Cervical cone

From patholines.org
Jump to navigation Jump to search

Author: Mikael Häggström [note 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. 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 1][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

edit
Look for cervical dysplasia. It is mainly seen as nuclei with hyperchromasia, coarse chromatin and irregular contours.[2]

Further information: Cervical dysplasia


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.

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").
From left to right, a spectrum from normal, to borderline koilocytosis, to low-grade SIL, to high-grade SIL.[4]

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. Each slice may be individually numbered.
  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.

Main page

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. 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
  3. Source image by Ed Uthman from Houston, TX, USA. Creative Commons Attribution 2.0 Generic (CC BY 2.0) license
  4. Image by Ed Uthman from Houston, TX, USA. Creative Commons Attribution 2.0 Generic (CC BY 2.0) license

Image sources