Histopathological study of cervix in hysterectomy specimen

Introduction

The cervix is a cylindrical shaped neck of tissue that connects the vagina and uterus, located at the lower most portion of the uterus and is composed primarily of fibromuscular tissue.1 The development of female genital track is closely influenced by chromosome XY and XX¹ and cervix is developed from fused lower vertical parts of the two paramesonephric ducts.2 The uterus and cervix being a vital reproductive and hormone-responsive organ, is subjected to a variety of physiological changes and benign and malignant disorders.3 Uterine cervix acts as a “gateway” of various infections, which affects cervix, uterus and upper genital tract, thus working under various pathological conditions leading to various lesions of cervix as well as a sentinel for upper genital tract infections.4 Hysterectomy is the most common major Gynaecological procedure in the world. It can be done through either abdominal or vaginal route.3 Cervical specimens like biopsies and sections of cervix from hysterectomy specimens form a significant part of surgical specimens in any histopathology laboratory. Among all cervical lesions, cervical inflammatory lesions are the most common cervical lesions on histopathology, followed by benign and malignant lesions.5 The organisms most commonly responsible for active inflammation in the cervix are Candida albicans, Trichomonas vaginalis, Neisseria gonorrhoeae, Gardnerella vaginalis, herpes simplex virus (HSV), Chlamydia trachomatis, human papillomavirus (HPV) and cytomegalovirus (CMV).6, 7 Benign tumors includes Leiomyoma, Blue nevus, Squamous papilloma and Condyloma acuminatum.6 Microscopic types of malignant tumors includes squamous cell carcinoma and its varients (Verrucous carcinoma, Spindle cell carcinoma, Basaloid (squamous cell) carcinoma, Lymphoepithelioma-like carcinoma, Transitional cell (urothelial) carcinoma), adenocarcinoma and its varients (Endometrioid adenocarcinoma, Serous (papillary) carcinoma, Adenoma malignum, Villoglandular (papillary) adenocarcinoma, Adenosquamous (mixed) carcinoma, Glassy cell carcinoma, Mucinous carcinoma of the endocervix, Adenoid cystic carcinoma, Adenoid basal carcinoma, Clear cell carcinoma, Mesonephric (adeno)carcinoma), Neuroendocrine carcinoma, Botryoid rhabdomyosarcoma, Alveolar rhabdomyosarcoma, Mixed müllerian tumors, Malignant lymphomas of the cervix, Metastatic carcinomas.8

Materials and Methods

This is a study of gross and histological findings of cervix in 150 hysterectomy specimens received in pathology department, Government medical college, Bhavnagar. Gross examination was carried out on specimens. Specimens immedietly transferred to 10% formalin. Tissue sections were given from anterior and posterior cervix and lesions if any. Tissue bits were routinely processed, 3 to 5 micron thick sections were made from paraffin embedded blocks and stained with H & E stain. Sections were examined with the help of light microscopy. Only resected uterus without cervix was excluded from study. The data were analysed in percentage, frequency, Chi-square test.

Results

It is evident from Table 1 that age of the patient ranged from 28-78 years and peak age for incidence for hysterectomy was 4^th decade of life. Lesser number of hysterectomy specimens were received below 30 year and above 60 year of age.

It is evident from Table 2 that menorrhagia with or without abdominal cramps was commonest symptoms and abnormal uterine bleeding and uterine prolepse was least common clinical symptoms.

It is evident from Table 3 that chronic nonspecific inflammation of cervix was found in 97/150 hysterectomy specimen which is commonest finding. Malignant cervical lesions are less common findings in hysterectomy specimen.

Discussion

Hysterectomy is commonly performed surgical procedure in gynecology in perimenopausal age.11 Uterine cervix forms the major portal for the non-neoplastic lesions in the routine histopathology specimens. Accordingly, for the diagnosis of non-neoplastic uterine cervical lesions, histopathological examination still remains gold standard.12 A closer study of the pathology of the uterine cervix reveals a number of non-neoplastic lesions of local origin, which are of great importance to the clinician and the pathologist. The diagnosis of these lesions have been grossly neglected. On the basis of this, the present study was undertaken to identify the various histological features of the uterine cervix. As such, the hysterectomy specimens which are associated with the non-neoplastic lesions of the cervix do not exhibit any major morphological variations.13

It is evident from Table 4 that nonspecific cervicitis was most common findings in adult females in this present study, which is similar observation in Dr. Varsha Dhuliya, Dr. Varsha Dhuliya and Dr. Priyadarshini D. Chronic cervicitis affects preferentially squamocolumnar junction and endocervix. Lesions with focal and sometimes dense inflammatory cell infiltrate seen most commonly in patient who underwent hysterectomy for various reason like prolapsed of uterus, fibroid uterus and dysfunctional uterine bleeding and pelvic inflammatory disease and found in all age group. Incidence of epithelial cell abnormality was different in different studies. The difference in the incidence of epithelial cell abnormalities are mostly due to difference in geographic area of study and difference in socioeconomic standards, racial, religious and other ethic factors peculiar to the population studied. As our study was done on Hospital based patients and majority of them were of low socioeconomic class and more than 50% were from rural area having poor genital hygiene and early age at marriage.

Conclusions

In our study, 150 hysterectomy specimens of cervix of Sir T. Hospital, Bhavnagar were examined for gross and microscopic feature and reported with the help of light microscopic examination; the age group was between 20 and 79 years, of which 68.66% were in reproductive age group; 68.66% had healthy looking cervix; 45.33% spicemens had chronic cervicitis on microscopic examination. In our study mode of presentation for hysterectomy was leiomyoma which is 64% and most common presenting age group was 4^th decade of life. On gross examination, majority of cervix are normal which is 68.33% but on microscopic examination majority of the cervix had non-specific chronic inflammatory features which is 45.33%. One case of small cell carcinoma of cervix was noted during study. Out of 11.33% case of uterovaginal prolepse, 41.17% cervix had hyperkeratinisation and mean age group of presentation was 6^th decade of life. Peak age for incidence for hysterectomy was 4^th decade of life, which is 47.33%.

Financial support and Sponsorship

None.

Conflicts of Interest

There are no conflicts of interest.