Anais Malpica MD - Biopsy Interpretation of the Uterine Cervix and Corpus

BIOPSY INTERPRETATION SERIES

BIOPSY INTERPRETATION OF THE UTERINE CERVIX AND CORPUS

Second Edition

BIOPSY INTERPRETATION SERIES

BIOPSY INTERPRETATION OF THE UTERINE CERVIX AND CORPUS

Second Edition

Anais Malpica, MD

Professor

Department of Pathology

The University of Texas, MD Anderson Cancer Center

Houston, Texas

Elizabeth D. Euscher, MD

Associate Professor

Department of Pathology

The University of Texas, MD Anderson Cancer Center

Houston, Texas

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First Edition, 2010 Lippincott Williams & Wilkins, a Wolters Kluwer business.

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Library of Congress Cataloging-in-Publication Data

Malpica, Anais, author.

Biopsy interpretation of the uterine cervix and corpus / Anais Malpica, Elizabeth D. Euscher. Second edition.

p. ; cm. (Biopsy interpretation series)

Includes bibliographical references and index.

ISBN 978-1-4511-9296-4 (alk. paper)

I. Euscher, Elizabeth, author. II. Title. III. Series: Biopsy interpretation series.

[DNLM: 1. Uterine Cervical Neoplasmspathology. 2. Biopsy. 3. Diagnosis, Differential.

4. Endometrial Hyperplasiapathology. 5. Endometrial Neoplasmspathology. WP 480]

RC280.U8

616.994660758dc23

2014040052

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PREFACE

Biopsy pathology may be particularly challenging due to the potential loss of architectural patterns and surrounding normal structures as well as artifactual changes naturally imparted during the process of obtaining the biopsy. This edition of Biopsy Interpretation of the Uterine Cervix and Corpus will provide the reader with a practical approach to the assessment of biopsy specimens from the uterine cervix and corpus. As understanding of pathology of the uterine cervix and corpus continues to evolve, so too has this edition, which includes updated references with respect to the latest research in the field of gynecologic pathology. This second edition includes a tenth chapter addressing metastatic carcinomas involving the uterus as well as the addition of numerous new e-figures. The 10 chapters in this book are organized by pathologic entity, with special sections dedicated to the findings in benign cervix and endometrium. The text focuses on the differential diagnosis and frequently encountered pitfalls of the most common entities observed in the cervix, endometrium, and myometrium. It is hoped that the numerous images in the e-figures, in addition to those contained in the text, will be useful to the reader during the evaluation of problematic biopsies from the uterus.

We are indebted to Ms. Kim-Anh Vu for her invaluable help with the images presented in this book. We warmly dedicate this book to our families, the LyosAndrew, Alexander, Nicholas, and Sebastianand the EuschersDavid, Kathryn, John, Alex, and Margaret, whose constant support and encouragement make our professional lives possible, and to our trainees and referring pathologists, whose challenging questions and comments have guided us in preparing this book.

TABLE OF CONTENTS

NORMAL UTERINE CERVIX

The uterine cervix comprises the lower portion of the uterus. It is a roughly cylindrical structure, which averages 2.5 to 3 cm in length and 2.5 to 3 cm in horizontal diameter in adults, and is divided into two portions, the portio vaginalis (vaginal) and the portio supravaginalis (supravaginal). These segments lie below and above the vaginal reflection, which is located at the junction of the middle and inferior thirds of the cervix ().

The outer surface of the portio vaginalis is the exocervix or ectocervix and is lined by squamous epithelium. The endocervical canal or anatomic endocervix is lined by columnar mucin-producing epithelium. The anatomic point at which the endocervical canal opens into the exocervix is the external os. In parous women, this opening is usually slit shaped, dividing the exocervix into anterior and posterior lips. The upper limit of the endocervical canal is the internal os, a funnel-like widening of the endocervical canal that has a gradual transition from endocervical epithelium into endometrium of the lower uterine segment. The junction of the exocervical squamous epithelium and the endocervical columnar epithelium is the squamocolumnar junction ().

The location of the squamocolumnar junction changes throughout a womans life. Before puberty, it is located at or near the external os. During adolescence, it moves outward due to the swelling of the stroma in response to hormonal stimulation, so endocervical mucosa covers part of the portio vaginalis. This ectopic endocervical mucosa, usually referred to as ectropion, appears red and ulcerated to the naked eye, and can be mistaken for an erosion. After menarchial ectropion occurs, there is a progressive replacement of the endocervical epithelium by squamous epithelium, or squamous metaplasia, throughout the reproductive years. The original squamocolumnar junction is the point at which the original exocervical squamous epithelium meets the endocervical glandular epithelium. However, a second squamocolumnar junction, the so-called functional squamocolumnar junction (also known as squamocolumnar junction when no modifier is used), develops due to the squamous metaplasia mentioned earlier ).