary sarcoma of
cervix ; <100 ,
May develop in cervical stump after subtotal hysterectomy ( Ginekol Pol

2002;73:613 )
( 2002; 73:613 )
To diagnose cervical primary, must exclude tumors of lower uterine
segment ,

Peri- and postmenopausal women ages 40 to 60 years -
40 60
Commonly presents with abnormal vaginal bleeding, abdominopelvic
pain and a palpable cervical mass
,

Poor prognosis ( Cancer 1973;31:1176 ) ( , 1973;
31:1176 )
Case reports: Case of the Week #92 , epithelioid tumors ( Gynecol Oncol
2005;97:957 , Gynecol Oncol 2003;91:636 ), with endometrial adenocarcinoma
and cervical squamous cell carcinoma ( Gynecol Oncol 2001;82:400 ),
xanthomatous tumor ( Int J Gynecol Pathol 1998;17:89 ), 10 kg tumor (
Gynecol Oncol 1998;69:169 ) : # 92 ,
( , 2005; 97:957 , , 2003 91:636 ),

( , 2001; 82:400 ),
( , 1998; 17:89 ), 10 , (
, 1998; 69:169 )
Gross: large (up to 12 cm), polypoid, soft, with irregular outline; may
thicken and expand cervical canal; often hemorrhage and necrosis
: ( 12 ), , ,
; ,

Gross images: tumor attached by short pedicle #1 ; #2sagittal section :
# 1 ; # 2
Micro: interlacing fascicles of smooth muscle cells with large,
atypical, hyperchromatic nuclei; 5+ mitotic figures/10 HPF; may have
osteoclast-like giant cells, epithelioid , myxoid or xanthomatous
features :
, , ; 5 +
/10 ; ,
,
-
Micro images: interlacing fascicles #1 ; #2 ; various
images ; large pleomorphic nuclei #1 ; #2 ; muscle
specific actin ; smooth muscle actin ; uterus-not
necessarily cervix - leiomyosarcoma #1 ; #2 ; #3 with
bizarre giant cells ; #4 :
# 1 , # 2 ; ;
# 1 , # 2 ;
; ;
- # 1 , # 2 ; # 3
; # 4
Positive stains: actin, desmin : ,
References: Diagn Pathol 2006;18:30 : 2006; 18:30
Lymphoma of cervix
top
Primaries are rare in cervix (<100 cases reported)
(<100 )
Mean age approximately 40 years; range 20's to 80's
40 ; 20 80-
Usually present with abnormal uterine or vaginal bleeding; may have
negative cervical smear or be reported as SIL
;

Most cases present with stage IE disease ( Am J Obstet Gynecol
2005;193:866 ) (
2005; 193:866 )
Usually diffuse large B cell lymphoma or follicular lymphoma ( Mod
Path 2000;13:19 )
( 2000;
13:19 )
5 year survival: 83% in low stage tumors, 29% in high stage tumors 5
: 83% , 29%

Should confirm with immunostains to rule out other unusual tumors
and to classify

Case reports: MALT lymphoma presenting as endocervical polyp (
Archives 2001;125:537 ), NK lymphoma #1 ( Archives 2000;124:1510 ); #2 with
relapse in cervix ( Leuk Lymphoma 2002;43:203 ), Burkitt's lymphoma with
HSIL ( Pathol Res Pract 2005;201:521 ), two patients with cervical CLL/SLL
and squamous cell carcinoma ( Gynecol Oncol 2004;92:974 ), relapse of TALL in cervix and uterine corpus ( Ann Diagn Pathol 2002;6:125 )
:
end_of_the_skype_highlighting:537 ), # 1 ( 2000 124
begin_of_the_skype_highlighting 2000 124 end_of_the_skype_highlighting:1510 ) # 2
( 2002 43:203 ),
( 2005 201
/
( , 2004 92:974 ), -
( 2002, 6 : 125 )
diffuse large B cell lymphoma - 3 patients requiring repeat biopsy
for diagnosis ( Eur J Gynaecol Oncol 2005;26:36 ); spindle cell variant ( Int J
Gynecol Pathol 2003;22:289 ), diffuse large B cell lymphoma and follicular
lymphoma at biopsy but HSIL by pap smear ( Gynecol Oncol 2005;98:484 )
- 3
( 2005; 26:36
) ( , 2003; 22:289 ),

( , 2005; 98:484
)
Gross: diffuse enlargement of cervix (barrel-shaped), or polypoid
mass with fish-flesh appearance; soft, gray-white :
( ), ; , -
Micro: tumor cells infiltrate stroma without destroying glandular or
squamous epithelium :

-
Micro images: diffuse large B cell lymphoma #1 ; #2 ; #3 ;
#4 ; #5 (CD20+); marginal zone lymphoma; high grade
MALT presenting as endocervical polyp ; NK
lymphoma :
# 1 , # 2 ; # 3 , # 4 , # 5 (20 +)
;
;
DD: lymphoid follicles of chronic cervicitis, infectious mononucleosis
or other reactive changes (polymorphic infiltrate with plasma cells and
neutrophils, Gynecol Oncol 2005;99:481 , Eur J Obstet Gynecol Reprod Biol
2001;97:235 ), granulocytic sarcoma (positive for myeloperoxidase,
lysozyme, CD68, negative for lymphocytic markers) :

,
(
, , 2005; 99:481 ,
2001 97:235 ), (
, , 68,
)
References: AJSP 2005;29:1512 (gynecologic lymphomas ) :
2005 29:1512 ( )
Malignant mixed Mullerian tumor (MMMT) of cervix

()
top
Also called malignant mixed mesodermal tumor or carcinosarcoma (if
homologous)
( )
Rare, < 100 reported cases, less common than leiomyosarcoma
, <100 ,
Most tumors of cervix are extensions from endometrium; may be

secondary to radiation therapy for cervical squamous cell carcinoma
;

50 65 , 12 93
Often confined to uterus at presentation, with better prognosis
,
Case reports: with adenoid cystic carcinoma component ( AJSP
1995;19:229 , Int J Gynecol Pathol 1998;17:91 , Eur J Gynaecol Oncol 2000;21:292 ),
with coexisting adenoid basal carcinoma ( Int J Gynecol Pathol 2002;21:186
), with neuroendocrine differentiation ( Int J Gynecol Cancer 2002;12:223 ),
with osteosarcomatous component ( J Obstet Gynaecol Res 2005;31:404 ),
initially interpreted as high grade sarcoma ( Hum Path 1988;19:605 ), after
subtotal hysterectomy ( Gynecol Oncol 1997;67:322 ), :
( 1995; 19:229 ,
, 1998; 17:91 , 2000; 21:292 ),
( ,
2002, 21 : 186 ), (
, 2002; 12:223 ), (
, 2005 31:404 ), (
1988; 19:605 ), ( ,
1997; 67:322 ), heterologous tumor arising in cervical stump due to
hysterectomy for benign disease ( Gynecol Oncol 1983;16:422 ), tumor in
12 year old girl ( Eur J Gynaecol Oncol 1988;9:365 )

( , 1983; 16:422 ), 12
( 1988; 9:365 )
Treatment: usually hysterectomy with or without radiation therapy or
chemotherapy ( Gynecol Oncol 2005;97:442 ) :
(
, 2005; 97:442 )
Gross: polypoid mass with variable necrosis :

Micro: may resemble uterine tumor; neoplastic epithelial and

mesenchymal components; usually accompanied by high grade
squamous intraepithelial lesion; invasive epithelial component may be
adenoid basal, adenoid cystic, basaloid squamous cell or keratinizing
squamous cell, but is usually NOT adenocarcinoma :
;
,
;
, ,
,

Sarcomatous component usually homologous resembling
fibrosarcoma or endometrial stromal sarcoma, often with prominent
myxoid change ( Int J Gynecol Pathol 1998;17:211 ); heterologous
component is usually rhabdomyosarcoma, present in 50%; also
chondrosarcoma, liposarcoma

, ( ,
1998; 17:211 )
, 50%, ,
-
Positive stains: both components - EMA, keratin, vimentin (most);
sarcomatous component - muscle specific actin or smooth muscle
actin, desmin : - , ,
(); -
,
Molecular: HPV DNA positive in 8/8 cases ( AJSP 2001;25:338 )
: 8 / 8 ( 2001;
25:338 )
DD: squamous cell carcinoma with sarcoma-like stroma :

Melanoma of cervix
top
Rare; <100 cases reported; more common in vulva and vagina ;
<100 ,
Usually presents with vaginal bleeding

Poor prognosis with historical 5 year survival of 40% with stage I
disease ( Gynecol Oncol 1989;32:375 , Zhonghua Fu Chan Ke Za Zhi
2005;40:183 ) 5
40% ( ,
1989; 32:375 , 2005; 40:183 )
Case reports: 39 year old woman with vaginal bleeding ( Indian J
Cancer 2005;42:201 ), 67 year old woman with vaginal bleeding (
Anticancer Res 2003;23:1063 ), 63 year old woman with S100 negative
tumor ( Int J Gynecol Pathol 1999;18:265 ), 33 year old Japanese woman
with clear cell variant ( Gynecol Oncol 2001;80:409 ), after radiation for
cervical squamous cell carcinoma ( Clin Oncol (R Coll Radiol) 2000;12:234 )
: 39 (
, 2005; 42:201 ), 67 (
2003; 23:1063 ), 63 100
( , 1999; 18:265 ), 33
( , 2001; 80:409 ),
(
( ) 2000; 12:234 )
Gross: gray-blue-black nodule : --
Gross images: melanoma of vagina with extension into
cervix :
Micro: often small cell and spindle cell variants; junctional activity
present in <50%, variable melanin pigment; stromal infiltration by
malignant cells. :
; <50%,
; .
-
Micro images: small cell variant (common in vagina) ;
epithelioid cells ; prominent junctional activity ;
vaginal melanoma extending into cervix ; various
images in advanced tumor :
( ) ;
; ;
;

Positive stains: S100, HMB45, vimentin, Ki-67 (high percentage)
: 100, 45, , -67 (
)
Negative stains: keratin, CD45, ER, PR :
, 45, ,
DD: metastatic melanoma (usually from vulva or vagina, no junctional
change in cervix) : (
, )
Other tumors of cervix (case reports)

()
top
PEComas: large study with 2 cases in cervix ( AJSP 2005;29:1558 ) :
2 ( 2005; 29:1558 )
Undifferentiated carcinoma: HPV+ stroma ( Hum Path 1999;30:483 )
: + ( 1999; 30:483 )
Plasmacytoma of cervix
top
Rare in cervix
Case reports: 38 year old woman ( Acta Obstet Gynecol Scand 1989;68:279
) : 38 ( , 1989; 68:279 )
-
Micro images: H&E and stains : &
DD: reactive plasmacytosis ( Geburtshilfe Frauenheilkd 1983;43:40 ) :

( 1983; 43:40 )
Rhabdomyosarcoma (embryonal) of cervix

()
top
Rhabdomyosarcomas are divided into embryonal, botyroid (subtype
of embryonal), alveolar or pleomorphic (anaplastic) subtypes
,
( ),
()
Embryonal type is most common; occurs in children; more common in
vagina than cervix ;
,
Cases in older women often contain cartilage and have better
prognosis

Case reports: embryonal rhabdomyosarcoma - pediatric
heterologous tumors in sisters ( Gynecol Oncol 2005;99:742 ), 19 year old
with tumor in cervical polyp ( Gynecol Oncol 2004;95:243 ), 13 year old girl
with anaplastic (pleomorphic) subtype ( Arch Gynecol Obstet 2004;270:278 ),
17 year old woman with botyroid subtype and recurrence after
excision and chemotherapy ( Acta Cytol ;43:475 ), 46 year old woman
with botyroid subtype ( Int J Gynecol Pathol 2004;23:78 ) :
-
( , 2005 99:742 ), 19
( , 2004 95:243 ), 13
() ( 2004 270

( ; 43:475 ), 46
( , 2004; 23:78 )
other types - 39 year old woman with alveolar rhabdomyosarcoma (
Gynecol Oncol 2003;91:623 ) - 39
( , 2003; 91:623 )
Treatment: minor surgery plus chemotherapy may be recommended
for stage I disease ( Eur J Pediatr 2004;163:452 , Br J Cancer 1999;80:403 )
: ,
( , 2004; 163:452 , ,
1999; 80:403 )
Gross: botyroid cases have protrusion of grape-like masses (due to
edema and myxoid stroma) from cervix into vagina; surface is
glistening and translucent :
( )
,
Gross images: embryonal rhabdomyosarcoma with gray
surface and hemorrhage ; bladder tumor with
polypoid masses :

;
Micro: botyroid - polypoid mass of rhabdomyoblasts at different
maturational stages covered by attenuated epithelium; resembles
vaginal tumor; often cambium layer beneath cervical epithelium in
botyroid cases; often loose myxoid stroma, surface ulceration; may
have cartilage in older women; variable mitotic rate :
-
;
,
, ,
; ,

In young children, tumor cells may lack marked atypia and may blend
in with normal, immature, cellular stroma ,

, ,
Micro images: embryonal rhabdomyosarcoma-various

images ; cambian layer and edematous stroma ;
edematous stroma ; cambian layer (vaginal botyroid
tumor) ; tadpole and strap cells ; cross striations
: -
; ;
; (
) ; ;
-
Positive stains: in young children, focal staining for desmin, musclespecific actin, smooth muscle actin, myoD1 and WT1, although not
specific ( Pediatr Dev Pathol 2005;8:427 ) :
, , ,
, 1 1, (
, , , 2005; 8:427 )
DD: yolk sac tumor, adenosarcoma (fibrous stroma so no grape-like
clusters, no edematous, leaf-like pattern resembling phyllodes tumor),
edematous mesodermal polyp (adult women, small, soft fleshy
protuberances up to 1.5 cm, stroma is uniform, no cambium layer, no
rhabdomyoblasts, may have widely scattered atypical stromal cells)
: , ( ,
, , -
),
( , , 1,5 ,
, , ,
)
References: : Radiographics 1997;17;919 1997;
17; 919
Stromal sarcoma of cervix
top
Usually post-menopausal women (mean 54 years, range 29 to 72
years) ( 54 , 29
72 )
Usually represents extension from uterine corpus; may arise from
cervical endometriosis
;
Poor prognosis unless low grade
Case reports: uterine tumor presenting as cervical polyp ( Ann Diagn
Pathol 2005;9:101 ), polypoid tumor with heterologous elements ( Eur J
Obstet Gynecol Reprod Biol 2000;88:103 ), after hormonal therapy for breast
cancer ( Gynecol Oncol 2000;79:120 ), :
( 2005 9:101 ),
(
2000 88:103 ), (
, 2000; 79:120 ), Gynecol Oncol 1985;22:105 , 1985; 22:105
Micro: sheets of spindle-shaped cells with minimal cytoplasm and
high mitotic activity; resembles endometrial stromal sarcoma but
without prominent vessels :
;

Micro images - uterus - H&E ; H&E, CD10+, ER+, PR+

- - & ; & , 10 +, +,
+
-
Positive stains: reticulin (outlines each cell) :
( )
DD: small cell carcinoma, lymphoma : ,
Teratoma of cervix
top
Very uncommon
Usually mature elements with benign behavior

Case reports: with lymphoid hyperplasia ( Pathol Int 2003;53:327 ), with
pulmonary differentiation ( Archives 1995;119:848 ), HIV+ patient with
squamous cell carcinoma arising in teratoma ( Gynecol Oncol 1996;60:475
), immature teratoma in 13 year old girl ( Eur J Gynaecol Oncol 1990;11:37 ),
mature cystic teratoma ( Asia Oceania J Obstet Gynaecol 1990;16:363 ), with
extensive surface ulceration ( Archives 2003;127:759 ) :
( 2003; 53:327 ),
( 1995; 119:848 ), +
(
, 1996; 60:475 ), 13 (
1990; 11:37 ), (
1990; 16:363 ), (
2003; 127:759 )
Gross: polypoid lesion of cervix :
Micro: mature squamous epithelium resembling skin with sebaceous

glands and hair; also bone, cartilage, lymphoid tissue, choroid plexus
and ganglion cells; immature elements are very rare :
,
, , ,
;
Micro images: epidermal elements and fat ; endocervical
cystic gland, nerve tissue, cartilage (arrow) ; figure 1:
squamous epithelium and adipose tissue; 2: mature

neural tissue; 3: cartilage :
;
, , () ;
1: , 2:
; 3:
DD: epidermal metaplasia (only ectodermal derivatives), fetal
remnants implantation (can differentiate with DNA typing), mixed
mullerian tumor, perforation of cystic ovarian teratoma :
( ),
( ),
,
Wilm's tumor of cervix
top
Very rare in cervix (<10 reported cases)

(<10 )
Case reports: 13 year old with polypoid vaginal mass producing
bleeding ( Archives 1985;109:371 ), 13 year old girl with 7 cm tumor (
Gynecol Oncol 2000;76:107 ), 12 year old girl with large vaginal mass ( J
Pediatr Hematol Oncol 1999;21:548 ), 11 year old girl with cervical polyp ( Int
J Gynecol Pathol 1998;17:277 ) : 13
( 1985; 109:371 ), 13
7 , ( , 2000 76:107 ), 12
(
, 1999; 21:548 ), 11 (
, 1998; 17:277 )
Gross: gray, solid, rubbery to gelatinous : , ,

Micro: triphasic with blastema, epithelial areas and mesenchyme
: ,
Micro images: kidney - triphasic tumor #1 ; #2 :
- # 1 ; # 2
DD: MMMT (no glomeruloid differentiation, no tubules, has
adenocarcinoma) : ( ,
, )
Yolk sac tumor of cervix

top
Also called endodermal sinus tumor

More common in vagina; some arise in both areas ,

Usually girls 1-2 years old with blood-tinged vaginal discharge and
variably elevated serum alpha-fetoprotein 1-2

-
Case reports: 6 month old girl with tumor of vagina and cervix (
Pediatr Radiol 1993;23:57 ), Indian J Cancer 1996;33:43 : 6
(
, 1993; 23:57
), , 1996; 33:43
Gross: partially eroded, pedunculated, soft and friable :

, ,
Micro: reticular (net-like), solid and festoon (string or garland)
patterns are most common; usually Schiller-Duval bodies (central
blood vessel surrounded by primitive cells) :
(-), ( )
; - (
)
Micro images: microcystic pattern ; festoon pattern with
Schiller-Duval bodies :
; -
Miscellaneous
Procedures relating to cervix

top
Fractional curettage: separate sampling from the endocervical and

endometrial cavities during the same procedure; the endocervical
specimen should be obtained first; purpose is to distinguish
endocervical extension of an endometrial carcinoma from isolated
tumor fragments in endocervical specimen :

;

This procedure may be replaced by hysteroscopy

Trachelectomy: excise cervix but preserve uterine corpus (
Radiographics 2005;25:41 ) : ,
( 2005; 25:41 )
Diagrams: trachelectomy technique :

Grossing of cervical specimens

top
Note: see Uterus chapter for grossing of hysterectomy specimens
:

Specimen should be oriented by the surgeon (either directly showing
pathologist or by labeling with a stitch or ink mark)
(
)
All tissue submitted should be examined (check the container and lid
carefully) (
)
Describe the number and size of pieces and any gross abnormalities

Describe gross tumor location, size, depth of invasion, extension to
margins or adjacent organs ,
, ,

Submit labeled specimens separately
Cone biopsies: ink deep margin, orient by quadrants, fixation for 3

hours may be helpful; then section by quadrant, and within each
quadrant at 1-3 mm intervals :
, , 3
, ,
1-3
Sections should be along plane of endocervical canal, and include
epithelium in each section
,
Diagrams: hysterectomy specimen ; grossing diagrams
: ;
Staging of cervical carcinoma

top
Many patients are treated with radiation therapy, and never undergo
surgical-pathologic staging
, -
Thus, AJCC prefers clinical staging (FIGO staging) of all patients for
uniformity , (
)
Clinical stage should be determined prior to start of definitive therapy,
and not be altered because of subsequent findings once treatment
has started
,

Pathologic findings should be recorded as pT, pN or pM, but should
not change the clinical staging ,
,
In AJCC 7th edition, TNM has changed to reflect FIGO 2008
7. , 2008
Primary tumor and FIGO stage
top
TX: Primary tumor cannot be assessed :

T0: No evidence of primary tumor 0:
Tis: Carcinoma in situ (preinvasive carcinoma) :

( )
T1 (FIGO I): Cervical carcinoma confined to uterus (extension to
corpus should be disregarded) 1 ( )
(
)
T1a (FIGO IA): Invasive carcinoma diagnosed only by microscopy (ie
no macroscopically visible); stromal invasion has a maximum depth of
5.0 mm measured from the base of the epithelium and a horizontal
spread of 7.0 mm or less; vascular space involvement (venous or
lymphatic) does not affect classification 1 ( ):
(.
);
5,0
7.0 ; (
)
T1a1 (FIGO IA1): Measured stromal invasion 3.0 mm or less in depth
and 7.0 mm or less in horizontal spread 11 ( 1):
3,0 7.0

T1a2 (FIGO IA2): Measured stromal invasion more than 3.0 mm and
not more than 5.0 mm in depth with a horizontal spread 7.0 mm or
less 12 ( 2):
3,0 5,0 7,0

T1b (FIGO IB): Clinically visible lesion confined to the cervix or
microscopic lesion greater than T1a (FIGO IA2) 1 ( ):

1 ( 2)
T1b1 (FIGO IB1): Clinically visible lesion 4.0 cm or less in greatest
dimension 11 ( 1): 4.0

T1b2 (FIGO IB2): Clinically visible lesion more than 4.0 cm in

greatest dimension 12 ( 2):
4,0
T2 (FIGO II): Cervical carcinoma invades beyond uterus but not to
pelvic wall or to lower third of vagina 2 ( )
,

T2a (FIGO IIA): Tumor without parametrial invasion 2 (
):
T2a1 (FIGO IIA1): Clinically visible lesion 4.0 cm or less in greatest

T2a 2(FIGO IIA2): Clinically visible lesion more than 4.0 cm in
greatest dimension 2 2 ( 2):
4,0
T2b (FIGO IIB): Tumor with parametrial invasion 2 ( ):

T3 (FIGO III): Tumor extends to pelvic wall or involves lower third of
vagina, or causes hydronephrosis or non-functioning kidney 3
( ):
,

T3a (FIGO IIIA): Tumor involves lower third of vagina, no extension to
pelvic wall 3 ( ):
,
T3b (FIGO IIIB): Tumor extends to pelvic wall or causes
hydronephrosis or non-functioning kidney 3 ( ):

T4 (FIGO IVA): Tumor invades mucosa of bladder or rectum, or
extends beyond true pelvis (bullous edema is not sufficient to classify
a tumor as T4) 4 ( ):
, (
4)
Note: all macroscopically visible lesions - even with only superficial
invasion - are at least pT1b (FIGO IB) :
- - 1
( )
Regional lymph nodes (N) ()
top
NX: Regional lymph nodes cannot be assessed :

N0: No regional lymph node metastasis 0:

N1 (FIGO IIIB): Regional lymph node metastasis 1 ( ):

Note: Specify number of nodes examined and number positive
:
Distant Metastasis (M) ()
top
M0: No distant metastasis 0:
M1 (FIGO IVB): Distant metastasis (including peritoneal spread,
involvement of supraclavicular, mediastinal or paraaortic lymph
nodes, lung, liver or bone) 1 ( ):
( ,
,
, , )
Stage grouping
top
Stage 0: T1s N0 M0 0: 1 0 0
Stage I: T1 N0 M0 : 1 0 0
Stage IA: T1a N0 M0 : 1 0 0
Stage IA1: T1a1 N0 M0 1: 11 0 0
Stage IA2: T1a2 N0 M0 2: 12 0 0
Stage IB: T1b N0 M0 : 1 0 0
Stage IB1: T1b1 N0 M0 1: 11 0 0
Stage IB2: T1b2 N0 M0 2: 12 0 0
Stage II: T2 N0 M0 : 2 0 0
Stage IIA: T2a N0 M0 : 2 0 0
Stage IIA1: T2a1 N0 M0 1: 21 0 0
Stage IIA2: T2a2 N0 M0 2: 22 0 0
Stage IIB: T2b N0 M0 : 2 0 0
Stage III: T3 N0 M0 : 3 0 0
Stage IIIA: T3a N0 M0 : 3 0 0
Stage IIIB: T1-T3 N1 M0 or T3b any N M0 : 1-3 1
0 3 0
Stage IVA: T4 any N M0 : 4 0
Stage IVB: M1 : 1
Drawings: cervix staging diagram (upper row) ; WHO
reference for FIGO staging ; National Cancer Institute
(USA) reference for staging :
( ) ;
;
()
Features of cervical tumors to report

Editor's note
Cone biopsy
top
Macroscopic tumor site (quadrant: either 12-3, 3-6, 6-9 or 9-12 o'clock
or right superior/inferior, left inferior/superior or not specified)
(: 12-3, 3-6, 6-9 9-12
/ , /
)
Tumor size (one dimension required, two or three recommended)
( ,
)
Histologic tumor type (WHO) ()
Tumor grade
Depth of invasion (mm) - measure from most superficial epithelialstromal interface of the adjacent intraepithelial process
(): - -

Width (horizontal extent) of tumor (mm) (
) ()
Endocervical margin - involved by invasive carcinoma (specify
location, focal or diffuse) or __ mm from closest invasive carcinoma
-
( , ) __

Endocervical margin - involved or not involved by intraepithelial
neoplasia (specify grade) -
(
)
Exocervical margin - involved by invasive carcinoma (specify location,
focal or diffuse) or __ mm from closest invasive carcinoma
-
( , ) __

Exocervical margin - involved or not involved by intraepithelial
(
)
Deep margin - involved by invasive carcinoma (specify location, focal
or diffuse) or __ mm from closest invasive carcinoma
- (
, ) __

Deep margin - involved or not involved by intraepithelial neoplasia
(specify grade) -
( )
Cone biopsy-optional features to report -

top
Whether tumor width is continuous tumor or multiple small foci

Additional pathologic findings: koilocytosis, inflammation, glandular
atypia or dysplasia, other : ,
, ,
Angiolymphatic invasion: present, not present, indeterminate
: , ,
Colpectomy, Hysterectomy or Pelvic Exenteration ,

top
Specimen type
Other organs present
(: 12-3, 3-6, 6-9 9-12
/ , /
)
( ,
)
Histologic tumor type (WHO)
Tumor grade
Depth of invasion (mm)
pTNM / FIGO staging
Margins (specify for all) - involved by invasive carcinoma (specify
location) or __ mm from closest invasive carcinoma
Distal margin - involved or not involved by carcinoma in situ
Colpectomy, Hysterectomy or Pelvic Exenteration-optional
features to report
top
Presence of carcinoma in situ at margins other than distal margin
Presence of tumor in other organs
Additional pathologic findings: intraepithelial neoplasia, glandular
atypia or dysplasia, koilocytosis, inflammation, other
Sample templates: Michigan Cancer Consortium (PDF file) , University of
Michigan
References: Archives 1999;123:55 , Mod Path 2000;13:1029
End of Cervix chapter

top
Go to Cervix-cytology chapter
Jobs-Pathologist/PhD
Jobs-Laboratory/Other
Fellowships
Conferences
Books
Affiliates
Home page
Cervix
2006
2003-2009, .,
( )
Home Page
See also Cervix-cytology , Uterus ,
Primary references
Cervix: embryology , normal anatomy, normal histology ,
metaplasia : ,
, ,
Inflammation: inflammation-general , actinomycosis , amebiasis ,
bacterial vaginosis , Candida/fungi , chlamydia , chronic
cervicitis , CMV , Enterobius, granuloma :
, , ,
, / , ,
, , ,
Benign/non-neoplastic lesions: adenomyoma , adenosis , AriasStella reaction , atrophy , atypical polypoid adenomyoma , blue
nevus , cervical pregnancy , decidual nodule , decidual reaction ,
diffuse laminar endocervical glandular hyperplasia , ectopic
tissue/heterotopia , endocervical polyp , endometrial polyp ,
endometriosis , endosalpingiosis , florid deep glands , glial
polyp , hemangioma , inflammatory pseudotumor , inverted
urothelial papilloma , leiomyoma , lipoleiomyoma , lobular
endocervical hyperplasia , melanosis , mesonephric papilloma ,
mesonephric rests , mesonephric hyperplasia , microglandular
hyperplasia , myofibroblastoma , Nabothian cysts , necrobiotic
granulomas , neurofibroma , pagetoid dyskeratosis , papillary
adenofibroma , papillary endocervicitis , placental site nodule ,
post-operative spindle cell nodule , pseudosarcomatous
fibroepithelial stromal polyps , pyogenic granuloma ,
rhabdomyoma , squamous papilloma , traumatic neuroma ,
tunnel clusters / - : ,
, - , ,
, ,
, , ,
,
/ , ,
, , ,
, , ,
,
, , ,
, , ,
, ,
, ,
, , ,
, ,
, ,
,
,
, , ,
,
Premalignant/preinvasive lesions: HPV , condyloma , atypical
squamous lesion , SIL-general , LSIL/CIN I , HSIL/CIN II ,
HSIL/CINIII , SIL variants , endocervical glandular
atypia/dysplasia , adenocarcinoma in situ , radiation atypia ,
stratified mucin producing intraepithelial lesions /
: - , ,
, - , / , /
, / , ,
/ , ,
,

Carcinoma: WHO classification , squamous cell and variants ,
microinvasive squamous cell , adenocarcinoma and variants ,
microinvasive adenocarcinoma , adenoid basal , adenoid cystic ,
adenosquamous , basaloid squamous cell , carcinoid , clear
cell , endometrioid , epithelioid trophoblastic tumor , glassy cell ,
large cell neuroendocrine , lymphoepithelioma-like ,
mesonephric adenocarcinoma , metastases to cervix , minimal
verrucous , villoglandular papillary adenocarcinoma , warty
: ,
, ,
, ,
, , ,
, , ,
, ,
, ,
, ,
,
, ,
, , ,
, , ,

sarcoma/PNET , granulocytic sarcoma , leiomyosarcoma ,
lymphoma , malignant mixed mullerian tumor , melanoma , other
(case reports), plasmacytoma , rhabdomyosarcoma , stromal
sarcoma , teratoma , Wilm's tumor , yolk sac tumor /
/ : , ,
, / ,
, , ,
, , (
), , ,
, , ,
Miscellaneous: procedures , grossing , staging of cervical
carcinoma , features to report : , ,
,
Primary references
top

(7. .)
American Journal of Clinical Pathology (AJCP), August 1975 to
February 2006
(), 1975 2006
American Journal of Surgical Pathology (AJSP), March 1977 to
January 2006 ,
(), 1977 2006
Archives of Pathology and Laboratory Medicine (Archives) , June
1976 to January 2006
(), 1976 2006
( ), 1974 2006
( ), 1988 2006
Kurman: Tumors of the Cervix, Vagina, and Vulva (AFIP, 3rd
Series, Vol 4) : , ,
(, 3. , 4)
Rosai, J: Ackerman's Surgical Pathology (9th Ed); Mosby, 2004
, .: (9. ), ,
2004
Sternberg, S: Diagnostic Surgical Pathology (4th Ed); Lippincott
Williams & Wilkins, 2004 :
(4. ); &
, 2004
Website: Histopathology and cytopathology of the Uterine Cervix
Digital Atlas :
-
: ,

Cervix-embryology ,
top
54.
,



,

;
77
and 105
91 105

top

)
2,0 2,5
--

():
:


;
,



,
Drawings: local anatomy ; microanatomy ; saggital section of

local anatomy #1 ; #2 ; uterus, cervix and vagina #1 ; #2 ;
vasculature : ; ;
# 1 , # 2 ; ,
# 1 , # 2 ;
;
References: ASCCP :
top


: ;

;

, ; ,
,
/
;


:
; ;
,
,
;

;


;
, ( 1985; 109:200 )
( ):
/ ;
;
;


: ,
/ ( )
-;

:
infiltrate : ,

,
,
; / ,
;
,
;

Drawings: location of glandular and squamous epithelium
:
Gross images: squamocolumnar junction :

: ( & , , ) ;
# 1 , # 2 ; # 3 ; # 4
# 1- , # 2 ; # 3
endocervix (H&E, stains, EM ); endocervix #1 ; #2 ; #3 ; #4 ; #5 ;
infoldings resemble glands ; endocervical canal (whole mount) ;
normal exocervix ; squamocolumnar junction ; cervical
myometrium #1 ; #2 ; myometrium and adventitia ; prepubertal
squamous epithelium shows only basal and parabasal cells with
no maturation ( & , , ); # 1
, # 2 ; # 3 , # 4 , # 5 ; ;
( ) ; ;
;
# 1 , # 2 ; ;


-
References: ASCCP :
top
progeny commit

Not neoplastic
:
,

top
Very rare

, 41 62
37 ( 2000; 36:60 )
,
;
,
/ ;
, ,
References: :
1997; 16:99
Int J Gynecol Pathol 1997;16:99
top
Very rare
( 1974; 44:53
)
2004;128:1052 ) : 44
( 2004; 128:1052 )
,
Micro images: (1) with sebaceous glands ; (2) figure 1: cervix
covered by keratinized squamous epithelium with prominent
granular cell layer; 2: stroma has mature sebaceous glands; 3:
sebaceous cells are surrounded by epithelial cells :
(1) , (2) 1:

; 2: ,
3:

top
epithelium : ,
;
,
,
, ,
, ,
( ),

-
Micro images: immature squamous metaplasia ; with mild atypia

: ;
top

Gynecol Pathol 1986;5:163 ) : ( 1985,
9:551 ), (
, 1999; 74:504 ),
( 1993; 58:481 ),
( , 1986;
5:163 )

top

,

( )
;

( )

associated with prolapsed uteri (see pagetoid dyskeratosis below)
: ,
(
)
, ;
, ;

;
-
Micro images: various images ; early metaplasia ; involving
clefts ; with cytoplasmic vacuoles : ;
; ;

top
,
injury ;

: -
( ,
, , ),
(
,
, ) (
, , ),
; ;
, ,
,
,

,
,
,
, ( 1995;
103:618 )
-
Micro images: tubal metaplasia #1 ; #2 ; #3 ; #4 ; #5 (bcl2+)
: # 1 , # 2 ; # 3 , # 4 , # 5
(2 +)
: (
)
( , ,
-67 ), (
,
; ,
, )
References: :
Archives 1993;117:734 , Mod Path 2000;13:261
1993; 117:734 , 2000; 13:261
top



androgen exposure

23
( , 2004; 23:182 )

,
,
, / /

-
Micro images: : urothelial metaplasia #1 ; #2 ; #3 ;
#4 (serotonin+) ; transitional metaplasia and atrophy after
androgen treatment #1 ; #2 # 1 , # 2 ;
# 3 , # 4 ( +) ;
# 1 ; # 2
: 20 ( )
, )
References:
AJSP 1997;21:510 , Mod Path 2000;13:252
1997; 21:510 , 2000; 13:252
top

, ,

;
, ()
,

;
,
;

Micro images: reactive (inflammatory) atypia #1 (various imagesmainly ectocervix) ; #2-endocervix ; #3-transformation zone
: () # 1 (
- ) ; # 2- ; # 3
top
,
( 1999; 180:265 )
11%,
( 1994; 39:585 , , 1983; 17:1 )

,
,
;
,

-
Amebiasis of cervix
top
1992; 46:759 ,
1987; 25:249 , 1985; 109:1121

carcinoma : ;

Micro images: various images (not cervix), figures 1-5 ; clusters
of trophozoites (liver) : (
), 1-5 ; ()
Bacterial vaginosis
top
Candida / fungi /
top

top
() , 4

, , , /

(, )
( ,
)
Causes infertility
,
/ ( 2000; 124:840 )


( , 2005; 142:914 )
: (
, ), ,

-
:
Chronic cervicitis
top
( )
, , ,
()
, , ,

;
(), , ,

; ; ;

-
CMV of cervix
top

) ( 2004; 57:691 )
+ ( , 1999;
59:469 )

; ,
, ,
, ,
,

Micro images: intracytoplasmic inclusions #1 (endocervical
cells) ; #2 (endothelial cells) ; CMV+ glands and stroma ;
associated acute inflammatory infiltrate ; intracytoplasmic
vacuoles within endocervical glandular cells ; fibrin thrombi
within small vessels ; not cervix - lung #1 (Giemsa stain) ; #2 ;
# 1 ( ) ; # 2 ( ) ;
+ ;
;
;
, - # 1 (
) ; # 2 , ; ;
-
top
-
top
,



,

1997;108:510 )
( 1997; 108:510 )
( , 1990; 66:380 )
-
top
Rare

( 2002; 117:771 )

endometriosis ( )

: ( , 2002; 21:191 ,
1992; 21:282 ), ( 1981; 84:215 )
Micro images: (1) xanthogranuloma (ceroid granuloma) ; (2) A:
PAS+; B: Perls' iron stain+; C: Ziehl-Neelsen (acid fast)+; D:
Schmorl's reagent (melanin)+ : (1)
( ) , (2) : + :
' + : - ( ) + :
() +
-
: ( 1995; 48:1057 )

()
top
physicians in one study ( J Clin Virol 2005;33:25 )
, 3% (1), 8% (2)
( , 2005; 33:25 )

epithelium :
, ;
(
) ;
,
-
margination :
;

molding) : (
)
top
;


: 37

, 2005 99:481
, 1992; 46:69
), + (

sclerosis : ,
, ,
;
; ,
, , ,

Micro images: dense lymphoid infiltrate with germinal centers
:

-
2001;97:235 : , 1985 4:289 ,
2001; 97:235
top
Trop Med Hyg 2001;65:233 )
( 2001; 65:233 )
(
, 2004; 23:403 )
Archives 2003;127:1637 ) : 27
( 2003; 127:1637 )
; . mansoni in ectocervix ; figure 1/2: calcified
eggs; 3: terminal spine ; various images (rectal mass)
; 1 / 2: , 3:
; ( )
-
79:193 .
Syphilis of cervix
top

1995;104:643 )
( 1995; 104:643 )

abundant plasma cells ; dermal lesion with anti-T. :
# 1- , # 2 ;
; -. pallidum immunostain

-
top
-
top
Assoc 1995;93:167 )
( . 1995; 93:167)
( , 2002; 78:62 ),
( 2001; 75:269 )


: ,
Micro images: various images ; granulomas with giant cells ;

acid-fast bacilli #1 ; #2 (lung) : ;
; #
1 , # 2 ()
-

top
2000;19:258 )
( 10%
, 2000; 19:258 )
Path 1994;7:610 )
- ,
- (
1994; 7:610 )
Case reports:
Case of the Week #91
# 91

: - # 1 , #
2;#3
References: :
Int J Gynecol Path 1998;17:193
1998; 17:193

top
-

/ -

top
First described in 1996 ( Mod Path 1996;9:220 ), although actually
very common and often overlooked 1996 (
1996 9:220 ),
, 21 55
()
,

1999;49:1019 ) : 44 ( 2001; 109:546 ,
1999; 49:1019 )
hemorrhagic : 1
8 , ,
(11-23 ), -,


;
, ,
;
; ;
, / ,

-
: + -67 + ( 20%),


( , , )
Adenosis of cervix
top
( )
Educ 1992;7:21 )

( 2003
(3): 004271 , 1992; 7:21 )

, - (
, 2005; 24:391 )
-
: 2004; 131:1639 ( 63 - )

top
1954;58:112 ) 1954 - (
1954; 58:112)


(10%) -

Gross: no mass :
, ( )
,

, , ;
, ,
;
,
, , / ;

enometrium but with cervical stroma ; nuclear enlargement and
hyperchromasia :
;

endometrium (not cervix) - pregnant patient (
) -
-
( ,
,
, / , )
2004 28:608 , 1992; 116:943
Atrophy of cervix
top
May resemble SIL
, ;
;
; ;
, ,
, ,

-
( -67 + 16 75-80%, + 31%,
. , 2005 9:100 ),
( ` ,
)
top
,
,
syndrome (<150 ),

, 21-73

May persist or recur, but does not metastasize; may have

increased risk for later carcinoma; may be contiguous with
adenocarcinoma ,
;
;
Case reports: with hyperprolactinemia ( Int J Gynecol Cancer
2001;11:326 ) : (
, 2001; 11:326 )
hysterectomy in peri/postmenopausal women, but with follow
up :
/ ,

: ; , ,
2 ,
;
: - ()
desmoplasia :
( ,
),
; (90%),
;
(< 3 10 );
adenocarcinoma -

hyperplasia, smooth muscle stroma and morules #1 ; #2 ; #3 ;
#4 ; #5 ; #6 ; #7 : -
,
# 1 , # 2 ; # 3 , # 4 , # 5 , # 6 ; # 7
-
activity : ( ), -67

( , , ,
), ( ,
, , )
References: :
AJSP 1996;20:1 1996; 20:1

top

1991;41:751 ) 2% ;
, (
, 1991; 41:751 )
2004;12:79 ) : 2 (
2004 69:411 ), (
2004; 12:79 )

, ;
,
Micro images: pigment containing nevus cells in cervical stroma
#1 ; #2 :
# 1 ; # 2
HMB45 : - (
), 100, 45
, -
, ( 1983; 107:87 )
( ),
( ,
), ( +
- , ,
)
References:
Hum Path 1985;16:79
1985; 16:79
Cervical pregnancy
top
,

( )
( , 2005; 84:509 )
retention ( Am J Obstet Gynecol 2004;191:364 ), with Arias-Stella reaction (
Acta Cytol 1994;38:218 ) : 1800
( 2005 76:304 ),
( , 2003; 79:428 ),
( 2004; 191:364 ),
-( 1994; 38:218 )


top
;
, ,
, ,

: - ,


top

/
carcinoma , , ,

Oncol 2005;26:499 ) : 28

( . , 2005 9:52 ),

end_of_the_skype_highlighting: 117 , 2005; 26:499 )
nuclei :
,
Micro images: various images ; ectopic decidual deposits in
lymph nodes : ;

-

top

First described in 1991 (
1991; 15:1123 )
AJSP 1991;15:1123
) 1991 (

, 22 48

7 (
1995; 45:283 )
: ,
, ,

` ; ;
,
; , /
( , 2002; 21:125 ),

( ,
, , )

top
cartilage islands

1983;61:261 )
( 1983; 61:261 )
: 38 (
1997; 16:291 ),
23
( , 2004; 23:182 ),
( 1996; 7:414 )

( )
References: :
2006;30:209 (#2) 2000 24:1224 ( # 1) , 2006 30:209 (#

2)
Endocervical polyp
top
30-59

,
Pathol 1993;13:415 ) :
( 2001 51:305 ), 5
( , 1993; 13:415 )

Gross images: polyp #1 ; #2 ; #3 : # 1 , # 2 ; #
3
() , ;
;
;
,
Micro images: whole mount ; various images :

;
-


top
occur in pregnancy
,


( 2003; 24:565 ),
( 1984; 29:837 )
Micro images: not necessarily cervix - endometrial polyp #1 ; #2 ;
#3 : -
# 1 , # 2 ; # 3
-
top
,

, 20 51
, &

Arch 2001;438:302 ) :
( 1994; 18:849 ), 47

( 2001; 438:302 )

# 2
: ,
- ,
, ;
, ;
,
;
; ,

Micro images: various images ; endometriosis :
;
-
Pathol 2001;20:173 ) : 10;
( , 2001; 20:173 )
( ,
), ,
References: :
Arch Gynecol Obstet 2005;272:289 , Int J Gynecol

top
/
, 29 64

, ,
;
Pathology 1997;29:426 ) :
, ( 1997; 29:426 )
References:
AJSP 1990;14:449
1990; 14:449
top

serous neoplasms
, ,


2002;33:944 , AJSP 1999;23:166 ) (
, 2002 33:944 , 1999; 23:166 )
1991;36:675 ) ( 2000; 45:526 ,
1991; 36:675 )
Micro images: not necessarily cervix - glands lined by tubal type
epithelium #1 ; #2 :
- # 1 ; # 2
-

top

:
,

, ,
,
References:
AJCP 1995;103:614
1995; 103:614

top
5
/ (
1983; 61:261 , 1980; 73:718 ), ,

Case reports:
# 135

;
;
, , ,

Micro images: polypoid mass of glia below endocervical surface
(AFIP) :
()
case of the week - #1 ; #2 ; #3 ; #4 ; #5 ; GFAP # 1 , # 2 ; # 3 , # 4 , # 5 ;
( ), -( ,
, 1985; 21:385 )
top
Micro images: cavernous hemangioma #1 ; #2 :

# 1 ; # 2

top
Very rare


( , 2005
98:325 ), 58 (
, 1994; 13:80 )
,

: - , ; ;


top

( 2002 6:49 )
( 1995; 19:1138 )
;
""
;
; ; /

Micro images: bladder - inverted papilloma #1 ; #2 ; #3 ; basaloid
appearance ; with squamous metaplasia : # 1 , # 2 ; # 3 , ;

Leiomyoma of cervix
top
, 8%

:
( , 2005 97:253 ),
( 2003 30:144 )
( , 1996; 62:119 )
1 cm or less : ,
; 1
( )
: ,
;
Micro images: spindled cells ; spindled cells in streaming

pattern : ;

-
top

,
, - # 1 , # 2 ; # 3 ; # 4
Lobular endocervical glandular hyperplasia of cervix, NOS

,
top
1999 ( 1999; 23:886 )
( 2000; 24:325 )
, 37 71

( 2005;
18:1199 )

;

/ ,
,
,
; ;
, , ,

-

: ( ),
(1083)
: ( , 2005; 24:296 )
( ,
, ,
, 2005; 55:412 )
Melanosis of cervix
top
: ( 1990; 93:802 )
,
,
;
,
DD: blue nevus :
top

adult women , ,

( . , 1998; 11:29 ), 18
(
2005 65:388 ),
( 1998; 51 : 875 )
: ,

; ,
,
: ;
borderline vaginal tumor in above case history - papillary tumor
with various epithelial types ; focal atypia due to stratification,
pleomorphism and atypical mitotic figure
-
;
,
125,
: 20, ,
References: :
Ultrastruct Pathol 2005;29:209 (EM findings)
, 2005; 29:209 ( )

/
top
()
, 1 / 3
;
( 1990; 14:1100 , 1991; 115:1059 )
1988;62:1594 ) ( 1994;
18:1265 , 2004 40:109 ),
, 1988; 62:1594

,
;

Micro images: clusters of mesonephric tubules surround a
branching duct ; mesonephric remnants with hyaline secretion ;
cells are cuboidal with a distinct basement membrane ; complex
and deep duct with focal squamous metaplasia ; CD10+
:
; ;
;
; 10 +
-

: , 53, -67, ,
( , ,
,
, )
References: :
Histopathology 2003;43:144 (CD10) , AJSP
2003;27:178 (CD10) 2003 43:144 (10) , 2003 27:178 (10)

top
38 47 , 21 81
Benign


; ,
( , )
(,

);

;
,
, ,
, ,
Micro images: marked tubular proliferation but with lobular
architecture ; more nuclear variation than in mesonephric rests ;
bland glands deep in cervical stroma #1 ; #2 ; large ducts deep in
stroma with tufting :
, ;
;
# 1 , # 2 ;

-
,
,
References:
Gynecol Oncol 1993;49:41 ,
, 1993;
49:41 , AJSP 1990;14:1100 , Mod Path 2000;13:261 1990; 14:1100 ,

2000; 13:261

top
,
women
,

, ;
cells :
,
/ ;
, ;
;
, (
), , ,
, ,
,
Micro images: dense glands but no atypia ; solid pattern #1 ; #2 ;
possible involvement by HSIL :
; # 1 , # 2 ;
-
( )
(), 10,
(, , +),
( ,
, ,
, ),
(
, , ,
, ,
-67 +, , 1992; 16:1092 ,
, 2003; 22:261 ),
( "" ,
, + 2003; 7:180 )
References: :
AJSP 1989;13:50 (worrisome patterns) , Mod Path

) , 2000 13:261 ( )
top
55 58 , 23 80
,


vagina : , ,
3 ( 1 6 )


,
,
; ,

Micro images - breast : (1) epithelioid type #1 ; #2 ; #3 ; CD34+ ;
(5) figure 1: sharply circumscribed tumor with fibrous
pseudocapsule; 2: composed of bland spindle cells in
collagenous or myxoid stroma; 3A: CD34+; 3B: bcl2+; 4:
desmin+ (focal) - : (1) # 1 ,
# 2 ; # 3 , 34 + , (5) 1:
, 2:
; 3: 34 + ; 3:
2 + 4: + ()
(25%) : , , , 34, 99,
2, , (45%),
(25%)
: 100, , , - 117,
angiomyxoma : ,
,
2005;46:137 : 2001 32:715 , 2005 37:144 ,
2005; 46:137
Nabothian cysts
top

1999;44:567 )
, ,

( 1999; 44:567 )
( 1990; 14:895 )


1,5
Gross images: in situ #1 ; #2 ; Nabothian cysts #1 (arrows) ; #2 ;
#3 ; various images : # 1 , # 2 ;
# 1 () ; # 2 , # 3 ;
;
;

; , ,

: # 1 ; # 2

( , ,
, 1989; 8:340 )

top

( 1984; 8:841 )

top
Very rare in cervix
1996;88:699 , AJSP 1989;13:873 ) : 39
(
),
( 1996 88:699 , 1989; 13:873 )

Int Braz J Urol 2005;31:153 ) :
( , 2005; 31:153 )
Micro images: plexiform neurofibroma ; figure 2 :

; 2
top
proliferate

-

, ( 2000; 24:1518 )
Paget's disease :
, ,
;

: , ,
,
( ),
(, , -
"-" ),
( ,
; , ,
, ;
), - ,


top

,
: 55
( 2005 26:186 ), 46
( 1996;
88:135 )
: ; ,
5 ; , , -
; ,

;
;
; ,
, ; / ,

Micro images: glandular epithelium and connective tissue
proliferation ; adenofibroma-not necessarily from cervix
: ;

atypia) : ( ,
), (
)
top


;
, ,

;
; , ;
, (
, 2004; 47:178 )
top
Incidental finding; benign ( AJSP 1990;14:1001 )
; ( 1990; 14:1001 )
, ;
, ,
, ()
,
,
;
, / ;

Micro images: nodule just below surface with sparsely cellular
stroma ; cytoplasmic vacuoles and nuclear enlargement ; HLAG+ (not necessarily cervix) :
;
; + (
)
variable HPL : , ,
18, - 63;
(<8% )
(,
, ),
( , , ),

References:
Hum Path 1999;30:687
1999; 30:687

top

bladder ( J Urol 1990;143:824 ) / (
1995; 26:571 ), ( , 1990; 143:824 )
;

;
; ,
, ,


cervix

top
, 16 75
-

with recurrence , ,

, , , -
,
, (> 10/10 ),
;
,
-


delicate walls :
, ,
,
: ,
/ , ,
+ +
,
,
:
, ,
,

50% are S100+ :
, 50% 100 +
References:
AJSP 2000;24:231 , Cancer 1983;51:1148 (vaginal)
2000 24:231 , , 1983; 51:1148 ()

top
: ---,

: ,
,

top
:
,

-
-
Micro images: various images and stains ; kidney #1 ; #2 ;
various cardiac tumors : ;
# 1 , # 2 ;
: , , 1,
top
, ,

(, , ),


(
)
;
influence
, ()
, ()
, , ()
, ( ) + / +

,
,
,
;
-

, ,
, , ,
/
Micro images: squamous epithelium overlying fibrovascular
papillae ; not cervix - respiratory squamous papilloma ; GE
junction :
, ;
-
desmin : , , ,
,
( ),
(, ; -67 -
, 2000 24:1393 ), ,
,
, , (
)

top


(
),

,
( 1989; 113:945 )

55% , (
1996; 28:153 )
scar : 2



top

:
(), ,
;
;

; ;
,
; ; ,

activity : ;
;
, ,



, , 2
; ,
/
Micro images: tunnel clusters (type B) with sharp
circumscription #1 ; #2 with dense secretion :
( ) # 1 ; # 2

: , -67 ( )
( , /
)
References:
AJSP 1996;20:1312 (type A with atypia) , AJSP 1990;14:895 (early

1996 20:1312 ( ) , 1990; 14:895 ( ) , 2000
13:261 ( )

/

()
top
(,
)
60 + ; , 55

epithelium ;

/ :
4

,
,
( -)
, -

without HPV
(
1990; 114:1038 ),
1:S25 ) -6 53; -7
() ,
,
( , 2005, 32 1: 25 )
grade SIL): 6, 11, 40, 42, 43, 44, 54, 61, 70, 72, 81, CP6108
(
): 6, 11, 40, 42, 43, 44, 54, 61, 70, 72, 81, 6108
Dis 2005;9:154 ) (
): 16, 18, 31, 33, 35, 39, 45, 51,
52, 56, 58, 59, 68, 73, 82; 26, 53 66 "
" ( , 2005; 9:154 )

; 18 +
,
( 2006;
20:253 )

- 16 18 200
2 ( 2006;
125:114 )
present : - ,

adenocarcinoma :
( + ),

, ,
, (),
-
Micro images: :
HPV immunostains - normal cervix has some HPV background
staining ; cervical condyloma is HPV+ ; LSIL/CIN1 ; HSIL/CIN2 ;
HSIL/CIN3 ; carcinoma -
- ;
+ ; /1 ; /2 ; /3 ;

: -67 ( - +
,
)
:
(" ") ;
( 1990; 14:643 )
: -


organization : 2003; 127:935 ( ) ,

top
,

Benign
spontaneously

: ,

8% are multiple :
, 8%
, ,
, ; ;
, , (
) ( )
excrescences ; cervical condyloma is HPV+ :
# 1 , # 2 ; # 3 , ;
+
-
6 11 70-90% , -16


top

-6 11 ( 1992; 5:391 )
endocervix : ;

:
,
; ,

; , /

Micro images: papillary immature metaplasia ; p16 negative
(page 2) : ; 16
( 2)
-
: -67
, ; 16
: 6 11
;
,
( . , 2001; 16:762 )
, ( ,
, -67
), ( ,
)
References:
Hum Path 1998;29:641 , Mod Path 2000;13:252
1998; 29:641 , 2000; 13:252

top
( , , )

(5 )
(0-2) : ,
, , ,
1 / 3 , 16 +
2 / 3 , -67 + 2 / 3
( 2005; 123:699 )
2-3% ,
/ , ,
, ,
, / ,
;

;
-

top

visible abnormality


,
-

(<10%) - ( ,
)
1983;51:2214 ) :
( , 1983; 51:2214 )
;

;

; , /
; ,
;
, ,

Micro images: image1 ; image2 : 1 ; 2
cervix : -67 ,

risk HPV : 2 / 3
-; -
, ( )
2000;13:252 : 1999; 30:345 , 1999; 30:1161 ,
2000; 13:252
Squamous intraepithelial lesions (SIL) of cervix-general

()
top
, 20

one study)
( 26 )
HPV infection)
( 17 ,
, )

( ),
,
, ,
, (
)
, ,


; ,

regress -

prognostic factor 3

/ (
, 2005; 97:1816 )
, 2 / 3 , 1 / 6 , 1 /
6
, , 1 / 3 9 ,
16, 18, 31, 33; 30-39 ;
0,2% ;
()


, , , ()
() - ,
, -, () ()
( ) -
:
, , , ;

(
121:226 )
2005;

: (
), ,
,
( ),

1999;12:233 ) :
, ,
( 1999; 12:233 )
;
;


,
;

;

,
,
-
systems / : # 1 # 2 ;


2 / 3
( 2002; 26:1501 ) -1
,
( 2001; 25:884 ) -1
( 2002; 26:70 )
LSIL / CIN I / low grade dysplasia of cervix / /

top
epithelium () ,
() (
)
-;

: ,
- ( , 2005; 105:253 )
16- / ( ,
2005; 97:1066 )
Micro: :
:
,
,
,
,

,
;

(2 +
,
),
;
; ,

,
,
-
;
+

- ( 1998; 29:1068 )
():
, , ,
( , 1993 6:313 ),

; / ,
,
;
-
koilocytosis #1 ; #2 ; #3 with markedly enlarged bizarre nuclei ;
#4 ; Cdc6 and MIB-1 (figures C, D) : ;

; # 1 , # 2 ; # 3
; # 4 ; 6 -1 (
, )
crystalline array :
;

DD of LSIL: :
: ,
; ,
,
,
, ;
;
,
, ,

Path 1995;8:408 () :
/
, ,
, ;
, - ( 1995; 8:408
epithelium () :

atypia ()
: ,
,
References:
AJSP 2002;26:1389 (p16)
2002; 26:1389 (16)

/
top

;
1 / 3 2 / 3
, / ,
, ,

-
Micro images: various images ; H&E #1 ; #2 ; #3 :
; & # 1 , # 2 ; # 3

/
top
; 10-20%


, ,

1994;18:1265 ) :
( 1994; 18:1265 )
# 1 ; # 2


;
;
,
, ;
;
;
;
/
Micro images: various images #1 ; #2 ; #3 ; #4 ; #5 ; #6 ; #7 ; #8 ;

#9 ; involvement of endocervical glands ; at squamocolumnar
junction ; LSIL merging into HSIL ; Cdc6, MIB-1 (figures E, F)
: # 1 , # 2 ; # 3 , # 4 , # 5 , # 6 , # 7 , # 8 ,
# 9 , ;
; ; 6, - 1 ( ,
)
Virtual slides: high grade SIL #1 ; #2 :
# 1 ; # 2
-
: -1, 4 ( 2001; 32:1197 )
,
,
DD of HSIL: :
: (),
,
, , ,
, ;


: , ,
,
,
: ,
, ,
, ,
, -1 , -67/1 16
( .
, 2005 9:100 ), ,

,
, , ,
/ ,
: (
)
, ,

():

top

top
, ,
,

( ,
),

top



-
,
, /
,
, ,
;

16, 1 , -
References: :
AJSP 2004;28:1474 2004; 28:1474

/
top
( )
-



( 1992; 79:101 )
2000;31:656 , AJCP 1998;110:200 )
( 2000 31:656 , 1998; 110:200 )
1997;16:99 ) :

, ,

, ,
, ;
( 1997; 16:99 )

,
, , ,
;
; /

,

-
Micro images: reactive glandular atypia #1 ; #2 ; low grade
intraepithelial neoplasia/dysplasia ; glandular dysplasia-various
images ; glandular dysplasia #1 ; #2 :
# 1 , # 2 ;
/ ; - ;
# 1 ; # 2
Positive stains: p16 (in dysplasia, Hum Path 2004;35:689 , but not
atypia or reactive lesions, AJSP 2003;27:187 ) :
16 ( , 2004 35:689 ,
, 2003; 27:187 )
, , -,
, ,

: 2003 27:452 ( ) , 2000; 13:261

()
top
(
)
35 40 , 27
74
50-90% of cases -16 18 ( , 2006;
94:171 ) 50-90%

disease
;

,

Week #202 ) : (
), 30
( # 202 )

(
,
);
junction : ,
,

,

,
, ,
, ,
( 18/10 ); (
16/10 ); ;
, (
, ,
- ,
), ;
;
( )
( , 2005; 24:125 );
, ,
-
Micro images: various images #1 ; #2 ; endocervical type #1 ;
#2 ; #3 ; #4 ; #5 ; #6 ; : # 1 , # 2 ;
# 1 , # 2 ; # 3 , # 4 , # 5 , # 6 ; endometrioid
type #1 ; #2 ; #3 ; #4 ; #5 ; intestinal type ; adenosquamous type
#1 ; #2 ; with HSIL-#1 ; #2 ; #3 ; Cdc6, MIB-1 (figures A, B) ;
adenocarcinoma in situ ; #2 ; #3 ; #4 - with HSIL ; #5 - with HSIL ;
biopsy # 1 , # 2 ; # 3 , # 4 , # 5 ;
; # 1 , # 2 ; -#
1 , # 2 ; # 3 , 6, -1 ( , , ) ;
; # 2 , # 3 , # 4 - ; # 5 - ;
: ( ),
6 1 (6 , 2002 126
16 ( , 2004 35:689 , 2003 27:187 ),
(50%)
, 2,
(70% )
(
, ),
,
( ,
,
), - (
, , /
), (,
, , ),
( ,
; 10 +),
( , ,
), (
, )
: 1998; 22:434 ( ) , 2000; 13:261

top


,
;
; ,
;
; ,

, ,
; , /
, /
-
# 1 , # 2 ; # 3
References: :
, 1996; 15:242
Stratified Mucin producing Intraepithelial Lesions (SMILE)

of cervix
()
top
,




;
; ;

:
-1
63
: ,
References:
AJSP 2000;24:1414
2000; 24:1414
Carcinoma of cervix

top
Epithelial tumors

,
Keratinizing
Nonkeratinizing
Basaloid
Verrucous
Squamotransitional
()
/ ()
( ),

SIL ()
)
, )
( , , )
Squamous papilloma
Adenocarcinoma
(, , ,
, )
(
)
Glandular dysplasia
Mullerian papilloma
Endocervical polyp
Carcinoid tumor
-


Leiomyosarcoma
,

( )
Angiosarcoma

Leiomyoma
Genital rhabdomyoma

( )
Adenosarcoma
Wilms tumor
Adenofibroma
Adenomyoma
Melanocytic tumors
Malignant melanoma
Blue nevus
teratoma) ( ,
, )

)
Secondary tumors

top
, # 8 ( # 1
1940), # 1
(1
-, 13.000
, 2004; 100:1035 )
ages 45-55 years 51 , 30
, 45-55
Path 1999;30:626 ) : ,
( , 2003; 89:2078 ),
, ;
( 1999; 30:626 )
( ), ( , 2006; 118:1481
), , , ,

():
( ), 95%
, 90%
45, 51, 52, 56, 58, 59, 68 and others
: 16, 18, 31, 33, 35, 39, 45, 51, 52,
56, 58, 59, 68
: 6, 11, 42, 44 ( )
bound by Rb - 6 7 ,
-;
(
) , 16 18, 6 53 ,
; 7
()

HPV - , () -
() 10-15%
-
,


;

: , ,
,
, , ,
, ; -
; ;
( ,
1996; 27:904 ),
(
2005; 25:1663 )
: , ,

;
, , ,
, ;
, , ,
(1%)

( Gynecol Oncol 2004;92:974 ), : ( 1985
), (
2004
),
2004 104 begin_of_the_skype_highlighting 2004
),

( 2005;
26:499 ), - (
, 2005 97:976 ), / ( , 2004 ; 92:974 ),
2005;97:253 )
( , 2005; 97:253 )
104 end_of_the_skype_highlighting:1086 , 2005; 20:247

) -
( 1992; 116:187 ),
( , 2004 94:825 ),
( 2005 53:645 ),
( 1999; 30:587 ), (
2005 7:26 ), ( 1995 8:307
), ( , 2005; 15:1183 ), (
, 2003 28:28 , , 2001; 11:244 ),
+ ( , 2001
11:78 ), ( , 2004; 97:301 , 2004
25:742 ), ( , 2003; 7:187 )
Radiother 2003;7:187

: (:
), , (
), ( -
; 5 23%;
- )
95%, Ib2-IIb: 80-90%, III: 50%, IV: 25-35% 5
1993-1995 : 1-1:> 95%, 2: 80-90%, : 50%, 25-35%
Gross images: barrel shaped cervix ; ulcerative tumor ; stage I

tumor ; tumor extending to vagina ; stage IV tumor with bladder
extension #1 ; #2 ; invading lower uterine segment ; squamous
tumor : ;
; ; ;
# 1 , # 2 ;
;
; ,
,
- ,
;
; (
1993; 117:199 ), - ( , , 1992; 2:152
), ( , 2003; 22:285 )
) / 3 ( , ,
2000; 10:95 )

:
,
, ,


,

,
; /
;
-
Drawings: evolution of invasive carcinoma from SIL ; lymphatic
pathways of spread :
,
Micro images: various images ; invasive tumor #1 ; #2 ; #3 ;
central keratinization ; resembling clear cell carcinoma ; margin
involvement ; Cdc6, MIB-1 (figures G, H) ; :
; # 1 , # 2 ; # 3 ,
; ; ;
6, -1 ( , ) ;
UC Irvine, California (USA) : squamous cell carcinoma #1 ; #2
,
, (): #
1;#2
Grading: well differentiated with prominent keratin pearl ;
moderately differentiated with invasion by nests and single
cells ; poorly differentiated spindled tumor with focal
keratinization ; poorly differentiated with markedly pleomorphic
nuclei :
;
;
;

: # 1 , # 2 ; # 3
involucrin : ( 100%), , (90%),
, (,
), 63 ( 2001 32:479 ), ,

1999;123:1098 ) : 53 (), 2 ,
(, 1999; 123:1098 )
,
,

; 16 3

( ,
),

( , / ; -),
(
, / , +),
( ,
, ,
),
(
, , ,
;
)
: , 2005, 4: 38 ()

top
;
for stage I is 54%)
(5 54%)
factors - ,

diagnosis ,


:
;

;
; ;
-
,
, ,> 25
, ,
,
Micro images: central cystic degeneration ; multiple keratin
pearls : ;

References:
AJSP 2001;25:1310
2001; 25:1310

top
stage I is 84%)
(5 84%)
mitotic figures :
,
;

: # 1 , # 2 ; # 3 ; # 4

top
,
( . , 2005; 9:149 )

( , 1998; 19:455 )



, /
, ;
,

Micro images: papillae covered by atypical basal cells #1 ; #2 ;
focal squamous differentiation ; infiltration of stroma
: # 1 , # 2
; ;

16 + ( , 1998; 83:521 )
References:
AJSP 1997;21:915
1997; 21:915

, ), (,
)

top

42%

, ,
, 60%


()
References:
Mod Path 1991;4:586
1991; 4:586

top
5 ( )
" (), " "
" "
(
,
, 2005; 98:183 )
than 7 mm), IARC :
5
7 1 (
3 ; 7 ) 2 (
3 , 5 , 7 )

1% 3 (
) 13% 3-5
, 6% 3 13% 5
( 2003; 24:513 )
, ;
( 2005; 112:807 )
positive margins :
; ,

( , 2005 15:88 )
-
- ), ,
,
(: ,

), , ,
(. )

: (
, 2004; 30:363 ),
<1 1 ( , 2003; 90:443 )
,
(

)
: ,

pseudoglands :
;
, , ,
, ,

,
( );
- ,

-
tongues of squamous epithelium with loose fibroblastic stroma
#1 ; #2 with differentiated overlying squamous epithelium ; #3 ;
#4 ; small invasive bud ; individual cell keratinization of invasive
angiolymphatic invasion ; angiolymphatic invasion confirmed by
factor VIII related antigen immunostain ; HSIL with focal necrosis
and nearby angiolymphatic invasion :
# 1 , # 2 ;
# 1 ; # 2
; # 3 , # 4 ;
;
; ;
;
;

Virtual slides: early invasive carcinoma :

(
), /
,
, -
,

top
women 5-15% ,


25% ,

,
( , 2004; 100:1035 )
( 5 ,
)




see Hum Path 2002;33:899 ) 16 /
( ),
( 2003 27:187 ,
2002; 33:899 )

, ;
, ,
Usually EBV negative (
( 1999; 123:1098 )
Archives 1999;123:1098

10%
: -79%, -37%, / - 9%
CA125 : (
> 5 , 2004; 14:104 ),
, ( , 2004; 92:262 ),
2 , 125
( 2005 193
( 2004 54:63 ,
, 2003; 22:220)

2005;96:857 ) -
( , 2006; 101:346 ), ( , 2005
15:561 ),
( , 2005; 96:857 )
),
, (
2004; 5:119 )
( )

; ,
,
:

;
, , ,
;

; ( 2005; 49:187 )
( , ,
):
(10% );
;
;
( ),

(11% 50% ),

; 50%
; ; ;

), ;
; ;
;
; ;

-
Micro images: various images ; poorly defined glands lined by
malignant cells ; malignant glands with necrotic debris #1 ; #2 ;
#3 ; poorly differentiated tumor #1 ; #2 :
;
; #
1 , # 2 ; # 3 ; # 1 ; # 2
, , , , 16, 25%, 53

: 10 (
), 63 ( 2001 32:479 ), ()
1996;106:52 , Br J Cancer 2005;93:1301 ) : -16
(
,
,
, ;
- /
; , ,
, 2002 26:998 , 2003 27:1080 ),
(
, , ),
(
),
(
,
, ),
(, ,
, 10 +, ,
)
References:
Mod Path 2000;13:261
2000; 13:261

()
top

;
,
( , ,
2005; 24:125 )
endocervical type cells ; colloid type with clusters of tumor cells
floating in mucin :
;

,
, ,
, , 2000; 19:322 )

top
, 34 78


;
; ,
;

, ,
, (
,
)
References:
AJSP 2000;24:369
2000; 24:369

See below

top
Rare
;
,
; ,
( 1990; 114:731 )
Micro images: intestinal type cells #1 ; #2 ; #3 ; A: H&E; B:
CDX2-; C: CK7+; D: CEA+; E: CK20- ; metastatic colonic
adenocarcinoma is CDX2+ :
# 1 , # 2 ; # 3 , &; : 2-: 7 + : + :
20- ; 2 +
( ; 2

top
;
: ( 2004 54:787 ),
( , , 1999; 9:433 )


-
Micro images: signet-ring type tumor cells ; A: H&E, B: CDX2-, C:
CK7+, D: CEA+, E: CK20- :
; : & , -2, : 7 + : + :
20Positive stains: CEA, CK7 : , 7
DD: metastatic adenocarcinoma from breast ( Gynecol Oncol 1998;71:461
) or stomach ( Cancer 1993;71:3472 , Acta Cytol 1997;41:291 ) :
( , 1998; 71:461 )
( , 1993; 71:3472 , 1997; 41:291 )

top
3-5
Excellent prognosis (
2001; 97:701 )
Obstet Gynecol 2001;97:701
) (

2004;14:104 ) (
, 2004; 14:104 )

, ,
, ,
,
Gynecol Oncol 1995;59:297 ) : 62
1
( , 2000 77:467 ),
( , 1995; 59:297 )
:
;
( , 2002; 85:327 )
;
; (
); ;

, ,

-
desmoplasia ; complex / labyrinthine pattern of malignant
epithelium ; buds of early stromal invasion :
; ; /
;

(50%)
definition : 2003 27:187 (16) , 2002 26:1389 (16) ,
/

top
, ( 60 71
, 30 91 ),
, (
1997; 27:437 )
; 16

metastases ; ,
, 4 (
2 10 ) , , /

( 1998;
22:965 )
( 2005 36:82 )
/
( 2001 25:338 , , 1998; 17:211 )
Archives 2004;128:485 ), with carcinosarcoma ( Int J Gynecol Pathol
2002;21:186 ) : 79
end_of_the_skype_highlighting:485 ), (
, 2002; 21:186 )
these lesions : ;

: ;

()

( )
,
;
; , /
,
; ( )

-
differentiation of small basaloid cells with scant cytoplasm and
hyperchromatic nuclei, bottom-true lumina may be present ; topCK17+, bottom-CK18+ ; figure 1: nests of basaloid cells with
overlying HSIL; 2: central squamous differentiation with
microcysts, plus nests of small basaloid cells with scant
cytoplasm and hyperchromatic nuclei ; various images (figures
1-4) ; nests of basaloid cells infiltrating the stroma ; squamous
differentiation and microcyst formation ; squamous
differentiation : ,
;

, -
; 17 + 18 + ; 1:
, 2:
,

; ( 1-4) ;
;
;

: 16 + ( 1997; 16:301 )
;
, ,
( , 2000; 33:241 )
( ,
, ,
+ +) ,
, (
,
, 7 + , 2005 55:445 ),
(
, )
References:
AJSP 1980;4:235 , Hum Path 2000;31:740
1980; 4:235 , 2000; 31:740

top
),
,
40 ( , 1989; 32:26
)
metastases

( 2001; 25:338 , , 2000; 21:292 )
2004;128:817 ) : 83
( 2004; 128:817 )
: ,
,
Gross images: contributed by Dr. Ihab Hosny, Ohio - image #1 ;
#2 : , - # 1 ;
#2
squamoid pattern :
/ ,
, ;
, ,
, ;
,

Micro images: cribriform architecture and basement membrane

material #1 ; #2 ; #3 ; figure 1: friable and ulcerated cervical
mass, 2: cribriform islands of basaloid cells with peripheral
palisading, high N/C ratio and scant mitotic activity; 3: focal
solid pattern; 4: infiltrating cords of cells within basement
# 1 , # 2 ; # 3 ,
1: , 2:

, / ;
3: , 4:

contributed by Dr. Ihab Hosny, Ohio : image #1 ; #2 ; #3 ; #4 ; #5 ;
#6 ; vascular invasion ; actin #1 ; #2 ; CEA #1 ; #2 ; EMA ; high
molecular weight keratin #1 ; #2 ; S100
, : # 1 , # 2 ; # 3 , # 4 , # 5 , # 6 ,
; # 1 , # 2 ; , # 1 , # 2 ; ;
# 1 , # 2 ; 100
other sites: esophagus ; salivary gland-various images as part of
case history : ;
-
: , , (
), 45,
100
Molecular: HPV16+ (
+ ( 1996; 49:805 )
J Clin Pathol 1996;49:805
) : 16

: ,
,
( 1982; 77:494 )
laminin, AJSP 1999;23:448 ) : (
,
, , 1999; 23:448 )
: 1988; 12:134 , , 1992; 11:2 (
)

top



,

: (
, 2004; 14:625 ), (
, 2000 76:409 ), ( ,
1999; 74:130 )

;

;
,

-
Micro images: various images ; poorly formed glands and
squamous components #1 (arrows) ; #2 ; #3 :
; #
1 () ; # 2 ; # 3
: 63 ( ), 7

,
,
,
( 2005 55:445 ),
(
), (
)

top
Aggressive behavior
,
;
, ,

( , 2002; 9:290 ) ,

Micro images: oral cavity ; skin : ;

,
top
2005;29:92 ) , 3 12-33% (
2005; 29:92 )


,
( )
2001;20:327 )
( ) (
2001; 20:327 )
1987;37:1183 ) : (
, 1989; 37:88 ), (
, 1988; 30:114 ), (
1987; 37:1183 )

Micro images: ribbons of tumor cells ; glandular features ; cords
and glands of tumor cells :
; ;

other sites - kidney ; small intestine - ;

;

top



( 1999; 84:4209 )
Micro images: various images and stains ; atypical carcinoid
tumor ; chromogranin+ atypical carcinoid tumor :
; ;
+

()
top
() -
( , 1978; 42:2435 )


children - (
1950, 1987; 316:514 ),
;
- 55% 5 40% 10
: ( , 2005 97:976
), ( 2000; 96:834 )
;
( , 2005; 97:296 )
( )
( );

, ;
( );
,
;
,

-
Micro images: various images ; clear cell carcinoma #1 ; #2 ; #3 ;
tubulocystic pattern ; approaching mesonephric remnants ;
vaginal tumor : ; # 1 ,
# 2 ; # 3 , ;
;
,
,
, ,

( 1976; 20:262 )
(,
, ),
( ,
), -(
, , ,
), (
,
),
(, ), (, ),
()


top

endocervical type

( , 2000; 89:1291 )
( )
( )

in situ : ,
;

&; ,

Micro images: branching glands whose cells lack mucin ;
stratified epithelium, cells have scant granular cytoplasm and no
mucin #1 ; #2 ; uterus, not necessarily cervix - endometrioid
adenocarcinoma #1 ; #2 ; #3 (invasive patterns ) :
;
,
# 1 , # 2 , , # 1 , # 2 ; # 3 (
)
: , (, 1996; 27:172 )
()
(
,
, , +
+, +, -, , 2003 27:1080 ),

1993; 17:660 1992; 20:351

top

, 6
,

25%, 10%;
;
2003;13:551 ) : 36
- ( , 2002;
87:219 ), 53 25
( , 2003; 13:551 )
:
;

, /
;
;
, 2 + /10 ;
,
,

, ;

Micro images: various images ; uterine tumor with coexisting
choriocarcinoma : ;

focal hCG : -1 (18%), 1/3, 18, -
-, 63, - ( , 1999;
Pathol 2000;19:179 ) : (
, ,
), ,
(
, 2000; 19:179 )
References:
AJSP 1998;22:1393 , Mod Path 2006;19:75
1998; 22:1393 , 2006; 19:75
) :

top


HPV 18 and 16 ( 41 ),
, - 18 16

( , 1991;
23:119 ), (


( , 2002; 21:134 )
, ,


Case reports: 33 year old woman ; combined with signet ring cell
carcinoma ( Pathol Int 2004;54:787 ) : 33 ;
( 2004;
54:787 )


,
, ,
, ,
;
;
(.
, , ),
,

-
Micro images: various images ; sheets of cells with abundant

lightly stained cytoplasm ; cells have distinct cell border and
prominent nucleoli ; nests of glassy cells separated by
eosinophil laden stroma ; eosinophils infiltrating into nests ;
focal glandular differentiation : ;
;
;

; ;

: + , ,
,
: 63, 45, ()
,

( 1991; 96:520 )
;
( , 1983; 51:2255 )

( ,
,
,
)
References:
Archives 1982;106:250
1982; 106:250

top
)
, 21 62


, , ( , 2003; 22:226 )
component ( Gynecol Oncol 1998;68:69 ), presenting as carcinomatous
meningitis , with well differentiated adenocarcinoma :
3 ( 2005 36:1096 ),
( 1999, 31:158 ), (
, 1998; 68:69 ),
,
,
; ,
, ;
,> 10 /10
; ,

Micro images: trabecular pattern with mitotic activity ; with
adenocarcinoma in situ ; metastatic to bone marrow ; keratin+
(MNF116) in paranuclear dot-like pattern ; synaptophysin+
: ;
; ;
+ (116) ;
+
(116) ;
, (
, 2005 15:646 ), 1 ( 2004; 57:48 ), (
2003; 47:799 )
: 2 (), ()

2002;55:108 ) : 16 18 (
2002; 55:108 )
Molecular images: HPV16+ by ISH : 16

+
,
References:
AJSP 1997;21:905
1997; 21:905

top

+ ( , 1997; 80:91 ) - -
( 2002; 126:1501 )


, -( 1993 99:195 ), 44
, - - + ( , 2005 97:716 ), -
+ ( 2001 32:135 ), (
, 2000; 19:179 )
, ,
;
; ,

-
Micro images: syncytial pattern of cells with prominent nucleoli,
atypical mitotic figure ; H&E and stains ; CD45+ infiltrating
lymphocytes :
, ; &
; 45 +
vagina - well circumscribed tumor ; large epithelioid cells with
prominent nucleoli in inflammatory background -
;

bladder - image#1 ; #2 ; AE1-AE3 positive - # 1 , #
2 ; 1-3
63, 53, -1; , 2
), 2, ,
+ ( 2003;
50:8 ) , 40
,

References:
AJSP 1985;9:883 , Archives 2000;124:746
1985 9:883 , 2000; 124:746

top
() ,
,

, 35 72
, ,


" " ,
( )
( +
7 + --, 2001; 25:379 )
2004;28:601 ) (
2004; 28:601 )
( 2004 128 begin_of_the_skype_highlighting
2004 128 end_of_the_skype_highlighting:1179 ), 18 (
1988; 26:137 ), 55

(), , , ; ;
,

, ;
;
; ;

Micro images: figure 1: 3 cm polypoid mass; 2: prominent tubule
formation; 3: stroma shows minimal desmoplasia; 4: CD10+
: 1: 3 , , 2:
, 3:
, 4: 10 +
1/3, 5.2, 1, 7, (100%), (88%),
(70%), 10 ( 2003 27:178 ),
(33%), (30%, ), -67 (15%)
, ,
DD: :
debris -
, ,
, / ,
,
, , +,
- ,

-
;

References:
AJSP 1995;19:1158
1995; 19:1158
top

than cervix

, , ( 2003; 127:1586 ), ,
,

( )
endocervical glands


2005 99:232 ), ( , 2003; 13:555 ),
( 1999; 20: 416 ,
1999; 83:57 ), (
, 1998; 71:461 )
;
,
-
Micro images: breast carcinoma metastatic to cervix (AFIP)
:
()
#4 ; ER ; PR ; GCDFP-15 ,
,
, - # 1 , # 2 ; # 3 , # 4 , , , -15

top

STK11 gene) , (,
,
, , ,
; 11 )
Usually HPV negative (
Gynecol Pathol 2005;24:296
Mod Path 1998;11:11 , Mod Path 2005;18:528 , Int J
) (
1998
11:11 , 2005 18:528 , , 2005; 24:296

,
( 2003; 53:440 )
Laparosc 2003;10:119 )
( , 2003; 10:119 )

/

Gynecol Oncol 2002;84:339 ) : -
( , 2004 92:337 ), > 10 ,
( , 2002; 84:339 )
( )
snouts; often has mitotic figures; often glands are close to thick-
walled vessels (within thickness of vessel wall, Int J Gynecol Pathol

( -) ;

;
,
, 50% /
, ,
,
( , ,
2005; 24:125 ) ;

-
Micro images: endocervical type ; malignant cells merging with
normal endocervical cells ; nonspecific type #1 ; #2 ;
endometrioid-type glands deep in cervix #1 ; #2 ; #3 ; various
images : ;
;
# 1 , # 2 ;
# 1 , # 2 ; # 3 ;
: - 2.5 ( /
), 1073 ( , 75%, 2004 17:962 ),
+ (
2005 46:130 ), ()
2.5 ( ), 53, 10,
: 11 ( 2003; 83:35 )
( , 1999; 23:375 )

2005;24:391 ), tunnel clusters (little variation in size, shape and depth of
glands) : (
; ,
, 1995 5:236 ),
( 1991; 15:1123 ),
( 2001 ; 109:546 ), (
,

, , 2000 19:322 ),
( , 1999 ; 23:166 ),
( ),
(

,
,
2005; 55:412 , 1999; 23:886 ),
( ; ),
( , 2005 24:391 ), (
, )
References:
AJSP 1993;17:660 (early study) ,
1993;
17:660 ( ) , AJSP 2000;24:559 (mucin stains) , AJSP 1989;13:717 (analysis

of 26 cases) , Mod Path 2000;13:261 2000 24:559 ( ) ,
1989 13:717 ( 26 ) , 2000; 13:261
top
- ;

,
component


top
,

metastases 1
;

; -


; -
, ( , 1998; 70:289 )

bodies common :

, ;
, /
;
;
,
, ;

-
-
: -125 (75%), , (50%), 53 (40%)

References:
AJSP 1998;22:113 , Mod Path 1992;5:426
1998; 22:113 , 1992; 5:426
Small cell (neuroendocrine / undifferentiated) carcinoma of

cervix ( /
)
top
), ;

63 years) (
43 , 23 63 )
Associated with HPV-18 ( AJSP 1991;15:28 , Int J Gynecol Pathol 2004;23:366
); occasionally associated with Cushing syndrome or symptoms of
other peptide hormones 18 ( 1991; 15:28 ,
, 2004; 23:366 ),

lesion ;

prognosis 5 30-40%; 2 / 3
8 ( , 2004 93:27 ),
( , 2003; 97:568 ),

(
1996 9:397 ), 27 ( 1992 97:516 ),
( , 2001; 81:117
), ( 2000; 23:269 )
:

,

: ,

inflammation :
, ,
, ,
, ,
;
; 9%,
; ( /
),

() ; ;
(<10 %)
,
: ,

-
Micro images: sheets of small cells with scant cytoplasm and
hyperchromatic nuclei #1 ; #2 ; H&E :
#
1,#2;&
: -
, ; (80%),
(60%), (70%), , , 16
( 2004 28:901 ; 2003 34:778 ), 100, ();
56 , ( , 2005;
24:113 ) 1
2004;17:732 ) : 20, , 53, 63, 117/- (
2004; 17:732 )
: 3 11
;
(
),
, ( )
References:
AJSP 1988;12:684 , Mod Path 1991;4:586 , Int J Gynecol Cancer
2005;15:295 , Ann Diagn Pathol 2002;6:345 : 1988; 12:684 ,

1991; 4:586 , , 2005; 15:295 , 2002;
6:345

top

, 29 76

2003;90:23 ) ; (
, 2003; 90:23 )
2000;21:287 ), : (
2000; 21:287 ),

,
Micro images: bladder #1 ; #2 : # 1 ; # 2
actin : , 63, , -,

( )

top

( 1995; 19:1138 )


( , , 2004
47:71 ), ( 2004 54:63 ,
, 2003; 22:220 )
,
-

;
: 16 + ( , 1999; 74:361 , ,
1998; 83:521 )
,
References:
AJSP 1995;19:1138
1995; 19:1138

top

), 50% ,

) +
,
( 1993; 36:147 )
Oncol 1999;74:115 ) :
( , 2003; 90:478 ), 13
( 2000 7:1079
), 32 ,
( 1999; 20:35 ),
( , 1999;
74:115 )

transformation : ;

;


( )
; ,
-
; ;
, /
,
-
Micro images: various images ; squamous cells with central
keratinization but no fibrovascular cores ; bland epithelium with
at most mild atypia ; pushing margin ; other sites - penis #1 ; #2 ;
vulva : ;
;
; ;
- # 1 , # 2 ;
( , ),
(
, ),
/ (
)

top
Rare


( 1999; 87:183 )


: ( 2004 202
( , 2004; 92:64 )
( , ,
2006; 101:168 , , 2001 81:310 ),

endometrium :
;
, ,
;
; 43 /10
, , ;
;

-
Micro images: tumor extends throughout most of cervix ;
papillary fibrovascular cores lined by mildly atypical epithelium
#1 ; #2 ; #3 ; adjacent area of higher grade adenocarcinoma
:
;
# 1 , # 2 ; # 3 ,

( , 2002; 12:308 ),
( , ),
( ,
)
References:
Cancer 1989;63:1773 , Mod Path 2000;13:261
1989; 63:1773 , 2000; 13:261

()
top
in vulva
,

: ( 1998;
194:713 )
,
,
-
( )
top

,
( 1998; 5:939 )
, 40%
, (
. 1998 22:87 ), (
, 2002; 84:161 ), 6 ,
( 1998; 48:649 ) ,
( , 1986; 57:1197 ), (
, 1985 4:146 ),
( , 1976; 37:1725 )

;

,
; , ,
(,
, , ,
); 2 + /10 ;
;
; ,
,
Micro images: phyllodes tumor-like pattern #1 ; #2 (more cellular

than adenofibroma) ; uterus, not necessarily cervix - with dilated
glands : #
1 , # 2 ( ) ; ,
-
: , ,

References:
Hum Path 1981;12:579
1981; 12:579

top
Gynecol Cancer 2004;14:1024 ) : 37-
( , 2004; 14:1024 )
:

top
1983 ( 1983; 7:463 )


2003;34:1072 ) ,
( 2003; 34:1072 )
, 60 20 ,


,
; ; /
,
-
# 1 , # 2 ; # 3 ;
: , , ,
; 13, ,


, , ,

References:
Hum Path 1985;16:621
1985; 16:621

top
Very rare

,
1989; 113:1179
), 39 (
), 8 ( 1993; 43:204 )
, 2005 24:131

, ,

;
, ;
,
; +
;
Micro images: nests of tumor cells with PAS+ crystals #1 ; #2
: -+ #
1;#2
HHF35 : - , 100,
3 ( );
, , , 35
100 ()
: (, 17) (. 11; 25) - 3-


;
6 ,
10 ,
,
, (
, , +
, ),
( 100 +
; , +
)
References:
Mod Path 1989;2:676
1989; 2:676
top

(5
70% ),

1998;17:83 ) :
end_of_the_skype_highlighting:1389 ), 21 (
, 2005 98:516 ), 36
( , 1998; 17:83 )

,
,
-
CD99+ : & , -
+ ; 99 +

: 99, , -
: , 45, ,
: (11:22) (24, 12) - /1

, ,
,
, , ,
, ,
top
( )
diagnosis ,

,
( , 1977; 40:3030 ,
, 1997; 23:261 )
6% ,
5
Cytol 1999;43:1124 ); in a child ( J Pediatr Hematol Oncol 1996;18:311 ), relapse
with abdominal tumor : 33
( , 2005; 98:493 )
- (
), ( 1999, 43: 1124

), ( 1996 18:311 ),

, 2004; 14:553

, ;

Micro images: various images (uterus, not necessarily cervix );
H&E ; (a) left - alpha-1-antitrypsin+; (b) right - chloroacetate
esterase+ ; thoracic lesion-various images :
(, ); & ; () -1- + () - + ;
-
CD68, CD43, CD45 : ,
, , 68, 43, 45
EM images: P-early promyelocyte, L-late stage granulocyte, MYmyofibroblast ; detail of promyelocyte - A is primary or
azurophilic granule; other granules have irregular or partially
extracted contents : - -
, - ;
- ,

,
1989;42:483 : 1997; 21:1156 , , 1992; 46:128 ;
1989; 42:483
top
cervix ; <100 ,

2002;73:613 )
( 2002; 73:613 )
segment ,

40 60

,

Poor prognosis (
31:1176 )
Case reports:
Cancer 1973;31:1176
) (
, 1973;
, epithelioid tumors ( Gynecol Oncol

Gynecol Oncol 1998;69:169 ) : # 92 ,
( , 2005; 97:957 , , 2003 91:636 ),

( , 2001; 82:400 ),
( , 1998; 17:89 ), 10 , (
, 1998; 69:169 )
: ( 12 ), , ,
; ,

Gross images: tumor attached by short pedicle #1 ; #2-sagittal
section : # 1 ; # 2

features :
, , ; 5 +
/10 ; ,
,
-
Micro images: interlacing fascicles #1 ; #2 ; various images ;
large pleomorphic nuclei #1 ; #2 ; muscle specific actin ; smooth
muscle actin ; uterus-not necessarily cervix - leiomyosarcoma #1
; #2 ; #3 with bizarre giant cells ; #4 :
# 1 , # 2 ; ;
# 1 , # 2 ; ;
; # 1 , # 2 ; # 3
; # 4
References:
Diagn Pathol 2006;18:30
2006; 18:30
Lymphoma of cervix
top
(<100 )
40 ; 20 80-
;

2005;193:866 ) (
2005; 193:866 )
Path 2000;13:19 )
( 2000; 13:19 )
: 83% , 29%

and to classify

:
begin_of_the_skype_highlighting 2000 124 end_of_the_skype_highlighting:1510 ) #
2 ( 2002 43:203 ),
( 2005 201
/
( , 2004 92:974 ), -
( 2002, 6 : 125 )

- 3
( 2005; 26:36
) ( , 2003; 22:289 ),

( , 2005; 98:484
)
( ), ; , -

-
Micro images: diffuse large B cell lymphoma #1 ; #2 ; #3 ; #4 ; #5
(CD20+); marginal zone lymphoma; high grade MALT presenting
as endocervical polyp ; NK lymphoma :
# 1 , # 2 ; # 3 , # 4 , # 5 (20 +)
;
;
,
(
, , 2005; 99:481 ,
2001 97:235 ), (
, , 68,
)
References:
AJSP 2005;29:1512 (gynecologic lymphomas
2005 29:1512 (
) :

()
top
homologous)
( )

, <100 ,

;

50 65 , 12 93
,
Case reports: with adenoid cystic carcinoma component (
AJSP
),
( 1995; 19:229 ,
, 1998; 17:91 , 2000; 21:292 ),
( ,
2002, 21 : 186 ), (
, 2002; 12:223 ), (
, 2005 31:404 ), (
1988; 19:605 ), ( ,

( , 1983; 16:422 ), 12
( 1988; 9:365 )
1995;19:229 , Int J Gynecol Pathol 1998;17:91 , Eur J Gynaecol Oncol 2000;21:292

(
, 2005; 97:442 )

;
,
;
, ,
,


, ( ,
1998; 17:211 )
, 50%, ,

-
actin, desmin : - ,
, (); ,
: 8 / 8 ( 2001;
25:338 )

Melanoma of cervix
top
<100 ,

2005;40:183 ) 5
40% ( ,
1989; 32:375 , 2005; 40:183 )

: 39 (
, 2005; 42:201 ), 67 (
2003; 23:1063 ), 63 100
( , 1999; 18:265 ), 33
( , 2001; 80:409 ),
(
( ) 2000; 12:234 )
Gross images: melanoma of vagina with extension into cervix
:
malignant cells. :
; <50%,
; .
-
Micro images: small cell variant (common in vagina) ; epithelioid
cells ; prominent junctional activity ; vaginal melanoma
extending into cervix ; various images in advanced tumor
: ( ) ;
; ;
;

: 100, 45, , -67 (
)
, 45, ,
, )

()
top
PEComas:
) :
2 ( 2005; 29:1558 )
large study with 2 cases in cervix ( AJSP 2005;29:1558

: + ( 1999; 30:483 )
top
Rare in cervix
) : 38 ( , 1989; 68:279 )
-
( 1983; 43:40 )

()
top
,
( ),
()
,
prognosis

with anaplastic (pleomorphic) subtype ( Arch Gynecol Obstet 2004;270:278
), 17 year old woman with botyroid subtype and recurrence after
-
( , 2005 99:742 ), 19
( , 2004 95:243 ), 13
() ( 2004 270

( ; 43:475 ), 46
( , 2004; 23:78 )
Gynecol Oncol 2003;91:623 ) - 39
( , 2003; 91:623 )
: ,
( , 2004; 163:452 , ,
1999; 80:403 )
( )
,
Gross images: embryonal rhabdomyosarcoma with gray surface
and hemorrhage ; bladder tumor with polypoid masses
:
;

-
;
,
, ,
; ,


, ,
Micro images: embryonal rhabdomyosarcoma-various images ;
cambian layer and edematous stroma ; edematous stroma ;
cambian layer (vaginal botyroid tumor) ; tadpole and strap cells ;
cross striations :
- ;
; ; (
) ; ;
-
, , ,
, 1 1, (
, , , 2005; 8:427 )
: , ( ,
, , -
),
( , , 1,5 ,
, , ,
)
References: :
Radiographics 1997;17;919 1997;
17; 919

top
years) ( 54 , 29
72 )
;
( 2005 9:101
), (
2000 88:103 ), (
, 2000; 79:120 ), Gynecol Oncol 1985;22:105 , 1985; 22:105
;

- - & ; & , 10 +, +, +

-
( )
Teratoma of cervix
top
Very uncommon

( 2003; 53:327 ),
( 1995; 119:848 ), +
(
, 1996; 60:475 ), 13 (
1990; 11:37 ), (
1990; 16:363 ), (
2003; 127:759 )

,
, , ,
;
Micro images: epidermal elements and fat ; endocervical cystic
gland, nerve tissue, cartilage (arrow) ; figure 1: squamous
epithelium and adipose tissue; 2: mature neural tissue; 3:
cartilage : ;
, ,
() ; 1: , 2:
; 3:

( ),
( ),
,

top
(<10 )
( 1985; 109:371 ), 13
7 , ( , 2000 76:107 ), 12
(
, 1999; 21:548 ), 11 (
, 1998; 17:277 )

: ,
- # 1 ; # 2
, )
top



-
(
, 1993; 23:57
),
, 1996; 33:43

, ,
(-), ( )
; - (
)
Micro images: microcystic pattern ; festoon pattern with SchillerDuval bodies : ;
-
Miscellaneous

top

;


( 2005; 25:41 )
top
:

(
)
carefully) (
)

, ,


, , 3
, ,
1-3
,
: ;

top
, -
uniformity , (
)

has started
,

,
7. , 2008
top


( )
(
)
(.
);
5,0
7.0 ; (
)
3,0 7.0

less 12 ( 2):
3,0 5,0 7,0



1 ( 2)

4,0
,

):

4,0

( ):
,

pelvic wall 3 ( ):
,

,
( 4)

- - 1
( )
top



:
top
( ,
,
, , )
Stage grouping
top
Stage 0: T1s N0 M0 0: 1 0 0
Stage I: T1 N0 M0 : 1 0 0
Stage IA1: T1a1 N0 M0 1: 11 0 0
Stage IA2: T1a2 N0 M0 2: 12 0 0
Stage IB1: T1b1 N0 M0 1: 11 0 0
Stage IB2: T1b2 N0 M0 2: 12 0 0
Stage II: T2 N0 M0 : 2 0 0

Stage IIA1: T2a1 N0 M0 1: 21 0 0
Stage IIA2: T2a2 N0 M0 2: 22 0 0
0 3 0
Stage IVB: M1 : 1
Drawings: cervix staging diagram (upper row) ; WHO reference
for FIGO staging ; National Cancer Institute (USA) reference for
staging : (
) ; ;
()

Editor's note
Cone biopsy
top
(: 12-3, 3-6, 6-9 9-12
/ , /
)
( ,
)
Tumor grade
(): - -


) ()
-
( , ) __

(
)
-
( , ) __

(
)
- (
, ) __

(specify grade) -
( )
Cone biopsy-optional features to report
top

, ,
: , ,

top
Specimen type
(: 12-3, 3-6, 6-9 9-12
/ , /
)
( ,
)
Tumor grade
pTNM / FIGO staging
features to report
top
Michigan

top
Fellowships
Conferences
Books
Affiliates
Home page
Cervix
2006
2003-2009, .,
( )
Home Page
See also Cervix-cytology , Uterus ,

Primary references
Cervix: embryology , normal anatomy, normal histology ,
metaplasia : ,
, ,
Inflammation: inflammation-general , actinomycosis , amebiasis ,
bacterial vaginosis , Candida/fungi , chlamydia , chronic
cervicitis , CMV , Enterobius, granuloma :
, , ,
, / , ,
, , ,
Benign/non-neoplastic lesions: adenomyoma , adenosis , AriasStella reaction , atrophy , atypical polypoid adenomyoma , blue
nevus , cervical pregnancy , decidual nodule , decidual reaction ,
diffuse laminar endocervical glandular hyperplasia , ectopic
tissue/heterotopia , endocervical polyp , endometrial polyp ,
endometriosis , endosalpingiosis , florid deep glands , glial
polyp , hemangioma , inflammatory pseudotumor , inverted
urothelial papilloma , leiomyoma , lipoleiomyoma , lobular
endocervical hyperplasia , melanosis , mesonephric papilloma ,
mesonephric rests , mesonephric hyperplasia , microglandular
hyperplasia , myofibroblastoma , Nabothian cysts , necrobiotic
granulomas , neurofibroma , pagetoid dyskeratosis , papillary
adenofibroma , papillary endocervicitis , placental site nodule ,
post-operative spindle cell nodule , pseudosarcomatous
fibroepithelial stromal polyps , pyogenic granuloma ,
rhabdomyoma , squamous papilloma , traumatic neuroma ,
tunnel clusters / - : ,
, - , ,
, ,
, , ,
,
/ , ,
, , ,
, , ,
,
, , ,
, , ,
, ,
, ,
, , ,
, ,
, ,
,
,
, , ,
,
Premalignant/preinvasive lesions: HPV , condyloma , atypical
squamous lesion , SIL-general , LSIL/CIN I , HSIL/CIN II ,
HSIL/CINIII , SIL variants , endocervical glandular
atypia/dysplasia , adenocarcinoma in situ , radiation atypia ,
stratified mucin producing intraepithelial lesions /
: - , ,
, - , / , /
, / , ,
/ , ,
,

Carcinoma: WHO classification , squamous cell and variants ,
microinvasive squamous cell , adenocarcinoma and variants ,
microinvasive adenocarcinoma , adenoid basal , adenoid cystic ,
adenosquamous , basaloid squamous cell , carcinoid , clear

cell , endometrioid , epithelioid trophoblastic tumor , glassy cell ,
large cell neuroendocrine , lymphoepithelioma-like ,
mesonephric adenocarcinoma , metastases to cervix , minimal
verrucous , villoglandular papillary adenocarcinoma , warty
: ,
, ,
, ,
, , ,
, , ,
, ,
, ,
, ,
,
, ,
, , ,
, , ,

sarcoma/PNET , granulocytic sarcoma , leiomyosarcoma ,
lymphoma , malignant mixed mullerian tumor , melanoma , other
(case reports), plasmacytoma , rhabdomyosarcoma , stromal
sarcoma , teratoma , Wilm's tumor , yolk sac tumor /
/ : , ,
, / ,
, , ,
, , (
), , ,
, , ,
Miscellaneous: procedures , grossing , staging of cervical
carcinoma , features to report : , ,
,
Primary references
top
(7. .)
American Journal of Clinical Pathology (AJCP), August 1975 to
February 2006
(), 1975 2006
American Journal of Surgical Pathology (AJSP), March 1977 to
January 2006 ,
(), 1977 2006
Archives of Pathology and Laboratory Medicine (Archives) , June

1976 to January 2006
(), 1976 2006
( ), 1974 2006
( ), 1988 2006
Kurman: Tumors of the Cervix, Vagina, and Vulva (AFIP, 3rd
Series, Vol 4) : , ,
(, 3. , 4)
Rosai, J: Ackerman's Surgical Pathology (9th Ed); Mosby, 2004
, .: (9. ), ,
2004
Sternberg, S: Diagnostic Surgical Pathology (4th Ed); Lippincott
Williams & Wilkins, 2004 :
(4. ); &
, 2004
Website: Histopathology and cytopathology of the Uterine Cervix
Digital Atlas :
-
: ,

Cervix-embryology ,
top
54.
,


,

;
77
and 105
91 105

top

)
2,0 2,5
--

():
:


;
,




,
Drawings: local anatomy ; microanatomy ; saggital section of

local anatomy #1 ; #2 ; uterus, cervix and vagina #1 ; #2 ;
vasculature : ; ;
# 1 , # 2 ; ,
# 1 , # 2 ;
;
References: ASCCP :
top


: ;

;

, ; ,
,
/
;


:
; ;
,
,
;

;


;
, ( 1985; 109:200 )
( ):
/ ;
;
;

: ,
/ ( )
-;

:

infiltrate : ,

,
,
; / ,
;
,
;

Drawings: location of glandular and squamous epithelium
:
Gross images: squamocolumnar junction :

: ( & , , ) ;
# 1 , # 2 ; # 3 ; # 4
# 1- , # 2 ; # 3
endocervix (H&E, stains, EM ); endocervix #1 ; #2 ; #3 ; #4 ; #5 ;
infoldings resemble glands ; endocervical canal (whole mount) ;
normal exocervix ; squamocolumnar junction ; cervical
myometrium #1 ; #2 ; myometrium and adventitia ; prepubertal
squamous epithelium shows only basal and parabasal cells with
no maturation ( & , , ); # 1
, # 2 ; # 3 , # 4 , # 5 ; ;
( ) ; ;
;
# 1 , # 2 ; ;


-
References: ASCCP :
top
progeny commit

Not neoplastic
:
,

top
Very rare

, 41 62
37 ( 2000; 36:60 )
,
;
,
/ ;
, ,
References: :
1997; 16:99
top
Very rare
( 1974; 44:53
)

2004;128:1052 ) : 44
( 2004; 128:1052 )
,
Micro images: (1) with sebaceous glands ; (2) figure 1: cervix
covered by keratinized squamous epithelium with prominent
granular cell layer; 2: stroma has mature sebaceous glands; 3:
sebaceous cells are surrounded by epithelial cells :
(1) , (2) 1:

; 2: ,
3:

top
epithelium : ,
;
,
,
, ,
, ,
( ),

-
Micro images: immature squamous metaplasia ; with mild atypia
: ;
top


Gynecol Pathol 1986;5:163 ) : ( 1985,
9:551 ), (
, 1999; 74:504 ),
( 1993; 58:481 ),
( , 1986;
5:163 )

top

,

( )
;

( )

associated with prolapsed uteri (see pagetoid dyskeratosis below)
: ,
(
)
, ;
, ;

;
-
Micro images: various images ; early metaplasia ; involving
clefts ; with cytoplasmic vacuoles : ;
; ;

top
,
injury ;

: -
( ,
, , ),
(
,
, ) (
, , ),
; ;
, ,
,
,

,
,
,
, (
103:618 )
1995;

-
Micro images: tubal metaplasia #1 ; #2 ; #3 ; #4 ; #5 (bcl2+)
: # 1 , # 2 ; # 3 , # 4 , # 5
(2 +)
: (
)
( , ,
-67 ), (
,
; ,
, )
References: :
Archives 1993;117:734 , Mod Path 2000;13:261
1993; 117:734 , 2000; 13:261
top


androgen exposure

23
( , 2004; 23:182 )

,
,
, / /

-
Micro images: : urothelial metaplasia #1 ; #2 ; #3 ;
#4 (serotonin+) ; transitional metaplasia and atrophy after
androgen treatment #1 ; #2 # 1 , # 2 ;
# 3 , # 4 ( +) ;
# 1 ; # 2
: 20 ( )
, )
References:
AJSP 1997;21:510 , Mod Path 2000;13:252
1997; 21:510 , 2000; 13:252
top
, ,

;
, ()
,

;
,
;

Micro images: reactive (inflammatory) atypia #1 (various imagesmainly ectocervix) ; #2-endocervix ; #3-transformation zone
: () # 1 (
- ) ; # 2- ; # 3
top
,
( 1999; 180:265 )
11%,
( 1994; 39:585 , , 1983; 17:1 )

,
,
;
,

-
Amebiasis of cervix
top
1992; 46:759 ,
1987; 25:249 , 1985; 109:1121

carcinoma : ;

Micro images: various images (not cervix), figures 1-5 ; clusters
of trophozoites (liver) : (
), 1-5 ; ()
Bacterial vaginosis
top
Candida / fungi /
top

top
() , 4

, , , /

(, )
( ,
)
Causes infertility
,
/ ( 2000; 124:840 )

( , 2005; 142:914 )
: (
, ), ,


-
:
Chronic cervicitis
top
( )
, , ,
()
, , ,

;
(), , ,

; ; ;

-
CMV of cervix
top
) ( 2004; 57:691 )
+ ( , 1999;
59:469 )

; ,
, ,
, ,
,

Micro images: intracytoplasmic inclusions #1 (endocervical
cells) ; #2 (endothelial cells) ; CMV+ glands and stroma ;
associated acute inflammatory infiltrate ; intracytoplasmic
vacuoles within endocervical glandular cells ; fibrin thrombi
within small vessels ; not cervix - lung #1 (Giemsa stain) ; #2 ;
# 1 ( ) ; # 2 ( ) ;
+ ;
;
;
, - # 1 (
) ; # 2 , ; ;
-
top
-
top
,


,

1997;108:510 )
( 1997; 108:510 )
( , 1990; 66:380 )

-
top
Rare

( 2002; 117:771 )

endometriosis ( )

: ( , 2002; 21:191 ,
1992; 21:282 ), ( 1981; 84:215 )
Micro images: (1) xanthogranuloma (ceroid granuloma) ; (2) A:
PAS+; B: Perls' iron stain+; C: Ziehl-Neelsen (acid fast)+; D:
Schmorl's reagent (melanin)+ : (1)
( ) , (2) : + :
' + : - ( ) + :
() +
-
: ( 1995; 48:1057 )

()
top
physicians in one study ( J Clin Virol 2005;33:25 )
, 3% (1), 8% (2)
( , 2005; 33:25 )


epithelium :
, ;
(
) ;
,
-
margination :
;

molding) : (
)
top
;


: 37

( , 2005 99:481 ), + (
, 1992; 46:69 )

sclerosis : ,
, ,
;
; ,
, , ,

Micro images: dense lymphoid infiltrate with germinal centers
:

-
2001;97:235 : , 1985 4:289 ,
2001; 97:235
top
Trop Med Hyg 2001;65:233 )
( 2001; 65:233 )
(
, 2004; 23:403 )
Archives 2003;127:1637 ) : 27
( 2003; 127:1637 )
; . mansoni in ectocervix ; figure 1/2: calcified
eggs; 3: terminal spine ; various images (rectal mass)
; 1 / 2: , 3:
; ( )
-
79:193 .
Syphilis of cervix
top


1995;104:643 )
( 1995; 104:643 )

abundant plasma cells ; dermal lesion with anti-T. :
# 1- , # 2 ;
; -. pallidum immunostain

-
top
-
top
Assoc 1995;93:167 )
( . 1995; 93:167)
( , 2002; 78:62 ),
( 2001; 75:269 )


: ,
Micro images: various images ; granulomas with giant cells ;

acid-fast bacilli #1 ; #2 (lung) : ;
; #
1 , # 2 ()
-

top
2000;19:258 )
( 10%
, 2000; 19:258 )
Path 1994;7:610 )
- ,
- (
1994; 7:610 )
Case reports:
# 91

: - # 1 , #
2;#3
References: :
Int J Gynecol Path 1998;17:193
1998; 17:193

top
-

/ -

top
First described in 1996 ( Mod Path 1996;9:220 ), although actually
very common and often overlooked 1996 (
1996 9:220 ),
, 21 55
()

,

1999;49:1019 ) : 44 ( 2001; 109:546 ,
1999; 49:1019 )
hemorrhagic : 1
8 , ,
(11-23 ), -,


;
, ,
;
; ;
, / ,

-
: + -67 + ( 20%),

( , , )
Adenosis of cervix
top
( )
Educ 1992;7:21 )

( 2003
(3): 004271 , 1992; 7:21 )

, - (
, 2005; 24:391 )
-
: 2004; 131:1639 ( 63 - )

top
1954;58:112 ) 1954 - (
1954; 58:112)


(10%) -

Gross: no mass :
, ( )
,

, , ;
, ,
;
,
, , / ;

enometrium but with cervical stroma ; nuclear enlargement and
hyperchromasia :
;

endometrium (not cervix) - pregnant patient (
) -
-
( ,
,
, / , )
2004 28:608 , 1992; 116:943
Atrophy of cervix
top
May resemble SIL
, ;
;
; ;
, ,
, ,

-

( -67 + 16 75-80%, + 31%,
. , 2005 9:100 ),
( ` ,
)
top
,
,
syndrome (<150 ),

, 21-73

May persist or recur, but does not metastasize; may have

increased risk for later carcinoma; may be contiguous with
adenocarcinoma ,
;
;
Case reports: with hyperprolactinemia ( Int J Gynecol Cancer
2001;11:326 ) : (
, 2001; 11:326 )
hysterectomy in peri/postmenopausal women, but with follow
up :
/ ,

: ; , ,
2 ,
;
: - ()
desmoplasia :
( ,
),
; (90%),
;
(< 3 10 );
adenocarcinoma -

hyperplasia, smooth muscle stroma and morules #1 ; #2 ; #3 ;
#4 ; #5 ; #6 ; #7 : -
,
# 1 , # 2 ; # 3 , # 4 , # 5 , # 6 ; # 7
-
activity : ( ), -67

( , , ,
), ( ,
, , )
References: :
AJSP 1996;20:1 1996; 20:1

top
1991;41:751 ) 2% ;
, (
, 1991; 41:751 )
2004;12:79 ) : 2 (
2004 69:411 ), (
2004; 12:79 )


, ;
,
Micro images: pigment containing nevus cells in cervical stroma
#1 ; #2 :
# 1 ; # 2
HMB45 : - (
), 100, 45
, -
, ( 1983; 107:87 )
( ),
( ,
), ( +
- , ,
)
References:
Hum Path 1985;16:79
1985; 16:79
Cervical pregnancy
top
,

( )
( , 2005; 84:509 )
retention (
), with Arias-Stella reaction (

) : 1800
( 2005 76:304 ),
( , 2003; 79:428 ),
( 2004; 191:364 ),
-( 1994; 38:218 )
Am J Obstet Gynecol 2004;191:364
Acta Cytol 1994;38:218


top
;
, ,
, ,

: - ,


top
/
carcinoma , , ,

Oncol 2005;26:499 ) : 28

( . , 2005 9:52 ),

end_of_the_skype_highlighting: 117 , 2005; 26:499

nuclei :
,
Micro images: various images ; ectopic decidual deposits in
lymph nodes : ;

-

top

First described in 1991 (
1991; 15:1123 )
AJSP 1991;15:1123
) 1991 (

, 22 48
7 (
1995; 45:283 )
: ,
, ,

` ; ;
,
; , /
( , 2002; 21:125 ),

( ,
, , )

top
cartilage islands

1983;61:261 )
( 1983; 61:261 )
: 38 (
1997; 16:291 ),
23
( , 2004; 23:182 ),
( 1996; 7:414 )
( )
References: :
2006;30:209 (#2) 2000 24:1224 ( # 1) , 2006 30:209 (#

2)
Endocervical polyp
top

30-59

,
Pathol 1993;13:415 ) :
( 2001 51:305 ), 5
( , 1993; 13:415 )

Gross images: polyp #1 ; #2 ; #3 : # 1 , # 2 ; #
3
() , ;
;
;
,
Micro images: whole mount ; various images :

;
-


top
occur in pregnancy
,


( 2003; 24:565 ),
( 1984; 29:837 )
Micro images: not necessarily cervix - endometrial polyp #1 ; #2 ;
#3 : -
# 1 , # 2 ; # 3
-
top
,

, 20 51
, &

Arch 2001;438:302 ) :
( 1994; 18:849 ), 47

( 2001; 438:302 )
# 2
: ,
- ,
, ;
, ;
,
;
; ,

Micro images: various images ; endometriosis :
;
-
Pathol 2001;20:173 ) : 10;
( , 2001; 20:173 )
( ,
), ,
References: :
Arch Gynecol Obstet 2005;272:289 , Int J Gynecol

top
/
, 29 64

, ,
;
Pathology 1997;29:426 ) :
, ( 1997; 29:426 )
References:
AJSP 1990;14:449
1990; 14:449
top


serous neoplasms
, ,


2002;33:944 , AJSP 1999;23:166 ) (
, 2002 33:944 , 1999; 23:166 )
1991;36:675 ) ( 2000; 45:526 ,
1991; 36:675 )
Micro images: not necessarily cervix - glands lined by tubal type
epithelium #1 ; #2 :
- # 1 ; # 2
-

top

:
,

, ,
,
References:
AJCP 1995;103:614
1995; 103:614

top

5
/ (
1983; 61:261 , 1980; 73:718 ), ,

Case reports:
# 135

;
;
, , ,

Micro images: polypoid mass of glia below endocervical surface
(AFIP) :
()
case of the week - #1 ; #2 ; #3 ; #4 ; #5 ; GFAP # 1 , # 2 ; # 3 , # 4 , # 5 ;
( ), -( ,
, 1985; 21:385 )
top

,
Micro images: cavernous hemangioma #1 ; #2 :

# 1 ; # 2

top
Very rare


( , 2005
98:325 ), 58 (
, 1994; 13:80 )
,

: - , ; ;


top

( 2002 6:49 )
( 1995; 19:1138 )
;
""
;
; ; /

Micro images: bladder - inverted papilloma #1 ; #2 ; #3 ; basaloid
appearance ; with squamous metaplasia : # 1 , # 2 ; # 3 , ;

Leiomyoma of cervix
top

, 8%

:
( , 2005 97:253 ),
( 2003 30:144 )
( , 1996; 62:119 )
1 cm or less : ,
; 1
( )
: ,
;
Micro images: spindled cells ; spindled cells in streaming

pattern : ;

-
top
,
, - # 1 , # 2 ; # 3 ; # 4
Lobular endocervical glandular hyperplasia of cervix, NOS

,
top
1999 ( 1999; 23:886 )

( 2000; 24:325 )
, 37 71

( 2005;
18:1199 )

;

/ ,
,
,
; ;
, , ,

-
: ( ),
(1083)
: ( , 2005; 24:296 )
( ,
, ,
, 2005; 55:412 )
Melanosis of cervix
top
: ( 1990; 93:802 )
,
,
;
,
DD: blue nevus :
top

adult women , ,

( . , 1998; 11:29 ), 18
(
2005 65:388 ),
( 1998; 51 : 875 )
: ,

; ,
,
: ;
borderline vaginal tumor in above case history - papillary tumor

with various epithelial types ; focal atypia due to stratification,
pleomorphism and atypical mitotic figure
-
;
,
125,
: 20, ,
References: :
Ultrastruct Pathol 2005;29:209 (EM findings)
, 2005; 29:209 ( )

/
top
()
, 1 / 3
;
( 1990; 14:1100 , 1991; 115:1059 )
1988;62:1594 ) ( 1994;
18:1265 , 2004 40:109 ),
( , 1988; 62:1594 )
,
;

Micro images: clusters of mesonephric tubules surround a
branching duct ; mesonephric remnants with hyaline secretion ;
cells are cuboidal with a distinct basement membrane ; complex
and deep duct with focal squamous metaplasia ; CD10+
:
; ;
;
; 10 +
-

: , 53, -67, ,
( , ,
,
, )
References: :
Histopathology 2003;43:144 (CD10) , AJSP
2003;27:178 (CD10) 2003 43:144 (10) , 2003 27:178 (10)

top
38 47 , 21 81
Benign

; ,
( , )
(,

);

;
,
, ,
, ,
Micro images: marked tubular proliferation but with lobular

architecture ; more nuclear variation than in mesonephric rests ;
bland glands deep in cervical stroma #1 ; #2 ; large ducts deep in
stroma with tufting :
, ;
;
# 1 , # 2 ;

-
,
,
References:
Gynecol Oncol 1993;49:41 ,
, 1993;
49:41 , AJSP 1990;14:1100 , Mod Path 2000;13:261 1990; 14:1100 ,

2000; 13:261

top
,
women
,

, ;
cells :
,
/ ;
, ;
;
, (
), , ,
, ,
,
Micro images: dense glands but no atypia ; solid pattern #1 ; #2 ;
possible involvement by HSIL :
; # 1 , # 2 ;
-
( )
(), 10,
(, , +),
( ,
, ,
, ),
(
, , ,
, ,
-67 +, , 1992; 16:1092 ,
, 2003; 22:261 ),
( "" ,
, + 2003; 7:180 )
References: :
AJSP 1989;13:50 (worrisome patterns) , Mod Path

) , 2000 13:261 ( )
top

55 58 , 23 80
,


vagina : , ,
3 ( 1 6 )


,
,
; ,

Micro images - breast : (1) epithelioid type #1 ; #2 ; #3 ; CD34+ ;
(5) figure 1: sharply circumscribed tumor with fibrous
pseudocapsule; 2: composed of bland spindle cells in
collagenous or myxoid stroma; 3A: CD34+; 3B: bcl2+; 4:
desmin+ (focal) - : (1) # 1 ,
# 2 ; # 3 , 34 + , (5) 1:
, 2:
; 3: 34 + ; 3:
2 + 4: + ()
(25%) : , , , 34, 99,
2, , (45%),
(25%)
: 100, , , - 117,

angiomyxoma : ,
,
2005;46:137 : 2001 32:715 , 2005 37:144 ,
2005; 46:137
Nabothian cysts
top

1999;44:567 )
, ,

( 1999; 44:567 )
( 1990; 14:895 )


1,5
Gross images: in situ #1 ; #2 ; Nabothian cysts #1 (arrows) ; #2 ;
#3 ; various images : # 1 , # 2 ;
# 1 () ; # 2 , # 3 ;
;
;

; , ,

: # 1 ; # 2


( , ,
, 1989; 8:340 )

top

( 1984; 8:841 )

top
Very rare in cervix
1996;88:699 , AJSP 1989;13:873 ) : 39
(
),
( 1996 88:699 , 1989; 13:873 )

Int Braz J Urol 2005;31:153 ) :
( , 2005; 31:153 )
Micro images: plexiform neurofibroma ; figure 2 :
; 2
top
proliferate


-

, ( 2000; 24:1518 )
Paget's disease :
, ,
;

: , ,
,
( ),
(, , -
"-" ),
( ,
; , ,
, ;
), - ,


top
,
: 55
( 2005 26:186 ), 46
(
88:135 )
1996;

: ; ,
5 ; , , -
; ,

;
;
; ,
, ; / ,

Micro images: glandular epithelium and connective tissue
proliferation ; adenofibroma-not necessarily from cervix
: ;

atypia) : ( ,
), (
)
top

;
, ,

;
; , ;
, (
, 2004; 47:178 )
top
Incidental finding; benign ( AJSP 1990;14:1001 )
; ( 1990; 14:1001 )
, ;
, ,
, ()
,
,
;
, / ;

Micro images: nodule just below surface with sparsely cellular
stroma ; cytoplasmic vacuoles and nuclear enlargement ; HLAG+ (not necessarily cervix) :
;
; + (
)
variable HPL : , ,
18, - 63;
(<8% )
(,
, ),
( , , ),

References:
Hum Path 1999;30:687
1999; 30:687

top

bladder ( J Urol 1990;143:824 ) / (
1995; 26:571 ), ( , 1990; 143:824 )
;

;
; ,
, ,


cervix

top
, 16 75
-

with recurrence , ,

, , , -
,
, (> 10/10 ),
;
,
-


delicate walls :
, ,
,
: ,
/ , ,
+ +
,
,
:
, ,
,

50% are S100+ :
, 50% 100 +
References:
AJSP 2000;24:231 , Cancer 1983;51:1148 (vaginal)
2000 24:231 , , 1983; 51:1148 ()
top
: ---,

: ,
,

top
:
,

-
-
Micro images: various images and stains ; kidney #1 ; #2 ;
various cardiac tumors : ;
# 1 , # 2 ;
: , , 1,
top
, ,


(, , ),


(
)
;
influence
, ()
, ()
, , ()
, ( ) + / +

,
,
,
;
-

, ,
, , ,
/
Micro images: squamous epithelium overlying fibrovascular
papillae ; not cervix - respiratory squamous papilloma ; GE
junction :
, ;
-
desmin : , , ,
,
( ),
(, ; -67 -
, 2000 24:1393 ), ,
,
, , (
)

top


(
),

,
( 1989; 113:945 )
55% , (
1996; 28:153 )
scar : 2




top

:
(), ,
;
;

; ;
,
; ; ,

activity : ;
;
, ,


, , 2
; ,
/
Micro images: tunnel clusters (type B) with sharp
circumscription #1 ; #2 with dense secretion :
( ) # 1 ; # 2

: , -67 ( )
( , /
)
References:
AJSP 1996;20:1312 (type A with atypia) , AJSP 1990;14:895 (early

1996 20:1312 ( ) , 1990; 14:895 ( ) , 2000
13:261 ( )

/

()
top
(,
)
60 + ; , 55

epithelium ;

/ :
4

,
,
( -)
, -

without HPV
(
1990; 114:1038 ),
1:S25 ) -6 53; -7
() ,
,
( , 2005, 32 1: 25 )
grade SIL): 6, 11, 40, 42, 43, 44, 54, 61, 70, 72, 81, CP6108
(
): 6, 11, 40, 42, 43, 44, 54, 61, 70, 72, 81, 6108
Dis 2005;9:154 ) (
): 16, 18, 31, 33, 35, 39, 45, 51,
52, 56, 58, 59, 68, 73, 82; 26, 53 66 "
" ( , 2005; 9:154 )

; 18 +
,
( 2006;
20:253 )
- 16 18 200
2 ( 2006;
125:114 )
present : - ,

adenocarcinoma :
( + ),

, ,
, (),
-
Micro images: :
HPV immunostains - normal cervix has some HPV background
staining ; cervical condyloma is HPV+ ; LSIL/CIN1 ; HSIL/CIN2 ;
HSIL/CIN3 ; carcinoma -
- ;
+ ; /1 ; /2 ; /3 ;

: -67 ( - +
,
)
:
(" ") ;
( 1990; 14:643 )
: -

organization : 2003; 127:935 ( ) ,

top
,


Benign
spontaneously

: ,

8% are multiple :
, 8%
, ,
, ; ;
, , (
) ( )
excrescences ; cervical condyloma is HPV+ :
# 1 , # 2 ; # 3 , ;
+
-
6 11 70-90% , -16

top


-6 11 ( 1992; 5:391 )
endocervix : ;

:
,
; ,

; , /

Micro images: papillary immature metaplasia ; p16 negative
(page 2) : ; 16
( 2)
-
: -67
, ; 16
: 6 11
;
,
( . , 2001; 16:762 )
, ( ,
, -67
), ( ,
)
References:
Hum Path 1998;29:641 , Mod Path 2000;13:252
1998; 29:641 , 2000; 13:252

top
( , , )

(5 )
(0-2) : ,
, , ,
1 / 3 , 16 +
2 / 3 , -67 + 2 / 3
( 2005; 123:699 )
2-3% ,
/ , ,
, ,
, / ,
;

;
-

top
visible abnormality



,
-

(<10%) - ( ,
)
1983;51:2214 ) :
( , 1983; 51:2214 )
;

;

; , /
; ,
;
, ,

Micro images: image1 ; image2 : 1 ; 2
cervix : -67 ,

risk HPV : 2 / 3
-; -
, ( )
2000;13:252 : 1999; 30:345 , 1999; 30:1161 ,
2000; 13:252
Squamous intraepithelial lesions (SIL) of cervix-general

()
top
, 20

one study)
( 26 )
HPV infection)
( 17 ,
, )

( ),
,
, ,
, (
)
, ,


; ,

regress -

prognostic factor 3


/ (
, 2005; 97:1816 )
, 2 / 3 , 1 / 6 , 1 /
6
, , 1 / 3 9 ,
16, 18, 31, 33; 30-39 ;
0,2% ;
()


, , , ()
() - ,
, -, () ()
( ) -
:
, , , ;

( 2005;
121:226 )
: (
), ,
,
( ),

1999;12:233 ) :
, ,
( 1999; 12:233 )
;
;


,
;

;

,
,
-
systems / : # 1 # 2 ;

2 / 3
( 2002; 26:1501 ) -1
,
( 2001; 25:884 ) -1
( 2002; 26:70 )
LSIL / CIN I / low grade dysplasia of cervix / /

top
epithelium () ,
() (
)
-;

: ,
- ( , 2005; 105:253 )
16- / ( ,
2005; 97:1066 )
Micro: :
:
,
,
,
,

,
;


(2 +
,
),
;
; ,

,
,
-
;
+

- ( 1998; 29:1068 )
():
, , ,
( , 1993 6:313 ),

; / ,
,
;
-
koilocytosis #1 ; #2 ; #3 with markedly enlarged bizarre nuclei ;
#4 ; Cdc6 and MIB-1 (figures C, D) : ;
; # 1 , # 2 ; # 3
; # 4 ; 6 -1 (
, )
crystalline array :
;

DD of LSIL: :
: ,
; ,
,
,
, ;
;
,
, ,

Path 1995;8:408 () :
/
, ,
, ;
, - ( 1995; 8:408
epithelium () :

atypia ()
: ,
,
References:
AJSP 2002;26:1389 (p16)
2002; 26:1389 (16)

/
top


;
1 / 3 2 / 3
, / ,
, ,

-
Micro images: various images ; H&E #1 ; #2 ; #3 :
; & # 1 , # 2 ; # 3

/
top
; 10-20%


, ,

1994;18:1265 ) :
( 1994; 18:1265 )
# 1 ; # 2

;
;
,
, ;
;
;
;
/
Micro images: various images #1 ; #2 ; #3 ; #4 ; #5 ; #6 ; #7 ; #8 ;

#9 ; involvement of endocervical glands ; at squamocolumnar
junction ; LSIL merging into HSIL ; Cdc6, MIB-1 (figures E, F)
: # 1 , # 2 ; # 3 , # 4 , # 5 , # 6 , # 7 , # 8 ,
# 9 , ;
; ; 6, - 1 ( ,
)
Virtual slides: high grade SIL #1 ; #2 :
# 1 ; # 2
-
: -1, 4 ( 2001; 32:1197 )
,
,
DD of HSIL: :
: (),
,
, , ,
, ;

: , ,
,
,

: ,
, ,
, ,
, -1 , -67/1 16
( .
, 2005 9:100 ), ,

,
, , ,
/ ,
: (
)
, ,

():

top

top

, ,
,

( ,
),

top



-
,
, /
,
, ,
;

16, 1 , -
References: :
AJSP 2004;28:1474 2004; 28:1474

/
top
( )

-



( 1992; 79:101 )
2000;31:656 , AJCP 1998;110:200 )
( 2000 31:656 , 1998; 110:200 )
1997;16:99 ) :

, ,

, ,
, ;
( 1997; 16:99 )

,
, , ,
;
; /
,

-
Micro images: reactive glandular atypia #1 ; #2 ; low grade

intraepithelial neoplasia/dysplasia ; glandular dysplasia-various
images ; glandular dysplasia #1 ; #2 :
# 1 , # 2 ;
/ ; - ;
# 1 ; # 2
Positive stains: p16 (in dysplasia, Hum Path 2004;35:689 , but not
atypia or reactive lesions, AJSP 2003;27:187 ) :
16 ( , 2004 35:689 ,
, 2003; 27:187 )
, , -,
, ,

: 2003 27:452 ( ) , 2000; 13:261

()
top
(
)
35 40 , 27
74
50-90% of cases -16 18 ( , 2006;
94:171 ) 50-90%
disease
;

,

Week #202 ) : (
), 30
)
# 202

(
,
);
junction : ,
,

,

,
, ,
, ,
( 18/10 ); (
16/10 ); ;
, (
, ,
- ,
), ;
;
( )
( , 2005; 24:125 );
, ,

-
Micro images: various images #1 ; #2 ; endocervical type #1 ;
#2 ; #3 ; #4 ; #5 ; #6 ; : # 1 , # 2 ;
# 1 , # 2 ; # 3 , # 4 , # 5 , # 6 ; endometrioid
type #1 ; #2 ; #3 ; #4 ; #5 ; intestinal type ; adenosquamous type
#1 ; #2 ; with HSIL-#1 ; #2 ; #3 ; Cdc6, MIB-1 (figures A, B) ;
adenocarcinoma in situ ; #2 ; #3 ; #4 - with HSIL ; #5 - with HSIL ;
biopsy # 1 , # 2 ; # 3 , # 4 , # 5 ;
; # 1 , # 2 ; -#
1 , # 2 ; # 3 , 6, -1 ( , , ) ;
; # 2 , # 3 , # 4 - ; # 5 - ;
: ( ),
6 1 (6 , 2002 126
16 ( , 2004 35:689 , 2003 27:187 ),
(50%)
, 2,
(70% )
(
, ),
,
( ,
,
), - (
, , /
), (,
, , ),
( ,
; 10 +),
( , ,
), (
, )
: 1998; 22:434 ( ) , 2000; 13:261

top


,
;
; ,
;
; ,

, ,
; , /
, /
-
# 1 , # 2 ; # 3
References: :
, 1996; 15:242
Stratified Mucin producing Intraepithelial Lesions (SMILE)

of cervix
()
top
,




;
; ;

:
-1
63
: ,
References:
AJSP 2000;24:1414
2000; 24:1414
Carcinoma of cervix

top
Epithelial tumors

,
Keratinizing
Nonkeratinizing
Basaloid
Verrucous
Squamotransitional
()
/ ()
( ),

SIL ()
)
, )
( , , )
Squamous papilloma
Adenocarcinoma
(, , ,
, )
(
)
Glandular dysplasia
Mullerian papilloma
Endocervical polyp
Carcinoid tumor
-


Leiomyosarcoma
,

( )
Angiosarcoma

Leiomyoma
Genital rhabdomyoma

( )
Adenosarcoma
Wilms tumor
Adenofibroma
Adenomyoma
Melanocytic tumors
Malignant melanoma
Blue nevus
teratoma) ( ,
, )
)
Secondary tumors

top
, # 8 ( # 1
1940), # 1
(1
-, 13.000
, 2004; 100:1035 )
ages 45-55 years 51 , 30
, 45-55
Path 1999;30:626 ) : ,
( , 2003; 89:2078 ),
, ;
( 1999; 30:626 )
( ), ( , 2006; 118:1481
), , , ,

():
( ), 95%
, 90%
45, 51, 52, 56, 58, 59, 68 and others
: 16, 18, 31, 33, 35, 39, 45, 51, 52,
56, 58, 59, 68

: 6, 11, 42, 44 ( )
bound by Rb - 6 7 ,
-;
(
) , 16 18, 6 53 ,
; 7
()

HPV - , () -
() 10-15%
-
,


;

: , ,
,
, , ,
, ; -
; ;
( ,
1996; 27:904 ),
(
2005; 25:1663 )

: , ,

;
, , ,
, ;
, , ,
(1%)

( Gynecol Oncol 2004;92:974 ), : ( 1985
), (
2004
),
2004 104 begin_of_the_skype_highlighting 2004
),

( 2005;
26:499 ), - (
, 2005 97:976 ), / ( , 2004 ; 92:974 ),
2005;97:253 )
( , 2005; 97:253 )
104 end_of_the_skype_highlighting:1086 , 2005; 20:247

Radiother 2003;7:187 ) -
( 1992; 116:187 ),
( , 2004 94:825 ),
( 2005 53:645 ),
( 1999; 30:587 ), (
2005 7:26 ), ( 1995 8:307
), ( , 2005; 15:1183 ), (
, 2003 28:28 , , 2001; 11:244 ),
+ ( , 2001
11:78 ), ( , 2004; 97:301 , 2004
25:742 ), ( , 2003; 7:187 )
: (:
), , (
), ( -
; 5 23%;
- )
95%, Ib2-IIb: 80-90%, III: 50%, IV: 25-35% 5
1993-1995 : 1-1:> 95%, 2: 80-90%, : 50%, 25-35%
Gross images: barrel shaped cervix ; ulcerative tumor ; stage I

tumor ; tumor extending to vagina ; stage IV tumor with bladder
extension #1 ; #2 ; invading lower uterine segment ; squamous
tumor : ;
; ; ;
# 1 , # 2 ;
;
; ,
,
- ,
;
; (
1993; 117:199 ), - ( , , 1992; 2:152
), ( , 2003; 22:285 )
) / 3 ( , ,
2000; 10:95 )

:
,
, ,


,

,
; /
;
-
Drawings: evolution of invasive carcinoma from SIL ; lymphatic
pathways of spread :
,
Micro images: various images ; invasive tumor #1 ; #2 ; #3 ;
central keratinization ; resembling clear cell carcinoma ; margin
involvement ; Cdc6, MIB-1 (figures G, H) ; :
; # 1 , # 2 ; # 3 ,
; ; ;
6, -1 ( , ) ;
UC Irvine, California (USA) : squamous cell carcinoma #1 ; #2
,
, (): #
1;#2
Grading: well differentiated with prominent keratin pearl ;
moderately differentiated with invasion by nests and single
cells ; poorly differentiated spindled tumor with focal
keratinization ; poorly differentiated with markedly pleomorphic
nuclei :
;
;
;

: # 1 , # 2 ; # 3
involucrin : ( 100%), , (90%),
, (,
), 63 ( 2001 32:479 ), ,

1999;123:1098 ) : 53 (), 2 ,
(, 1999; 123:1098 )
,
,

; 16 3

( ,
),

( , / ; -),
(
, / , +),
( ,
, ,
),
(
, , ,
;
)
: , 2005, 4: 38 ()

top
;
for stage I is 54%)
(5 54%)
factors - ,

diagnosis ,


:
;

;
; ;
-
,
, ,> 25
, ,
,
Micro images: central cystic degeneration ; multiple keratin
pearls : ;

References:
AJSP 2001;25:1310
2001; 25:1310

top
stage I is 84%)
(5 84%)
mitotic figures :
,
;

: # 1 , # 2 ; # 3 ; # 4

top
,
( . , 2005; 9:149 )

( , 1998; 19:455 )



, /
, ;
,

Micro images: papillae covered by atypical basal cells #1 ; #2 ;
focal squamous differentiation ; infiltration of stroma
: # 1 , # 2
; ;

16 + ( , 1998; 83:521 )
References:
AJSP 1997;21:915
1997; 21:915

, ), (,
)

top

42%

, ,
, 60%


()
References:
Mod Path 1991;4:586
1991; 4:586

top
5 ( )
" (), " "
" "
(
,
, 2005; 98:183 )
than 7 mm), IARC :
5
7 1 (
3 ; 7 ) 2 (
3 , 5 , 7 )

1% 3 (
) 13% 3-5
, 6% 3 13% 5
( 2003; 24:513 )
, ;
( 2005; 112:807 )
positive margins :
; ,

( , 2005 15:88 )
-
- ), ,
,
(: ,

), , ,
(. )

: (
, 2004; 30:363 ),
<1 1 ( , 2003; 90:443 )
,
(

)
: ,

pseudoglands :
;
, , ,
, ,

,
( );
- ,

-
tongues of squamous epithelium with loose fibroblastic stroma
#1 ; #2 with differentiated overlying squamous epithelium ; #3 ;
#4 ; small invasive bud ; individual cell keratinization of invasive
angiolymphatic invasion ; angiolymphatic invasion confirmed by
factor VIII related antigen immunostain ; HSIL with focal necrosis
and nearby angiolymphatic invasion :
# 1 , # 2 ;
# 1 ; # 2
; # 3 , # 4 ;
;
; ;
;
;

Virtual slides: early invasive carcinoma :

(
), /
,
, -
,

top
women 5-15% ,


25% ,

,
( , 2004; 100:1035 )
( 5 ,
)




see Hum Path 2002;33:899 ) 16 /
( ),
( 2003 27:187 ,
2002; 33:899 )

, ;
, ,
Usually EBV negative (
( 1999; 123:1098 )
Archives 1999;123:1098

10%
: -79%, -37%, / - 9%
CA125 : (
> 5 , 2004; 14:104 ),
, ( , 2004; 92:262 ),
2 , 125
( 2005 193
( 2004 54:63 ,
, 2003; 22:220)

2005;96:857 ) -
( , 2006; 101:346 ), ( , 2005
15:561 ),
( , 2005; 96:857 )
),
, (
2004; 5:119 )
( )

; ,
,
:

;
, , ,
;

; ( 2005; 49:187 )
( , ,
):
(10% );
;
;
( ),

(11% 50% ),

; 50%
; ; ;

), ;
; ;
;
; ;

-
Micro images: various images ; poorly defined glands lined by
malignant cells ; malignant glands with necrotic debris #1 ; #2 ;
#3 ; poorly differentiated tumor #1 ; #2 :
;
; #
1 , # 2 ; # 3 ; # 1 ; # 2
, , , , 16, 25%, 53

: 10 (
), 63 ( 2001 32:479 ), ()
1996;106:52 , Br J Cancer 2005;93:1301 ) : -16
(
,
,
, ;
- /
; , ,
, 2002 26:998 , 2003 27:1080 ),
(
, , ),
(
),
(
,
, ),
(, ,
, 10 +, ,
)
References:
Mod Path 2000;13:261
2000; 13:261

()
top

;
,
( , ,
2005; 24:125 )
endocervical type cells ; colloid type with clusters of tumor cells
floating in mucin :
;

,
, ,
, , 2000; 19:322 )

top
, 34 78


;
; ,
;

, ,
, (
,
)
References:
AJSP 2000;24:369
2000; 24:369

See below

top
Rare
;
,
; ,
( 1990; 114:731 )
Micro images: intestinal type cells #1 ; #2 ; #3 ; A: H&E; B:
CDX2-; C: CK7+; D: CEA+; E: CK20- ; metastatic colonic
adenocarcinoma is CDX2+ :
# 1 , # 2 ; # 3 , &; : 2-: 7 + : + :
20- ; 2 +
( ; 2

top
;
: ( 2004 54:787 ),
( , , 1999; 9:433 )


-
Micro images: signet-ring type tumor cells ; A: H&E, B: CDX2-, C:
CK7+, D: CEA+, E: CK20- :
; : & , -2, : 7 + : + :
20Positive stains: CEA, CK7 : , 7
DD: metastatic adenocarcinoma from breast ( Gynecol Oncol 1998;71:461
) or stomach ( Cancer 1993;71:3472 , Acta Cytol 1997;41:291 ) :
( , 1998; 71:461 )
( , 1993; 71:3472 , 1997; 41:291 )

top
3-5
Excellent prognosis (
2001; 97:701 )
Obstet Gynecol 2001;97:701
) (

2004;14:104 ) (
, 2004; 14:104 )

, ,
, ,
,
Gynecol Oncol 1995;59:297 ) : 62
1
( , 2000 77:467 ),
( , 1995; 59:297 )
:
;
( , 2002; 85:327 )
;
; (
); ;

, ,

-
desmoplasia ; complex / labyrinthine pattern of malignant
epithelium ; buds of early stromal invasion :
; ; /
;

(50%)
definition : 2003 27:187 (16) , 2002 26:1389 (16) ,
/

top
, ( 60 71
, 30 91 ),
, (
1997; 27:437 )
; 16

metastases ; ,
, 4 (
2 10 ) , , /

( 1998;
22:965 )
( 2005 36:82 )
/
( 2001 25:338 , , 1998; 17:211 )
Archives 2004;128:485 ), with carcinosarcoma ( Int J Gynecol Pathol
2002;21:186 ) : 79
end_of_the_skype_highlighting:485 ), (
, 2002; 21:186 )
these lesions : ;

: ;

()

( )
,
;
; , /
,
; ( )

-
differentiation of small basaloid cells with scant cytoplasm and
hyperchromatic nuclei, bottom-true lumina may be present ; topCK17+, bottom-CK18+ ; figure 1: nests of basaloid cells with
overlying HSIL; 2: central squamous differentiation with
microcysts, plus nests of small basaloid cells with scant
cytoplasm and hyperchromatic nuclei ; various images (figures
1-4) ; nests of basaloid cells infiltrating the stroma ; squamous
differentiation and microcyst formation ; squamous
differentiation : ,
;

, -
; 17 + 18 + ; 1:
, 2:
,

; ( 1-4) ;
;
;

: 16 + ( 1997; 16:301 )
;
, ,
( , 2000; 33:241 )
( ,
, ,
+ +) ,
, (
,
, 7 + , 2005 55:445 ),
(
, )
References:
AJSP 1980;4:235 , Hum Path 2000;31:740
1980; 4:235 , 2000; 31:740

top
),
,
40 ( , 1989; 32:26
)
metastases

( 2001; 25:338 , , 2000; 21:292 )
2004;128:817 ) : 83
( 2004; 128:817 )
: ,
,
Gross images: contributed by Dr. Ihab Hosny, Ohio - image #1 ;
#2 : , - # 1 ;
#2
squamoid pattern :
/ ,
, ;
, ,
, ;
,

Micro images: cribriform architecture and basement membrane

material #1 ; #2 ; #3 ; figure 1: friable and ulcerated cervical
mass, 2: cribriform islands of basaloid cells with peripheral
palisading, high N/C ratio and scant mitotic activity; 3: focal
solid pattern; 4: infiltrating cords of cells within basement
# 1 , # 2 ; # 3 ,
1: , 2:

, / ;
3: , 4:

contributed by Dr. Ihab Hosny, Ohio : image #1 ; #2 ; #3 ; #4 ; #5 ;
#6 ; vascular invasion ; actin #1 ; #2 ; CEA #1 ; #2 ; EMA ; high
molecular weight keratin #1 ; #2 ; S100
, : # 1 , # 2 ; # 3 , # 4 , # 5 , # 6 ,
; # 1 , # 2 ; , # 1 , # 2 ; ;
# 1 , # 2 ; 100
other sites: esophagus ; salivary gland-various images as part of
case history : ;
-
: , , (
), 45,
100
Molecular: HPV16+ (
+ ( 1996; 49:805 )
J Clin Pathol 1996;49:805
) : 16

: ,
,
( 1982; 77:494 )
laminin, AJSP 1999;23:448 ) : (
,
, , 1999; 23:448 )
: 1988; 12:134 , , 1992; 11:2 (
)

top



,

: (
, 2004; 14:625 ), (
, 2000 76:409 ), ( ,
1999; 74:130 )

;

;
,

-
Micro images: various images ; poorly formed glands and
squamous components #1 (arrows) ; #2 ; #3 :
; #
1 () ; # 2 ; # 3
: 63 ( ), 7

,
,
,
( 2005 55:445 ),
(
), (
)

top
Aggressive behavior
,
;
, ,

( , 2002; 9:290 ) ,

Micro images: oral cavity ; skin : ;

,
top
2005;29:92 ) , 3 12-33% (
2005; 29:92 )


,
( )
2001;20:327 )
( ) (
2001; 20:327 )
1987;37:1183 ) : (
, 1989; 37:88 ), (
, 1988; 30:114 ), (
1987; 37:1183 )

Micro images: ribbons of tumor cells ; glandular features ; cords
and glands of tumor cells :
; ;

other sites - kidney ; small intestine - ;

;

top



( 1999; 84:4209 )
Micro images: various images and stains ; atypical carcinoid
tumor ; chromogranin+ atypical carcinoid tumor :
; ;
+

()
top
() -
( , 1978; 42:2435 )


children - (
1950, 1987; 316:514 ),
;
- 55% 5 40% 10
: ( , 2005 97:976
), ( 2000; 96:834 )
;
( , 2005; 97:296 )
( )
( );

, ;
( );
,
;
,

-
Micro images: various images ; clear cell carcinoma #1 ; #2 ; #3 ;
tubulocystic pattern ; approaching mesonephric remnants ;
vaginal tumor : ; # 1 ,
# 2 ; # 3 , ;
;
,
,
, ,

( 1976; 20:262 )
(,
, ),
( ,
), -(
, , ,
), (
,
),
(, ), (, ),
()


top

endocervical type

( , 2000; 89:1291 )
( )
( )

in situ : ,
;

&; ,

Micro images: branching glands whose cells lack mucin ;
stratified epithelium, cells have scant granular cytoplasm and no
mucin #1 ; #2 ; uterus, not necessarily cervix - endometrioid
adenocarcinoma #1 ; #2 ; #3 (invasive patterns ) :
;
,
# 1 , # 2 , , # 1 , # 2 ; # 3 (
)
: , (, 1996; 27:172 )
()
(
,
, , +
+, +, -, , 2003 27:1080 ),

1993; 17:660 1992; 20:351

top

, 6
,

25%, 10%;
;
2003;13:551 ) : 36
- ( , 2002;
87:219 ), 53 25
( , 2003; 13:551 )
:
;

, /
;
;
, 2 + /10 ;
,
,

, ;

Micro images: various images ; uterine tumor with coexisting
choriocarcinoma : ;

focal hCG : -1 (18%), 1/3, 18, -
-, 63, - ( , 1999;
Pathol 2000;19:179 ) : (
, ,
), ,
(
, 2000; 19:179 )
References:
AJSP 1998;22:1393 , Mod Path 2006;19:75
1998; 22:1393 , 2006; 19:75
) :

top


HPV 18 and 16 ( 41 ),
, - 18 16

( , 1991;
23:119 ), (


( , 2002; 21:134 )
, ,


Case reports: 33 year old woman ; combined with signet ring cell
carcinoma ( Pathol Int 2004;54:787 ) : 33 ;
( 2004;
54:787 )


,
, ,
, ,
;
;
(.
, , ),
,

-
Micro images: various images ; sheets of cells with abundant

lightly stained cytoplasm ; cells have distinct cell border and
prominent nucleoli ; nests of glassy cells separated by
eosinophil laden stroma ; eosinophils infiltrating into nests ;
focal glandular differentiation : ;
;
;

; ;

: + , ,
,
: 63, 45, ()
,

( 1991; 96:520 )
;
( , 1983; 51:2255 )

( ,
,
,
)
References:
Archives 1982;106:250
1982; 106:250

top
)
, 21 62


, , ( , 2003; 22:226 )
component ( Gynecol Oncol 1998;68:69 ), presenting as carcinomatous
meningitis , with well differentiated adenocarcinoma :
3 ( 2005 36:1096 ),
( 1999, 31:158 ), (
, 1998; 68:69 ),
,
,
; ,
, ;
,> 10 /10
; ,

Micro images: trabecular pattern with mitotic activity ; with
adenocarcinoma in situ ; metastatic to bone marrow ; keratin+
(MNF116) in paranuclear dot-like pattern ; synaptophysin+
: ;
; ;
+ (116) ;
+
(116) ;
, (
, 2005 15:646 ), 1 ( 2004; 57:48 ), (
2003; 47:799 )
: 2 (), ()

2002;55:108 ) : 16 18 (
2002; 55:108 )
Molecular images: HPV16+ by ISH : 16

+
,
References:
AJSP 1997;21:905
1997; 21:905

top

+ ( , 1997; 80:91 ) - -
( 2002; 126:1501 )


, -( 1993 99:195 ), 44
, - - + ( , 2005 97:716 ), -
+ ( 2001 32:135 ), (
, 2000; 19:179 )
, ,
;
; ,

-
Micro images: syncytial pattern of cells with prominent nucleoli,
atypical mitotic figure ; H&E and stains ; CD45+ infiltrating
lymphocytes :
, ; &
; 45 +
vagina - well circumscribed tumor ; large epithelioid cells with
prominent nucleoli in inflammatory background -
;

bladder - image#1 ; #2 ; AE1-AE3 positive - # 1 , #
2 ; 1-3
63, 53, -1; , 2
), 2, ,
+ ( 2003;
50:8 ) , 40
,

References:
AJSP 1985;9:883 , Archives 2000;124:746
1985 9:883 , 2000; 124:746

top
() ,
,

, 35 72
, ,


" " ,
( )
( +
7 + --, 2001; 25:379 )
2004;28:601 ) (
2004; 28:601 )
( 2004 128 begin_of_the_skype_highlighting
2004 128 end_of_the_skype_highlighting:1179 ), 18 (
1988; 26:137 ), 55

(), , , ; ;
,

, ;
;
; ;

Micro images: figure 1: 3 cm polypoid mass; 2: prominent tubule
formation; 3: stroma shows minimal desmoplasia; 4: CD10+
: 1: 3 , , 2:
, 3:
, 4: 10 +
1/3, 5.2, 1, 7, (100%), (88%),
(70%), 10 ( 2003 27:178 ),
(33%), (30%, ), -67 (15%)
, ,
DD: :
debris -
, ,
, / ,
,
, , +,
- ,

-
;

References:
AJSP 1995;19:1158
1995; 19:1158
top

than cervix

, , ( 2003; 127:1586 ), ,
,

( )
endocervical glands


2005 99:232 ), ( , 2003; 13:555 ),
( 1999; 20: 416 ,
1999; 83:57 ), (
, 1998; 71:461 )
;
,
-
Micro images: breast carcinoma metastatic to cervix (AFIP)
:
()
#4 ; ER ; PR ; GCDFP-15 ,
,
, - # 1 , # 2 ; # 3 , # 4 , , , -15

top

STK11 gene) , (,
,
, , ,
; 11 )
Usually HPV negative (
Gynecol Pathol 2005;24:296
Mod Path 1998;11:11 , Mod Path 2005;18:528 , Int J
) (
1998
11:11 , 2005 18:528 , , 2005; 24:296

,
( 2003; 53:440 )
Laparosc 2003;10:119 )
( , 2003; 10:119 )

/

Gynecol Oncol 2002;84:339 ) : -
( , 2004 92:337 ), > 10 ,
( , 2002; 84:339 )
( )
snouts; often has mitotic figures; often glands are close to thick-
walled vessels (within thickness of vessel wall, Int J Gynecol Pathol

( -) ;

;
,
, 50% /
, ,
,
( , ,
2005; 24:125 ) ;

-
Micro images: endocervical type ; malignant cells merging with
normal endocervical cells ; nonspecific type #1 ; #2 ;
endometrioid-type glands deep in cervix #1 ; #2 ; #3 ; various
images : ;
;
# 1 , # 2 ;
# 1 , # 2 ; # 3 ;
: - 2.5 ( /
), 1073 ( , 75%, 2004 17:962 ),
+ (
2005 46:130 ), ()
2.5 ( ), 53, 10,
: 11 ( 2003; 83:35 )
( , 1999; 23:375 )

2005;24:391 ), tunnel clusters (little variation in size, shape and depth of
glands) : (
; ,
, 1995 5:236 ),
( 1991; 15:1123 ),
( 2001 ; 109:546 ), (
,

, , 2000 19:322 ),
( , 1999 ; 23:166 ),
( ),
(

,
,
2005; 55:412 , 1999; 23:886 ),
( ; ),
( , 2005 24:391 ), (
, )
References:
AJSP 1993;17:660 (early study) ,
1993;
17:660 ( ) , AJSP 2000;24:559 (mucin stains) , AJSP 1989;13:717 (analysis

of 26 cases) , Mod Path 2000;13:261 2000 24:559 ( ) ,
1989 13:717 ( 26 ) , 2000; 13:261
top
- ;

,
component


top
,

metastases 1
;

; -


; -
, ( , 1998; 70:289 )

bodies common :

, ;
, /
;
;
,
, ;

-
-
: -125 (75%), , (50%), 53 (40%)

References:
AJSP 1998;22:113 , Mod Path 1992;5:426
1998; 22:113 , 1992; 5:426
Small cell (neuroendocrine / undifferentiated) carcinoma of

cervix ( /
)
top
), ;

63 years) (
43 , 23 63 )
Associated with HPV-18 ( AJSP 1991;15:28 , Int J Gynecol Pathol 2004;23:366
); occasionally associated with Cushing syndrome or symptoms of
other peptide hormones 18 ( 1991; 15:28 ,
, 2004; 23:366 ),

lesion ;

prognosis 5 30-40%; 2 / 3
8 ( , 2004 93:27 ),
( , 2003; 97:568 ),

(
1996 9:397 ), 27 ( 1992 97:516 ),
( , 2001; 81:117
), ( 2000; 23:269 )
:

,

: ,

inflammation :
, ,
, ,
, ,
;
; 9%,
; ( /
),

() ; ;
(<10 %)
,
: ,

-
Micro images: sheets of small cells with scant cytoplasm and
hyperchromatic nuclei #1 ; #2 ; H&E :
#
1,#2;&
: -
, ; (80%),
(60%), (70%), , , 16
( 2004 28:901 ; 2003 34:778 ), 100, ();
56 , ( , 2005;
24:113 ) 1
2004;17:732 ) : 20, , 53, 63, 117/- (
2004; 17:732 )
: 3 11
;
(
),
, ( )
References:
AJSP 1988;12:684 , Mod Path 1991;4:586 , Int J Gynecol Cancer
2005;15:295 , Ann Diagn Pathol 2002;6:345 : 1988; 12:684 ,

1991; 4:586 , , 2005; 15:295 , 2002;
6:345

top

, 29 76

2003;90:23 ) ; (
, 2003; 90:23 )
2000;21:287 ), : (
2000; 21:287 ),

,
Micro images: bladder #1 ; #2 : # 1 ; # 2
actin : , 63, , -,

( )

top

( 1995; 19:1138 )


( , , 2004
47:71 ), ( 2004 54:63 ,
, 2003; 22:220 )
,
-

;
: 16 + ( , 1999; 74:361 , ,
1998; 83:521 )
,
References:
AJSP 1995;19:1138
1995; 19:1138

top

), 50% ,

) +
,
( 1993; 36:147 )
Oncol 1999;74:115 ) :
( , 2003; 90:478 ), 13
( 2000 7:1079
), 32 ,
( 1999; 20:35 ),
( , 1999;
74:115 )

transformation : ;

;


( )
; ,
-
; ;
, /
,
-
Micro images: various images ; squamous cells with central
keratinization but no fibrovascular cores ; bland epithelium with
at most mild atypia ; pushing margin ; other sites - penis #1 ; #2 ;
vulva : ;
;
; ;
- # 1 , # 2 ;
( , ),
(
, ),
/ (
)

top
Rare


( 1999; 87:183 )


: ( 2004 202
( , 2004; 92:64 )
( , ,
2006; 101:168 , , 2001 81:310 ),

endometrium :
;
, ,
;
; 43 /10
, , ;
;

-
Micro images: tumor extends throughout most of cervix ;
papillary fibrovascular cores lined by mildly atypical epithelium
#1 ; #2 ; #3 ; adjacent area of higher grade adenocarcinoma
:
;
# 1 , # 2 ; # 3 ,

( , 2002; 12:308 ),
( , ),
( ,
)
References:
Cancer 1989;63:1773 , Mod Path 2000;13:261
1989; 63:1773 , 2000; 13:261

()
top
in vulva
,

: ( 1998;
194:713 )
,
,
-
( )
top

,
( 1998; 5:939 )
, 40%
, (
. 1998 22:87 ), (
, 2002; 84:161 ), 6 ,
( 1998; 48:649 ) ,
( , 1986; 57:1197 ), (
, 1985 4:146 ),
( , 1976; 37:1725 )

;

,
; , ,
(,
, , ,
); 2 + /10 ;
;
; ,
,
Micro images: phyllodes tumor-like pattern #1 ; #2 (more cellular

than adenofibroma) ; uterus, not necessarily cervix - with dilated
glands : #
1 , # 2 ( ) ; ,
-
: , ,

References:
Hum Path 1981;12:579
1981; 12:579

top
Gynecol Cancer 2004;14:1024 ) : 37-
( , 2004; 14:1024 )
:

top
1983 ( 1983; 7:463 )


2003;34:1072 ) ,
( 2003; 34:1072 )
, 60 20 ,


,
; ; /
,
-
# 1 , # 2 ; # 3 ;
: , , ,
; 13, ,


, , ,

References:
Hum Path 1985;16:621
1985; 16:621

top
Very rare

,
1989; 113:1179
), 39 (
), 8 ( 1993; 43:204 )
, 2005 24:131

, ,

;
, ;
,
; +
;
Micro images: nests of tumor cells with PAS+ crystals #1 ; #2
: -+ #
1;#2
HHF35 : - , 100,
3 ( );
, , , 35
100 ()
: (, 17) (. 11; 25) - 3-


;
6 ,
10 ,
,
, (
, , +
, ),
( 100 +
; , +
)
References:
Mod Path 1989;2:676
1989; 2:676
top

(5
70% ),

1998;17:83 ) :
end_of_the_skype_highlighting:1389 ), 21 (
, 2005 98:516 ), 36
( , 1998; 17:83 )

,
,
-
CD99+ : & , -
+ ; 99 +

: 99, , -
: , 45, ,
: (11:22) (24, 12) - /1

, ,
,
, , ,
, ,
top
( )
diagnosis ,

,
( , 1977; 40:3030 ,
, 1997; 23:261 )
6% ,
5
Cytol 1999;43:1124 ); in a child ( J Pediatr Hematol Oncol 1996;18:311 ), relapse
with abdominal tumor : 33
( , 2005; 98:493 )
- (
), ( 1999, 43: 1124

), ( 1996 18:311 ),

, 2004; 14:553

, ;

Micro images: various images (uterus, not necessarily cervix );
H&E ; (a) left - alpha-1-antitrypsin+; (b) right - chloroacetate
esterase+ ; thoracic lesion-various images :
(, ); & ; () -1- + () - + ;
-
CD68, CD43, CD45 : ,
, , 68, 43, 45
EM images: P-early promyelocyte, L-late stage granulocyte, MYmyofibroblast ; detail of promyelocyte - A is primary or
azurophilic granule; other granules have irregular or partially
extracted contents : - -
, - ;
- ,

,
1989;42:483 : 1997; 21:1156 , , 1992; 46:128 ;
1989; 42:483
top
cervix ; <100 ,

2002;73:613 )
( 2002; 73:613 )
segment ,

40 60

,

Poor prognosis (
31:1176 )
Case reports:
Cancer 1973;31:1176
) (
, 1973;
, epithelioid tumors ( Gynecol Oncol

Gynecol Oncol 1998;69:169 ) : # 92 ,
( , 2005; 97:957 , , 2003 91:636 ),

( , 2001; 82:400 ),
( , 1998; 17:89 ), 10 , (
, 1998; 69:169 )
: ( 12 ), , ,
; ,

Gross images: tumor attached by short pedicle #1 ; #2-sagittal
section : # 1 ; # 2

features :
, , ; 5 +
/10 ; ,
,
-
Micro images: interlacing fascicles #1 ; #2 ; various images ;
large pleomorphic nuclei #1 ; #2 ; muscle specific actin ; smooth
muscle actin ; uterus-not necessarily cervix - leiomyosarcoma #1
; #2 ; #3 with bizarre giant cells ; #4 :
# 1 , # 2 ; ;
# 1 , # 2 ; ;
; # 1 , # 2 ; # 3
; # 4
References:
Diagn Pathol 2006;18:30
2006; 18:30
Lymphoma of cervix
top
(<100 )
40 ; 20 80-
;

2005;193:866 ) (
2005; 193:866 )
Path 2000;13:19 )
( 2000; 13:19 )
: 83% , 29%

and to classify

:
begin_of_the_skype_highlighting 2000 124 end_of_the_skype_highlighting:1510 ) #
2 ( 2002 43:203 ),
( 2005 201
/
( , 2004 92:974 ), -
( 2002, 6 : 125 )

- 3
( 2005; 26:36
) ( , 2003; 22:289 ),

( , 2005; 98:484
)
( ), ; , -

-
Micro images: diffuse large B cell lymphoma #1 ; #2 ; #3 ; #4 ; #5
(CD20+); marginal zone lymphoma; high grade MALT presenting
as endocervical polyp ; NK lymphoma :
# 1 , # 2 ; # 3 , # 4 , # 5 (20 +)
;
;
,
(
, , 2005; 99:481 ,
2001 97:235 ), (
, , 68,
)
References:
AJSP 2005;29:1512 (gynecologic lymphomas
2005 29:1512 (
) :

()
top
homologous)
( )

, <100 ,

;

50 65 , 12 93
,
Case reports: with adenoid cystic carcinoma component (
AJSP
),
( 1995; 19:229 ,
, 1998; 17:91 , 2000; 21:292 ),
( ,
2002, 21 : 186 ), (
, 2002; 12:223 ), (
, 2005 31:404 ), (
1988; 19:605 ), ( ,

( , 1983; 16:422 ), 12
( 1988; 9:365 )
1995;19:229 , Int J Gynecol Pathol 1998;17:91 , Eur J Gynaecol Oncol 2000;21:292

(
, 2005; 97:442 )

;
,
;
, ,
,


, ( ,
1998; 17:211 )
, 50%, ,

-
actin, desmin : - ,
, (); ,
: 8 / 8 ( 2001;
25:338 )

Melanoma of cervix
top
<100 ,

2005;40:183 ) 5
40% ( ,
1989; 32:375 , 2005; 40:183 )

: 39 (
, 2005; 42:201 ), 67 (
2003; 23:1063 ), 63 100
( , 1999; 18:265 ), 33
( , 2001; 80:409 ),
(
( ) 2000; 12:234 )
Gross images: melanoma of vagina with extension into cervix
:
malignant cells. :
; <50%,
; .
-
Micro images: small cell variant (common in vagina) ; epithelioid
cells ; prominent junctional activity ; vaginal melanoma
extending into cervix ; various images in advanced tumor
: ( ) ;
; ;
;

: 100, 45, , -67 (
)
, 45, ,
, )

()
top
PEComas:
) :
2 ( 2005; 29:1558 )
large study with 2 cases in cervix ( AJSP 2005;29:1558

: + ( 1999; 30:483 )
top
Rare in cervix
) : 38 ( , 1989; 68:279 )
-
( 1983; 43:40 )

()
top
,
( ),
()
,
prognosis

with anaplastic (pleomorphic) subtype ( Arch Gynecol Obstet 2004;270:278
), 17 year old woman with botyroid subtype and recurrence after
-
( , 2005 99:742 ), 19
( , 2004 95:243 ), 13
() ( 2004 270

( ; 43:475 ), 46
( , 2004; 23:78 )
Gynecol Oncol 2003;91:623 ) - 39
( , 2003; 91:623 )
: ,
( , 2004; 163:452 , ,
1999; 80:403 )
( )
,
Gross images: embryonal rhabdomyosarcoma with gray surface
and hemorrhage ; bladder tumor with polypoid masses
:
;

-
;
,
, ,
; ,


, ,
Micro images: embryonal rhabdomyosarcoma-various images ;
cambian layer and edematous stroma ; edematous stroma ;
cambian layer (vaginal botyroid tumor) ; tadpole and strap cells ;
cross striations :
- ;
; ; (
) ; ;
-
, , ,
, 1 1, (
, , , 2005; 8:427 )
: , ( ,
, , -
),
( , , 1,5 ,
, , ,
)
References: :
Radiographics 1997;17;919 1997;
17; 919

top
years) ( 54 , 29
72 )
;
( 2005 9:101
), (
2000 88:103 ), (
, 2000; 79:120 ), Gynecol Oncol 1985;22:105 , 1985; 22:105
;

- - & ; & , 10 +, +, +

-
( )
Teratoma of cervix
top
Very uncommon

( 2003; 53:327 ),
( 1995; 119:848 ), +
(
, 1996; 60:475 ), 13 (
1990; 11:37 ), (
1990; 16:363 ), (
2003; 127:759 )

,
, , ,
;
Micro images: epidermal elements and fat ; endocervical cystic
gland, nerve tissue, cartilage (arrow) ; figure 1: squamous
epithelium and adipose tissue; 2: mature neural tissue; 3:
cartilage : ;
, ,
() ; 1: , 2:
; 3:

( ),
( ),
,

top
(<10 )
( 1985; 109:371 ), 13
7 , ( , 2000 76:107 ), 12
(
, 1999; 21:548 ), 11 (
, 1998; 17:277 )

: ,
- # 1 ; # 2
, )
top



-
(
, 1993; 23:57
),
, 1996; 33:43

, ,
(-), ( )
; - (
)
Micro images: microcystic pattern ; festoon pattern with SchillerDuval bodies : ;
-
Miscellaneous

top

;


( 2005; 25:41 )
top
:

(
)
carefully) (
)

, ,


, , 3
, ,
1-3
,
: ;

top
, -
uniformity , (
)

has started
,

,
7. , 2008
top


( )
(
)
(.
);
5,0
7.0 ; (
)
3,0 7.0

less 12 ( 2):
3,0 5,0 7,0



1 ( 2)

4,0
,

):

4,0

( ):
,

pelvic wall 3 ( ):
,

,
( 4)

- - 1
( )
top



:
top
( ,
,
, , )
Stage grouping
top
Stage 0: T1s N0 M0 0: 1 0 0
Stage I: T1 N0 M0 : 1 0 0
Stage IA1: T1a1 N0 M0 1: 11 0 0
Stage IA2: T1a2 N0 M0 2: 12 0 0
Stage IB1: T1b1 N0 M0 1: 11 0 0
Stage IB2: T1b2 N0 M0 2: 12 0 0
Stage II: T2 N0 M0 : 2 0 0

Stage IIA1: T2a1 N0 M0 1: 21 0 0
Stage IIA2: T2a2 N0 M0 2: 22 0 0
0 3 0
Stage IVB: M1 : 1
Drawings: cervix staging diagram (upper row) ; WHO reference
for FIGO staging ; National Cancer Institute (USA) reference for
staging : (
) ; ;
()

Editor's note
Cone biopsy
top
(: 12-3, 3-6, 6-9 9-12
/ , /
)
( ,
)
Tumor grade
(): - -


) ()
-
( , ) __

(
)
-
( , ) __

(
)
- (
, ) __

(specify grade) -
( )
Cone biopsy-optional features to report
top

, ,
: , ,

top
Specimen type
(: 12-3, 3-6, 6-9 9-12
/ , /
)
( ,
)
Tumor grade
pTNM / FIGO staging
features to report
top
Michigan

top
Fellowships
Conferences
Books
Affiliates
Home page

Dokument 1

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Dokument 1

Uploaded by

Copyright:

Available Formats

Cervix

Last revised 19 April 2011 19. 2011

Table of contents - Cervix -

Inflammation: inflammation-general , actinomycosis , amebiasis , bacterial

pyogenic granuloma , rhabdomyoma , squamous

AJCC Cancer Staging Manual (7th ed)

Archives of Pathology and Laboratory Medicine

Human Pathology (Hum Path) , May 1974 to January 2006

Kurman: Tumors of the Cervix, Vagina, and Vulva

Journal search terms: cervix, cervicovaginal

Anteriorly abuts on bladder; posteriorly is covered by peritoneum that

Lymphatics: cervix is drained by parametrial, cardinal and

Drawings: local anatomy ; microanatomy ; saggital

Squamocolumnar junction: where squamous and glandular

Note: endocrine cells and melanocytes are seen occasionally in

squamous and columnar metaplasia; squamous epithelium overgrows

Gross images: squamocolumnar

Virtual slides: normal cervix :

Defined as change in differentiation pathway to which the stem cell

Atypical oxyphilic metaplasia of cervix

Epidermoid metaplasia of cervix

cervix covered by keratinized squamous epithelium

Micro: resembles squamous metaplasia but without cytoplasmic

Rare, may have mucin extravasation into stroma ,

See also immature squamous metaplasia above

Centered on transformation zone

May also arise from ingrowth of squamous epithelium from ectocervix

Keratosis: appearance of granular and horny epithelial layers, often

Micro: squamous epithelium overlies endocervical glands, may

Common (1/3 of women); in upper portion of endocervical canal, often

Micro images: tubal metaplasia #1 ; #2 ; #3 ; #4 ; #5

Urothelial metaplasia of cervix

Also called transitional cell metaplasia

Cytology: see Cervix-cytology :

DD: HSIL (high N/C ratio, cellular disorganization and pleomorphism,

At menarche, the ovaries produce estrogen, leading to glycogen

Actinomycetes normally reside in the female genital tract, so

Cytology: see Cervix-cytology :

May simulate or accompany carcinoma (

Am J Trop Med Hyg 1992;46:759 ,

Most common sexually transmitted disease (STD) in Western world; 4

Positive stains: immunocytochemistry can detect organisms

Found in almost all women (see normal histology above)

Micro: affects squamocolumnar junction and endocervix; produces

Micro images: chronic cervicitis ; various images ;

Cytology: See Cervix-cytology :

Patients are usually NOT immunocompromised ( J Clin Pathol 2004;57:691

Cytology: See Cervix-cytology :

Also called donovanosis

May occur in children of infected mothers via birth canal ( AJCP

Cytology: See Cervix-cytology :

Herpes simplex virus (HSV) of cervix

Relatively common; 3% (HSV1) and 8% (HSV2) of women visiting US

Also called lymphoma-like lesion; a form of chronic cervicitis

Case reports: 37 year old woman with cervical polyp containing

Also called bilharziasis

May form primary chancre at cervix

Micro images: #1-umbilical cord ; #2 ; dermal lesion with

Cytology: see Cervix-cytology :

Cytology: see Cervix-cytology :

May be simultaneous cervical and endometrial infections ( J Indian Med

Micro images: various images ; granulomas with giant

Vasculitis of any type affecting the female genital tract is usually an