Cervical cone

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


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. 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.[note 2][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

Anatomic/Histologic location

Describe mucosa as squamous (or ectocervical), endocervical (generally mucinous and glandular) and/or transformation zone mucosa.

Cervical dysplasia

Look for cervical dysplasia. It is mainly seen as nuclei with hyperchromasia, coarse chromatin and irregular contours.[3]

Further information: Cervical dysplasia


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.

HPV changes

Also look koilocytic changes of human papillomavirus (HPV), with such cells typically displaying:

  • Nuclear enlargement (two to three times normal size).
  • Irregularity of the nuclear membrane contour, creating a wrinkled or raisinoid appearance.
  • A darker than normal staining pattern in the nucleus, known as hyperchromasia.
  • Perinuclear cytoplasmic vacuolization ("nuclear halo").

Other findings

Other common findings:

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

High-grade squamous intraepithelial lesion (CIN-2), present at 3:00 to 12:00.
All margins of excision are negative for CIN-2.

Example report in a normal case:

Cervix at transformation zone without significant histopathologic changes.
Negative for neoplasia/carcinoma.

  See also: General notes on reporting


  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. Each slice may be individually numbered.

Main page


  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. International Federation for Cervical Pathology and Colposcopy (IFCPC) classification. References:
    -. Transformation zone (TZ) and cervical excision types. Royal College of Pathologists of Australasia.
    - Jordan, J.; Arbyn, M.; Martin-Hirsch, P.; Schenck, U.; Baldauf, J-J.; Da Silva, D.; Anttila, A.; Nieminen, P.; et al. (2008). "European guidelines for quality assurance in cervical cancer screening: recommendations for clinical management of abnormal cervical cytology, part 1 ". Cytopathology 19 (6): 342–354. doi:10.1111/j.1365-2303.2008.00623.x. ISSN 0956-5507. PMID 19040546. 
  3. Khaled J. Alkhateeb, M.B.B.S., Ziyan T. Salih, M.D.. HSIL / CIN II / CIN III. PathologyOutlines. Topic Completed: 29 March 2021. Minor changes: 9 February 2022
  4. Source image by Ed Uthman from Houston, TX, USA. Creative Commons Attribution 2.0 Generic (CC BY 2.0) license
  5. Anissa Ben Amor.. Cervical Ectropion. StatPearls, National Center for Biotechnology Information. Last Update: November 14, 2021.
    - This book is distributed under the terms of the Creative Commons Attribution 4.0 International License

Image sources