cervical lesion; cervical nodule

Introduction

Lesions observed on microscopic examination of Pap Smears.

Etiology

• precancerous cervical lesions are secondary to human papilloma virus (HPV) subtypes 16, 18 & 31
• infection
  • Candida
  • Herpes
  • HPV
  • Trichomonas
  • Haemophilus vaginalis
• reactive or reparative changes
  • inflammation
  • radiation-induced changes
  • chemotherapy-induced changes
• epithelial cell abnormalities
  • atypical squamous cells of undetermined origin
  • squamous intraepithelial lesions (SIL)
  • low grade: cervical intraepithelial neoplasia I
    • involves lower 3rd of the squamous mucosa
  • high grade: cervical intraepithelial neoplasia II
    • involves lower 2/3 of the squamous mucosa
  • cervical intraepithelial neoplasia III
    • involves entire mucosal thickness
  • squamous cell carcinoma - 90% of all invasive cervical cancer
• glandular cell abnormalities
  • endometrial cells in post menopausal woman
  • atypical glandular cells
  • adenocarcinoma - 5% of all invasive cervical cancer
• other epithelial malignant neoplasm
• non-epithelial malignant neoplasm

Clinical manifestations

• invasive carcinoma of the cervix may present with bleed, especially after sexual intercourse
• pre-invasive lesions are asymptomatic
• infectious lesions
  • purulent vaginal discharge
  • pelvic pain
  • dysparunia
  • cervical motion tenderness
  • mucopurulent discharge
  • condylomatous changes
• human papilloma virus may induce condyloma accuminata on the perineum, vagina or cervical mucosa

Laboratory

• cytology (Pap Smear)
• HPV DNA testing

Diagnostic procedures

• colposcopy
  • 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
  • procedures during colposcopy
    • cervical biopsy*
    • endocervical curettage

Management

• Atypia
  • treat infection
  • pap smear every 3 months until 2 negative pap smears
  • allow 3 months for full repair of cervical inflammatory changes
  • colposcopy for
    • persistent atypia despite antibiotic therapy
    • atypia secondary to human papilloma virus (HPV)
• cervical intraepithelial neoplasia (CIN I-III) & carcinoma in situ
  • cryocoagulation
  • laser evaporation
  • conization
  • LEEP procedure
• invasive cancer
  • staging
  • referral to gynecologic oncologist
• endometrial biopsy
  • endometrial cells present in a postmenopausal woman
  • endometrial cells present more than 7 days after menses
• excisional therapy
  • inadequate colposcopy
  • positive endocervical curettage
  • incompatible biopsy & cytology
• follow-up
  • 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
  • treated cervical intraepithelial neoplasia (CIN I-III)
    • repeat Pap smear at 4 months & 8 months
    • repeat every 6-12 months thereafter

More general terms

• abnormal morphologic structure (malformation)
• lesion

More specific terms

• ulcerative lesion arising from the transformation zone of the cervix

Additional terms

• cervix
• Papanicolaou (Pap) smear