8
Benign Proliferative Reactions, intraepithelial Neoplasia, and invasive Cancer of the Uterine Cervix
Fig. 8.13
Single-layer of
reserve cells
beneath endocervical columnar cells
(H&E x MP).
In cases of inflammation and atrophy (senile vaginitis), cell
changes due to infection and degeneration may cause diagnos-
tic problems (Figs 8.16 and 8.17). Nuclear chromatin becomes
coarsely granular and hyperchromatic. Owing to erosion or ulcera-
tion of the superficial stromal layers, regeneration of the epithe-
lium is induced. From these parabasal-type cells with relatively
large nuclei, prominent nucleoli may appear.7 In these cases,
differentiation from an epithelial abnormality may become dif-
ficult and at times virtually impossible. However, a short course of
locally applied or oral estrogenic hormones induces maturation
(Fig. 8.18). Because epithelial abnormalities do not react to the
estrogenic stimulus, or at least not to the same degree as normal
epithelia do, abnormal cells stand out clearly and diagnosis can be
readily made. In our material, after a short course of oral estrogenic
hormones, the number of smears with significant drying artifacts
was reduced from 66 to 32% and the percentage of smears with a
marked-to-moderate inflammatory exudate from 73 to 55%.
Key features of atrophy
• Smear composed of parabasal type cells;
• Cells arranged in aggregates with indistinct cell
borders (syncytia-like);
• Cytoplasm is cyanophilic to amphophilic;
of mature stratified nonkeratinizing squamous epithelium. Basal cell layers do
not stain (immunoperoxidase method x LP).
• Round to oval nuclei;
• Relatively high nucleus-to-cytoplasmic ratio;
• Coarsely granular chromatin with hyperchromasia; and
• Nucleoli not present.
Benign Proliferative Reactions
Hyperkeratosis
The covering epithelium of the vagina and ectocervix apparently
still has the potential for further "differentiation," as is dem-
onstrated when this epithelium comes under the influence of
chronic, rather severe stimulation. An example of such a chronic
stimulation is descensus uteri (prolapse of the uterus), but it may
also occur with inflammatory processes or as a reaction to hyper-
estrinism of long duration. The epithelium increases its protective
role by increasing its overall thickness (acanthosis). In addition,
a granular layer and the development of several layers of kerati-
nized cells—hyperkeratosis—may occur (Fig. 8.19). Hyperkera-
tosis implies excessive formation of keratin over the surface of
the stratified squamous epithelium. It should be emphasized
that keratinization of the stratified squamous epithelium of
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