Benign Proliferative Reactions, Intraepithelial Neoplasia, and Invasive cancer of the Uterine cervix
Fig. 8.34 Atypical squamous metaplasia.
Round, oval, and polygonal
cells with slightly enlarged, slightly irregular nuclei. Nuclear chromatin is
finely granular and evenly distributed (Papanicolaou x HP).
a diagnosis of slight-to-minimal atypia are nuclear enlargement
and aberrations from the normal configuration of the cells
(Fig. 8.37). Causative processes most often are inflammation,
regenerative reactions, certain deficiency states such as folic acid
deficiency, and the earliest changes in an epithelium that is in
neoplastic transformation.
In 70,625 first smears, minimally atypical squamous cells and
squamous metaplasia cells were identified in 16.8% of smears.
When related to the mode of contraception, these findings of
minimal atypia were noted in 14.1% of smears from women
using oral contraceptives and in 24.3% of smears from women
using lUDs. Diagnoses of minimal-to-slight atypical changes such
as "some abnormal squamous cells present" and "atypical squa-
mous metaplastic cells present" should be followed by a repeat
smear after 12 months.21 Patten advises maintaining patients with
evidence of cytologic atypia under surveillance at yearly intervals.8
Moderate atypia, frequently observed in reparative reactions,
should be followed by a repeat smear after 3 months.21
Reactive and Regenerative changes
A reactive change is an epithelial reaction to injury characterized
by the presence of sometimes highly atypical cells of endocervi-
cal and squamous metaplastic origin.
The epithelia covering the uterine ectocervix and endocervi-
cal canal are under the constant influence of physiologic stimuli
but also of ever-changing external stimuli.8
Regenerative epithelial reactions are commonly found in
patients after:
• Radiotherapy;
• Recent hysterectomy;
• Cautery or biopsy;
• Cryocoagulation diathermy;
• Past history of severe cervicitis; and
• Partial or complete destruction of the epithelium by
infection and inflammation.
These environmental changes result in various morphologic
responses, which may be classified as destructive, protective, or
Fig. 8.35
Cells from
atypical squamous metaplasia
simulating a dysplasia
because of abnormal size and shape of the cells. Nuclei are enlarged
but relatively small in comparison with the size of the cytoplasmic body
(Papanicolaou x HP).
Fig. 8.36 Epidermization.
Relatively mature squamous metaplastic
epithelium bridging an invagination of the endocervical mucosa into the
stroma. Complete blocking of the invagination may lead to large mucus-filled
cysts, Naboth's ovula in the cervix (H&E x LP).
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