Cervical cone

From patholines.org
Jump to navigation Jump to search

Author: Mikael Häggström [notes 1]
Unless otherwise specified, the primary focus is any cervical neoplasia.

Fixation

Generally 10% neutral buffered formalin.

See also: General notes on fixation

Gross processing

  • Measure length, as well as the transverse and sagittal diameter of the ectocervical surface.[1]
  • Optionally, weight the sample.[1]
  • Note the symmetry of the sample, and the position of the cervical canal.[1]
  • Note whether the circumference is complete. If not, and the directions are indicated on the cone, determine the approximate position of the defect.[1]
  • Cones excised by knife should be inked on the excision surfaces.[notes 2] Those excised by laser do not need inking.[1]

Selection and trimming

Gross preparation of cervical cone.svg
  • If the cone is more than 1 cm long, take transverse slices from the top of the cone and towards the ectocervix, and stop when approximately 1 cm of the ectocervical portion of the cone remains.
  • Cut the portion into radial or sagittal slices. Sagittal slices are made perpendicularly to the portion surface, and should be divided into at least the four quadrants.[notes 3][1]

In cases where the cone is small and fragmented, try to orient the preparations and divide them if possible to obtain sagittal slices.[1]

See also: General notes on gross processing

 

Microscopic evaluation

Look for dysplasia in the transformation zone.

Dysplasia grading

Cervical intraepithelial neoplasia edit
Histology Grade Corresponding Cytology Description Image
CIN 1 (Grade I) Low-grade squamous intraepithelial lesion (LSIL)
  • Mild epithelial dysplasia
  • Confined to the basal 1/3 of the epithelium
LSIL (CIN 1), Cervical Biopsy (3776284166).jpg
CIN 2/3 High-grade squamous intraepithelial lesion (HSIL)[notes 4]
  • Represents a mix of low and high-grade lesions not easily differentiated by histology
CIN 2 (Grade II)[notes 5]
  • Moderate dysplasia confined to the basal 2/3 of the epithelium
CIN 3 (Grade III)[notes 6]
  • Severe dysplasia with undifferentiated neoplastic cells that span more than 2/3 of the epithelium
  • May involve the full thickness
  • May also be referred to as cervical carcinoma in situ
Histopathology of CIN 3.jpg
Endocervical gland invasion is associated with high-grade lesions.[2]


Radicality

Locations of non-radicality should be reported in relation to tissue markings (such as needles), or in terms of quadrants or corresponding to a clock face, based on the patient being in supine position.

Look whether there is normal epithelium on each side of all slices where neoplasia is seen, and when the epithelium is missing in any direction, consider ordering additional serial sections or step sections.

Microscopy report

If a neoplasia is found, the report should include:[1]

  • The histolopathological type and degree of differentiation
  • Location and extent
  • Radicality
Histopathology of CIN 3.jpg
Histopathology of CIN 3 with endocervical gland invasion.jpg
The transition zone has thickened endocervical epithelium with poorly differentiated neoplastic cells, which span more than half of the epithelial thickness, and with invasion of endocervical glands. Otherwise, glands are clad by a simple columnar epithelium without atypia. The neoplastic cells are radically removed.
See also: General notes on reporting

Notes

  1. For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.
  2. Inking can be done with India ink, and will specify the serosa or resection margin in later histopathologic evaluation.
  3. Each slice may be individually numbered.
  4. HSIL+ encompasses HSIL, AGC, and cancer
  5. CIN 2+ encompasses CIN 2, CIN 3, adenocarcinoma in situ (AIS), and cancer
  6. CIN 3+ encompasses CIN 3, AIS, and cancer

References

  1. 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 Monica Dahlgren, Janne Malina, Anna Måsbäck, Otto Ljungberg. Stora utskärningen. KVAST (Swedish Society of Pathology). Retrieved on 2019-09-26.
  2. Nagi, Chandandeep S.; Schlosshauer, Peter W. (2006). "Endocervical glandular involvement is associated with high-grade SIL ". Gynecologic Oncology 102 (2): 240–243. doi:10.1016/j.ygyno.2005.12.029. ISSN 00908258.