cervix






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  • Normal

    • architecture
      • zones
        • ectocervix: squamous
        • transition: squamocolumnar junction
        • endocervix: columnar epithelium and glands
      • epithelium: squamous or columnar
      • stroma: mucinous glands
    • hormone effects
      • arias stella
      • pseudodecidual reaction of stromal cells
    • atrophy
      • postmenopausal
      • squamous epithelium lacks glycogen-rich vacuolated cells
      • lack of normal maturation/orientation, but no atypia (vs full thickness HSIL)
    • others

  • Non-neoplastic

  • WHO neoplasms

  • Patterns

    • clear cells
    • koilocyte-looking
      • HPV (p16+)
      • squamous repair (halos, but nucleus not rasinoid)
      • atrophy-related perinuclear halos
      • infection-related perinuclear halos (no nuclear enlargement or atypia)
    • HSIL or AIS like
      • HSIL, AIS (p16+)
      • reactive changes
      • immature metaplasia
      • atrophy
    • lymphoid follicle
      • normal lymphoid follicle (germinal center, has macrophages)
      • chronic cervicitis
      • lymphoma (infiltrates deep)
    • papillary
    • spindle cell

  • TNM (useful for grossing)

    • T1: uterus confined
      • T1a: microscopic
        • T1a1: stromal invasion <= 3mm deep, <= 7mm spread
        • T1a2: stromal invasion 3-5mm deep, <= 7mm spread
      • T1b: grossly visible or size > T1a2
        • T1b1: <= 4cm
        • T1b2: > 4cm
    • T2: beyond uterus
      • T2a: no parametrial invasion
      • T2b: parametrial invasion
    • T3: involves lower 1/3 vagina, pelvic wall, or causes hydronephrosis or non-functioning kidney
      • T3a: involves lower 1/3 vagina
      • T3b: involves pelvic wall or causes hydronephrosis or non-functioning kidney
    • T4: invades mucosa of bladder or rectum, or extends beyond true pelvis
    • Regional nodes
      • paracervical
      • hypogastric (internal iliac, obturator)
      • common and external iliac
      • presacral
      • lateral sacral

  • Staging

    • IA: T1a
    • IA1: T1a1
    • IA2: T1a2
    • IB: T1b
    • IB1: T1b1
    • IB2: T1b2
    • IIA: T2a
    • IIB: T2b
    • IIIA: T3a
    • IIIB: T3b or N1
    • IVA: T4
    • IVB: M1

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    • endocervical curretage
      • scant fragments of benign endocervical epithelium with reactive changes
      • Abundant admixed mucus and neutrophils
      • no dysplasia identified
    • cervical biopsy / LEEP / cone
      • CIN___
      • margins negative for dysplasia
      • benign endocervical glands
      • no invasive carcinoma
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