Cervical biopsy: Difference between revisions

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This article includes endocervical curettage.
This article includes endocervical curettage (ECC).
{{Comprehensiveness}}
{{Comprehensiveness}}
{{Fixation - standard}}
{{Fixation - standard}}
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==Microscopic evaluation==
==Microscopic evaluation==
Look for dysplasia:
===Anatomic/Histologic location===
{{CIN grades}}
Describe mucosa as squamous (or ectocervical), endocervical (generally mucinous and glandular) or transformation zone mucosa.
<gallery mode=packed heights=180>
File:Cervix Normal Squamocolumnar Junction (565238127).jpg|'''Squamous''' (or ectocervical) mucosa at left and '''endocervical''' (mucinous) mucosa at right, in an example with abrupt transition.
File:Histology of transformation zone mucosa.jpg|'''Transformation zone mucosa''', consisting of a mix of stratified squamous epithelium and mucinous glands, in an example with gradual transition.
File:Histology of endocervix.jpg|'''Endocervical mucosa''', with mucinous columnar epithelium and mucinous glands. H&E stain
</gallery>
<gallery mode=packed heights=180>
File:Columnar cell mucosa of endocervix.jpg|However, the endocervical mucosa may appear columnar and non-mucinous.
File:Histology of nabothian cysts on cervical biopsy.jpg|A cervical biopsy may contain '''nabothian cysts''', which are single or multiple cysts that contain mucin, lined by a single layer of columnar, cuboidal to flat cells with variable amounts of mucinous cytoplasm and small, basal, round to oval nuclei with fine chromatin, without conspicuous nucleoli or mitotic activity.<ref>{{cite web|url=https://www.pathologyoutlines.com/topic/cervixnabothiancyst.html|title=Cervix Benign / nonneoplastic epithelial lesions. Nabothian cysts.|author=Gulisa Turashvili, M.D., Ph.D.|website=Pathology Outlines}} Last author update: 1 February 2021. Last staff update: 4 April 2022}}</ref>
</gallery>
<gallery mode=packed heights=180>
File:Transformation zone types.png|The anatomic level of the transformation zone varies:<ref>International Federation for Cervical Pathology and Colposcopy (IFCPC) classification. References:<br>-{{cite web|url=https://www.rcpa.edu.au/Library/Practising-Pathology/Structured-Pathology-Reporting-of-Cancer/Docs/Transformation_zone|title=Transformation zone (TZ) and cervical excision types|website=[[:en:Royal College of Pathologists of Australasia|Royal College of Pathologists of Australasia]]}}<br>- {{cite journal|last1=Jordan|first1=J.|last2=Arbyn|first2=M.|last3=Martin-Hirsch|first3=P.|last4=Schenck|first4=U.|last5=Baldauf|first5=J-J.|last6=Da Silva|first6=D.|last7=Anttila|first7=A.|last8=Nieminen|first8=P.|last9=Prendiville|first9=W.|title=European guidelines for quality assurance in cervical cancer screening: recommendations for clinical management of abnormal cervical cytology, part 1|journal=Cytopathology|volume=19|issue=6|year=2008|pages=342–354|issn=0956-5507|doi=10.1111/j.1365-2303.2008.00623.x|pmid=19040546|s2cid=16462929|doi-access=free}}</ref><br>Type 1: Completely ectocervical (common under hormonal influence).<br>Type 2: Endocervical component but fully visible (common before puberty).<br>Type 3: Endocervical component, not fully visible (common after menopause).
File:Histology of normal simple columnar epithelium of the endometrium.jpg|If you see fragments of non-mucinous epithelium and glands, it is likely endometrial, so evaluate it like an '''[[endometrial curetting]]'''.
</gallery>


Other common findings:
===Pathologies===
<gallery mode=packed heights=190>
{{Cervical dysplasia}}
File:Endocervical curetting showing acute cervicitis.jpg|Acute cervicitis, by a largely neutrophilic infiltrate.
{{Other cervical findings}}
</gallery>
 
===Example report===
{|class=wikitable
| Endocervix, curettings:<br>Fragments of squamous and endocervical glandular epithelium without significant histopathologic changes.<BR>Negative for dysplasia.
|}
{{Bottom}}
{{Bottom}}

Latest revision as of 17:50, 15 September 2022

Author: Mikael Häggström [note 1]
This article includes endocervical curettage (ECC).

Comprehensiveness

On this resource, the following formatting is used for comprehensiveness:

  • Minimal depth
  • (Moderate depth)
  • ((Comprehensive))

Fixation

Generally 10% neutral buffered formalin.

  See also: General notes on fixation


Gross processing

Example report:

(Optionally: A. Container is labeled - __. The specimen is received in formalin and consists of ) 1 fragment(s) of pink-tan tissue with a vaguely recognizable mucosal surface. The tissue measures __ cm. (The surgical margin is inked black. The specimen is bisected and entirely submitted for microscopic examination in one cassette.)

Microscopic evaluation

Anatomic/Histologic location

Describe mucosa as squamous (or ectocervical), endocervical (generally mucinous and glandular) or transformation zone mucosa.

  • Squamous (or ectocervical) mucosa at left and endocervical (mucinous) mucosa at right, in an example with abrupt transition.
    Squamous (or ectocervical) mucosa at left and endocervical (mucinous) mucosa at right, in an example with abrupt transition.
  • Transformation zone mucosa, consisting of a mix of stratified squamous epithelium and mucinous glands, in an example with gradual transition.
    Transformation zone mucosa, consisting of a mix of stratified squamous epithelium and mucinous glands, in an example with gradual transition.
  • Endocervical mucosa, with mucinous columnar epithelium and mucinous glands. H&E stain
    Endocervical mucosa, with mucinous columnar epithelium and mucinous glands. H&E stain
  • However, the endocervical mucosa may appear columnar and non-mucinous.
    However, the endocervical mucosa may appear columnar and non-mucinous.
  • A cervical biopsy may contain nabothian cysts, which are single or multiple cysts that contain mucin, lined by a single layer of columnar, cuboidal to flat cells with variable amounts of mucinous cytoplasm and small, basal, round to oval nuclei with fine chromatin, without conspicuous nucleoli or mitotic activity.[1]
    A cervical biopsy may contain nabothian cysts, which are single or multiple cysts that contain mucin, lined by a single layer of columnar, cuboidal to flat cells with variable amounts of mucinous cytoplasm and small, basal, round to oval nuclei with fine chromatin, without conspicuous nucleoli or mitotic activity.[1]
  • The anatomic level of the transformation zone varies:[2] Type 1: Completely ectocervical (common under hormonal influence). Type 2: Endocervical component but fully visible (common before puberty). Type 3: Endocervical component, not fully visible (common after menopause).
    The anatomic level of the transformation zone varies:[2]
    Type 1: Completely ectocervical (common under hormonal influence).
    Type 2: Endocervical component but fully visible (common before puberty).
    Type 3: Endocervical component, not fully visible (common after menopause).
  • If you see fragments of non-mucinous epithelium and glands, it is likely endometrial, so evaluate it like an endometrial curetting.
    If you see fragments of non-mucinous epithelium and glands, it is likely endometrial, so evaluate it like an endometrial curetting.

Pathologies

edit
Look for cervical dysplasia. It is mainly seen as nuclei with hyperchromasia, coarse chromatin and irregular contours.[3]

  • Spectrum from normal to high grade SIL.[4]
    Spectrum from normal to high grade SIL.[4]

Further information: Cervical dysplasia

edit
Other common findings:

  • Acute cervicitis, having a largely neutrophilic intra-epithelial infiltrate.
    Acute cervicitis, having a largely neutrophilic intra-epithelial infiltrate.
  • Chronic cervicitis, displaying mononuclear inflammatory cells. When clearly forming follicles as shown it can be called follicular cervicitis
    Chronic cervicitis, displaying mononuclear inflammatory cells. When clearly forming follicles as shown it can be called follicular cervicitis
  • Endocervical polyp: With endocervical epithelium and glands (mucinous columnar linings), edematous stroma and clear congestion. H&E stain.[5]
    Endocervical polyp: With endocervical epithelium and glands (mucinous columnar linings), edematous stroma and clear congestion. H&E stain.[5]

Example report

Endocervix, curettings:
Fragments of squamous and endocervical glandular epithelium without significant histopathologic changes.
Negative for dysplasia.

Notes

  1. ↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.

Main page

References

  1. ↑ Gulisa Turashvili, M.D., Ph.D.. Cervix Benign / nonneoplastic epithelial lesions. Nabothian cysts.. Pathology Outlines. Last author update: 1 February 2021. Last staff update: 4 April 2022}}
  2. ↑ International Federation for Cervical Pathology and Colposcopy (IFCPC) classification. References:
    -. Transformation zone (TZ) and cervical excision types. Royal College of Pathologists of Australasia.
    - Jordan, J.; Arbyn, M.; Martin-Hirsch, P.; Schenck, U.; Baldauf, J-J.; Da Silva, D.; Anttila, A.; Nieminen, P.; et al. (2008). "European guidelines for quality assurance in cervical cancer screening: recommendations for clinical management of abnormal cervical cytology, part 1 ". Cytopathology 19 (6): 342–354. doi:10.1111/j.1365-2303.2008.00623.x. ISSN 0956-5507. PMID 19040546. 
  3. ↑ Khaled J. Alkhateeb, M.B.B.S., Ziyan T. Salih, M.D.. HSIL / CIN II / CIN III. PathologyOutlines. Topic Completed: 29 March 2021. Minor changes: 9 February 2022
  4. ↑ Source image by Ed Uthman from Houston, TX, USA. Creative Commons Attribution 2.0 Generic (CC BY 2.0) license
  5. ↑ Anissa Ben Amor.. Cervical Ectropion. StatPearls, National Center for Biotechnology Information. Last Update: November 14, 2021.
    - This book is distributed under the terms of the Creative Commons Attribution 4.0 International License

Image sources
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