Cervical cone

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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.

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
  • Represents a mix of low- and high-grade lesions not easily differentiated by histology
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

Report

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

  • The histolopathological type and degree of differentiation
  • Location and extent
  • Radicality
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.