Pathology of the Cervix and Uterus

Endometrial Histology during Menstrual Cycle – upper 2/3 sheds, lower 1/3 does not

(1) Proliferative/Follicular Phase – rapid growth of straight tubular glands (pseudostratified columnar cells) and endometrial stroma (thickly compacted spindle cells with scant cytoplasm but abundant mitotic activity); No mucus secretion/vaculation

(2) Luteal/Secretory Phase

Post-Ovulation – Endometrium growth slows and mitotic activity ceases; glands develop basal secretory vacuoles beneath the nuclei
Days 18-24 – Glands dilate as basal vacuoles push past nuclei.
Days 24-28 – Glands discharge secretions into lumen; glands get tortuous, begin to shrink, fragment

Endometritis – inflammation of endometrium

Acute endometritis – uncommon and limited to bacterial infections that arise after delivery or miscarriage

Chronic endometritis – may occur in following settings:

chronic PID
postpartal/postabortal endometrial cavities (due to retained gestational tissue)
IUDs
Tuberculosis.

Histological hallmark are plasma cells (not present in normal endometrium)

Endometrial Hyperplasia

related to abnormally high, prolonged estrogenic stimulation with diminution or absence of progestational activity

Etiologies: ovarian dysfunction (polycystic ovarian disease; hyperthecosis); obesity; postpartum; perimenopausal; estrogen secreting ovarian neoplasm; non-estrogen secreting ovarian neoplasm with stromal luteinization; exogenous hormones

Types of Endometrial Hyperplasias:

(1) Low grade, simple – irregular gland shape with cystic alterations; similar to proliferative endometrium

(2) Low grade, complex – Ý number and size of glands, with gland crowding, and irregular shape/size

also known as adenomatous hyperplasia

(3) High grade (atypical), simple – like #2 but with irregular epithelium

also known as adenomatous hyperplasia with atypia

(4) High grade (atypical), complex – can hardly be distinguished from adenocarcinoma

Benign lesions of Uterus

Endometrial Polyps – polypoid projections of endometrial glands and stroma into the uterine cavity

occur more frequently in post-menopausal women; can be a symptomatic or lead to metrorrhagia and/or menorrhagia

Adenomyosis

Uterine Leiomyomas

Malignant tumors of Uterus

Endometrial adenocarcinoma - most common gynecologic malignancy

Risk factors: obesity, diabetes, hypertension, infertility; long standing estrogen use; severe endometrial hyperplasia; dysfunctional uterine bleeding (polycystic ovarian syndrome); granulosa-cell tumors; Turner’s syndrome.

Clinical Presentation: Post menopausal bleeding.

Pathophysiology: Adenomatous hyperplasia and atypical hyperplasia are considered precursor lesions

Histology: variable glandular differentiation with occasional squamous differentiation (adeno-acanthoma or mixed adenosquamous carcinoma); low-grade endometrial carcinoma is hard to discern from adenomatous hyperplasia

Mesenchymal Tumors of uterus – rare. Leiomyosarcomas, Stromal sarcomas, Mixed epithelial-stromal tumors.

Malignant metastases to endometrium – rare; sometimes from breast cancer.

Benign lesions of Cervix

Endocervical Polyps – polypoid mass attached to endocervical mucosa by a stalk

may produce irregular vaginal "spotting" or bleeding.

Microglandular hyperplasia – clusters of benign tightly packed glands, usually seen in pregnant or post-partum women, or those on oral contraceptives

Endometriosis – aberrantly located endometrial glands and stroma; may lead to vaginal bleeding

Cervical Leiomyomas – benign smooth muscle tumors which protrude from the endocervical canal as a polyp

Embryonal remnants – bicornial uterus (two uteri connecting to one external os), two fused normal uteri

Malignant and Pre-malignant lesions of the Cervix

Infiltrating squamous cell carcinoma of cervix – see D3J Repro-268 for complete histological description

Risk factors include early onset of sexual activity, early age of pregnancy, multiple sexual partners, herpes simplex virus-type 2 and human papilloma virus infection.
three histologic types can be identified: (1) large cell keratinizing (2) large cell non-keratinizing and (3) small cell type.

Endocervical adenocarcinoma

less frequent than squamous cell carcinomas.
precursor lesions (adeno-carcinoma in situ and atypical hyperplasia of endocervical glands) have been identified