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cervical lesion; cervical nodule
Lesions observed on microscopic examination of Pap Smears.
Etiology:
1) precancerous cervical lesions are secondary to human papilloma virus (HPV) subtypes 16, 18 & 31
2) infection
a) Candida
b) Herpes
c) HPV
d) Trichomonas
e) Haemophilus vaginalis
3) reactive or reparative changes
a) inflammation
b) radiation-induced changes
c) chemotherapy-induced changes
4) epithelial cell abnormalities
a) atypical squamous cells of undetermined origin
b) squamous intraepithelial lesions (SIL)
a) low grade: cervical intraepithelial neoplasia I
- involves lower 3rd of the squamous mucosa
b) high grade: cervical intraepithelial neoplasia II
- involves lower 2/3 of the squamous mucosa
c) cervical intraepithelial neoplasia III
- involves entire mucosal thickness
c) squamous cell carcinoma - 90% of all invasive cervical cancer
5) glandular cell abnormalities
a) endometrial cells in post menopausal woman
b) atypical glandular cells
c) adenocarcinoma - 5% of all invasive cervical cancer
6) other epithelial malignant neoplasm
7) non-epithelial malignant neoplasm
Clinical manifestations:
1) invasive carcinoma of the cervix may present with bleed, especially after sexual intercourse
2) pre-invasive lesions are asymptomatic
3) infectious lesions
a) purulent vaginal discharge
b) pelvic pain
c) dysparunia
d) cervical motion tenderness
e) mucopurulent discharge
f) condylomatous changes
4) human papilloma virus may induce condyloma accuminata on the perineum, vagina or cervical mucosa
Laboratory:
1) cytology (Pap Smear)
2) HPV DNA testing
Special Laboratory:
- colposcopy
b) indications
- persistent atypia without response to antibiotic therapy
- human papilloma virus (HPV)
- visible cervical abnormality
- cervical intraepithelial neoplasia (CIN I-III), carcinoma in situ & invasive cancer
b) procedures during colposcopy
- cervical biopsy*
- endocervical curettage
Management:
1) Atypia
a) treat infection
b) pap smear every 3 months until 2 negative pap smears
c) allow 3 months for full repair of cervical inflammatory changes
d) colposcopy for
- persistent atypia despite antibiotic therapy
- atypia secondary to human papilloma virus (HPV)
2) cervical intraepithelial neoplasia (CIN I-III) & carcinoma in situ
- cryocoagulation
- laser evaporation
- conization
- LEEP procedure
3) invasive cancer
- staging
- referral to gynecologic oncologist
4) endometrial biopsy
- endometrial cells present in a postmenopausal woman
- endometrial cells present more than 7 days after menses
5) excisional therapy
- inadequate colposcopy
- positive endocervical curettage
- incompatible biopsy & cytology
6) follow-up
a) if Pap smear is normal, repeat annually
- after 3 negative smears, relative risk for excess cervical cancer for triennial vs annual screening is 3 per 100,000 in women 30-59 years of age
b) treated cervical intraepithelial neoplasia (CIN I-III)
- repeat Pap smear at 4 months & 8 months
- repeat every 6-12 months thereafter
Related
cervix
Papanicolaou (Pap) smear
Specific
ulcerative lesion arising from the transformation zone of the cervix
General
abnormal morphologic structure (malformation)
lesion
References
- NEJM Knowldege+. Question of the Week. Feb 2, 2016
http://knowledgeplus.nejm.org/question-of-week/1470/