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Anatomy, Histology, Cytology, and Colposcopy of the Cervix

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Atlas of Diagnostic Pathology of the Cervix

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Abstract

The cervix represents the lower portion of the uterus and plays an important anatomical role in supporting the internal genital organs during pregnancy and at birth. It also has importance as a cervical mucin-producing organ. The cervical stroma comprises a mixture of fibrous, muscular, and elastic tissue. It is lined by a columnar epithelium in the endocervical canal and by a mature, nonkeratinizing squamous epithelium in the ectocervix. The location of endocervical epithelium varies throughout life and is influenced by the hormonal milieu, such that endocervical epithelium can be visualized by colposcopy in women of reproductive age. The “transformation zone” encompasses a junctional area, containing combinations of glandular and metaplastic squamous epithelium, bounded proximally by endocervix and, distally, by ectocervix. This is considered to be the area where most neoplastic processes occur.

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References

  1. Konishi I, Fujii S, Nonogaki H, Nanbu Y, Iwai T, Mori T. Immunohistochemical analysis of estrogen receptors, progesterone receptors, Ki-67 antigen, and human papillomavirus DNA in normal and neoplastic epithelium of the uterine cervix. Cancer. 1991;68:1340–50.

    Article  CAS  PubMed  Google Scholar 

  2. Cid JM. Melanoid pigmentation of the endocervix: a neurogenic visceral argument. Anat Pathol. 1959;4:617–28.

    CAS  Google Scholar 

  3. Fetissof F, Arbeille B, Boivin F, Sam-Giao M, Henrion C, Lansac J. Endocrine cells in ectocervical epithelium. An immunohistochemical and ultrastructural analysis. Virchows Arch A Pathol Anat Histopathol. 1987;411:293–8.

    Article  CAS  PubMed  Google Scholar 

  4. Fetissof F, Serres G, Arbeille B, de Muret A, Sam-Giao M, Lansac J. Argyrophilic cells and ectocervical epithelium. Int J Gynecol Pathol. 1991;10:177–90.

    Article  CAS  PubMed  Google Scholar 

  5. Morris HH, Gatter KC, Stein H, Mason DY. Langerhans’ cells in human cervical epithelium: an immunohistological study. Br J Obstet Gynaecol. 1983;90:400–11.

    Article  CAS  PubMed  Google Scholar 

  6. Moll R, Franke WW, Schiller DL, Geiger B, Krepler R. The catalog of human cytokeratins: patterns of expression in normal epithelia, tumors and cultured cells. Cell. 1982;31:11–24.

    Article  CAS  PubMed  Google Scholar 

  7. Moll R, Levy R, Czernobilsky B, Hohlweg-Majert P, Dallenbach-Hellweg G, Franke WW. Cytokeratins of normal epithelia and some neoplasms of the female genital tract. Lab Investig. 1983;49:599–610.

    CAS  PubMed  Google Scholar 

  8. Franke WW, Moll R, Achtstaetter T, Kuhn C. Cell typing of epithelia and carcinomas of the female genital tract using cytoskeletal proteins as markers. In: Peto R, editor. Viral etiology of cervical cancer. Banbury report 21. New York: Cold Spring Harbor Laboratory; 1986. p. 121–44.

    Google Scholar 

  9. Nielsen LN, Hørding U, Daugaard S, Rasmussen LP, Norrild B. Cytokeratin intermediate filament pattern and human papillomavirus type in uterine cervical biopsies with different histological diagnosis. Gynecol Obstet Investig. 1991;32:232–8.

    Article  CAS  Google Scholar 

  10. Smedts F, Ramaekers F, Troyanovsky S, Pruszczynski M, Robben H, Lane B, et al. Basal-cell keratins in cervical reserve cells and a comparison to their expression in cervical intraepithelial neoplasia. Am J Pathol. 1992;140:601–12.

    CAS  PubMed  PubMed Central  Google Scholar 

  11. Berchuck A, Rodriguez G, Kamel A, Soper JT, Clarke-Pearson DL, Bast RC Jr. Expression of epidermal growth factor receptor and HER-2/neu in normal and neoplastic cervix, vulva, and vagina. Obstet Gynecol. 1990;76:381–7.

    CAS  PubMed  Google Scholar 

  12. Saegusa M, Takano Y, Hashimura M, Shoji Y, Okayasu I. The possible role of bcl-2 expression in the progression of tumors of the uterine cervix. Cancer. 1995;76:2297–303.

    Article  CAS  PubMed  Google Scholar 

  13. ter Harmsel B, Kuijpers J, Smedts F, Jeunink M, Trimbos B, Ramaekers F. Progressing imbalance between proliferation and apoptosis with increasing severity of cervical intraepithelial neoplasia. Int J Gynecol Pathol. 1997;16:205–11.

    Article  PubMed  Google Scholar 

  14. Kanai M, Shiozawa T, Xin L, Nikaido T, Fujii S. Immunohistochemical detection of sex steroid receptors, cyclins, and cyclin-dependent kinases in the normal and neoplastic squamous epithelia of the uterine cervix. Cancer. 1998;82:1709–19.

    Article  CAS  PubMed  Google Scholar 

  15. Cho NH, Kim YT, Kim JW. Correlation between G1 cyclins and HPV in the uterine cervix. Int J Gynecol Pathol. 1997;16:339–47.

    Article  CAS  PubMed  Google Scholar 

  16. Ibrahim EM, Blackett AD, Tidy JA, Wells M. CD44 is a marker of endocervical neoplasia. Int J Gynecol Pathol. 1999;18:101–8.

    Article  CAS  PubMed  Google Scholar 

  17. McCluggage WG, Buhidma M, Tang L, Maxwell P, Bharucha H. Monoclonal antibody MIB1 in the assessment of cervical squamous intraepithelial lesions. Int J Gynecol Pathol. 1996;15:131–6.

    Article  CAS  PubMed  Google Scholar 

  18. Fujiwara H, Tortolero-Luna G, Mitchell MF, Koulos JP, Wright TC Jr. Adenocarcinoma of the cervix. Expression and clinical significance of estrogen and progesterone receptors. Cancer. 1997;79:505–12.

    Article  CAS  PubMed  Google Scholar 

  19. Tateishi R, Wada A, Hayakawa K, Hongo J, Ishii S. Argyrophil cell carcinomas (apudomas) of the uterine cervix. Light and electron microscopic observations of 5 cases. Virchows Arch A Pathol Anat Histol. 1975;366:257–74.

    Article  CAS  PubMed  Google Scholar 

  20. Fluhmann CF. Focal hyperplasis (tunnel clusters) of the cervix uteri. Obstet Gynecol. 1961;17:206–14.

    CAS  PubMed  Google Scholar 

  21. Fluhmann CF. The nature and development of the so-called glands of the cervix uteri. Am J Obstet Gynecol 1957;74:753–66; discussion 766–8.

    Google Scholar 

  22. Anderson MC, Hartley RB. Cervical crypt involvement by intraepithelial neoplasia. Obstet Gynecol. 1980;55:546–50.

    CAS  PubMed  Google Scholar 

  23. Clement PB, Young RH. Deep nabothian cysts of the uterine cervix. A possible source of confusion with minimal-deviation adenocarcinoma (adenoma malignum). Int J Gynecol Pathol. 1989;8:340–8.

    Article  CAS  PubMed  Google Scholar 

  24. Wakefield EA, Wells M. Histochemical study of endocervical glycoproteins throughout the normal menstrual cycle and adjacent to cervical intraepithelial neoplasia. Int J Gynecol Pathol. 1985;4:230–9.

    Article  CAS  PubMed  Google Scholar 

  25. Maes G, Fleuren GJ, Bara J, Nap M. The distribution of mucins, carcinoembryonic antigen, and mucus-associated antigens in endocervical and endometrial adenocarcinomas. Int J Gynecol Pathol. 1988;7:112–22.

    Article  CAS  PubMed  Google Scholar 

  26. Gipson IK, Spurr-Michaud S, Moccia R, Zhan Q, Toribara N, Ho SB, et al. MUC4 and MUC5B transcripts are the prevalent mucin messenger ribonucleic acids of the human endocervix. Biol Reprod. 1999;60:58–64.

    Article  CAS  PubMed  Google Scholar 

  27. Riethdorf L, O’Connell JT, Riethdorf S, Cviko A, Crum CP. Differential expression of MUC2 and MUC5AC in benign and malignant glandular lesions of the cervix uteri. Virchows Arch. 2000;437:365–71.

    Article  CAS  PubMed  Google Scholar 

  28. Baker AC, Eltoum I, Curry RO, Stockard CR, Manne U, Grizzle WE, Chhieng D. Mucinous expression in benign and neoplastic glandular lesions of the uterine cervix. Arch Pathol Lab Med. 2006;130:1510–5.

    PubMed  Google Scholar 

  29. Moh M, Krings G, Ates D, Aysal A, Kim GE, Rabban JT. SATB2 expression distinguishes ovarian metastases of colorectal and appendiceal origin from primary ovarian tumors of mucinous or endometrioid type. Am J Surg Pathol. 2016;40:419–32. https://doi.org/10.1097/PAS.0000000000000553.

    Article  PubMed  Google Scholar 

  30. Moore KL. The developing human. Clinically oriented embryology. 3rd ed. Philadelphia: WB Saunders; 1982. p. 207–21.

    Google Scholar 

  31. Forsberg JG. Cervicovaginal epithelium: its origin and development. Am J Obstet Gynecol. 1973;115:1025–43.

    Article  CAS  PubMed  Google Scholar 

  32. Weikel W, Wagner R, Moll R. Characterization of subcolumnar reserve cells and other epithelia of human uterine cervix. Demonstration of diverse cytokeratin polypeptides in reserve cells. Virchows Arch B Cell Pathol Incl Mod Pathol. 1987;54:98–110.

    Article  CAS  Google Scholar 

  33. Smedts F, Ramaekers F, Leube RE, Keijser K, Link M, Vooijs P. Expression of keratins 1, 6, 15, 16, and 20 in normal cervical epithelium, squamous metaplasia, cervical intraepithelial neoplasia, and cervical carcinoma. Am J Pathol. 1993;142:403–12.

    CAS  PubMed  PubMed Central  Google Scholar 

  34. Mittal K. Utility of proliferation-associated marker MIB-1 in evaluating lesions of the uterine cervix. Adv Anat Pathol. 1999;6:177–85.

    Article  CAS  PubMed  Google Scholar 

  35. McCluggage WG. Immunohistochemistry as a diagnostic aid in cervical pathology. Pathology. 2007;39:97–111.

    Article  CAS  PubMed  Google Scholar 

  36. Herfs M, Yamamoto Y, Laury A, Wang X, Nucci MR, McLaughlin-Drubin ME, et al. A discrete population of squamocolumnar junction cells implicated in the pathogenesis of cervical cancer. Proc Natl Acad Sci USA. 2012;109:10516–21.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Herfs M, Vargas SO, Yamamoto Y, Howitt BE, Nucci MR, Hornick JL, et al. A novel blueprint for ‘top down’ differentiation defines the cervical squamocolumnar junction during development, reproductive life, and neoplasia. J Pathol. 2013;229:460–8. https://doi.org/10.1002/path.4110.

    Article  PubMed  Google Scholar 

  38. Crum CP, Egawa K, Fu YS, Lancaster WD, Barron B, Levine RU, et al. Atypical immature metaplasia (AIM). A subset of human papilloma virus infection of the cervix. Cancer. 1983;51:2214–9.

    Article  CAS  PubMed  Google Scholar 

  39. Herfs M, Parra Herran C, Howitt B, Laury A, Nucci MR, Feldman S, et al. Cervical squamocolumnar junction-specific markers define distinct, clinically relevant subsets of low-grade squamous intraepithelial lesions. Am J Surg Pathol. 2013;37:1311–8. https://doi.org/10.1097/PAS.0b013e3182989ee2.

    Article  PubMed  PubMed Central  Google Scholar 

  40. de Martel C, Ferlay J, Franceschi S, Vignat J, Bray F, Forman D, Plummer M. Global burden of cancers attributable to infections in 2008: a review and synthetic analysis. Lancet Oncol. 2012;13:607–15. https://doi.org/10.1016/S1470-2045(12)70137-7.

    Article  PubMed  Google Scholar 

  41. Stern JE, Givan AL, Gonzalez JL, Harper DM, White HD, Wira CR. Leukocytes in the cervix: a quantitative evaluation of cervicitis. Obstet Gynecol. 1998;91:987–92.

    CAS  PubMed  Google Scholar 

  42. Ferry JA, Scully RE. Mesonephric remnants, hyperplasia and neoplasia in the uterine cervix. A study of 49 cases. Am J Surg Pathol. 1990;14:1100–11.

    Article  CAS  PubMed  Google Scholar 

  43. Nogales FF. Mesonephric (Wolffian) tumours of the female genital tract: Is mesonephric histogenesis a mirage and trap? Curr Diag Pathol. 1995;2:94–100.

    Article  Google Scholar 

  44. Sneeden VD. Mesonephric lesions of the cervix; a practical means of demonstration and a suggestion of incidence. Cancer. 1958;11:334–6.

    Article  CAS  PubMed  Google Scholar 

  45. Ordi J, Nogales FF, Palacin A, Márquez M, Pahisa J, Vanrell JA, Cardesa A. Mesonephric adenocarcinoma of the uterine corpus: CD10 expression as evidence of mesonephric differentiation. Am J Surg Pathol. 2001;25:1540–5.

    Article  CAS  PubMed  Google Scholar 

  46. Silver SA, Devouassoux-Shisheboran M, Mezzetti TP, Tavassoli FA. Mesonephric adenocarcinomas of the uterine cervix: a study of 11 cases with immunohistochemical findings. Am J Surg Pathol. 2001;25:379–87.

    Article  CAS  PubMed  Google Scholar 

  47. Norris HJ, Taylor HB. Polyps of the vagina. A benign lesion resembling sarcoma botryoides. Cancer. 1966;19:227–32.

    Article  CAS  PubMed  Google Scholar 

  48. Elliott GB, Elliott JD. Superficial stromal reactions of lower genital tract. Arch Pathol. 1973;95:100–1.

    CAS  PubMed  Google Scholar 

  49. Clement PB. Multinucleated stromal giant cells of the uterine cervix. Arch Pathol Lab Med. 1985;109:200–2.

    CAS  PubMed  Google Scholar 

  50. Abdul-Karim FW, Cohen RE. Atypical stromal cells of lower female genital tract. Histopathology. 1990;17:249–53.

    Article  CAS  PubMed  Google Scholar 

  51. Metze K, Andrade LA. Atypical stromal giant cells of cervix uteri – evidence of Schwann cell origin. Pathol Res Pract 1991;187:1031–5; discussion 1036–8.

    Google Scholar 

  52. Rodrigues MI, Goez E, Larios KK, Cuevas M, Fernandez JA, Stolnicu SS, Nogales FF. Atypical stromal cells as a diagnostic pitfall in lesions of the lower female genital tract and uterus: a review and presentation of some unusual cases. Patol Rev Latinoam. 2009;47:103–7.

    Google Scholar 

  53. Wentzensen N, Massad LS, Mayeaux EJ Jr, Khan MJ, Waxman AG, Einstein MH, et al. Evidence-based consensus recommendations for colposcopy practice for cervical cancer prevention in the United States. J Low Gent Tract Dis. 2017;21:216–22.

    Article  Google Scholar 

  54. Wentzensen N, Schiffman M, Silver MI, Khan MJ, Perkins RB, Smith KM, et al. ASCCP colposcopy standards: risk-based colposcopy practice. J Low Gent Tract Dis. 2017;21:230–4.

    Article  Google Scholar 

  55. Munsick RA, Janovski NA. Walthard cell rest of the cervix uteri. Report of a case. Am J Obstet Gynecol. 1961;82:909–12.

    Article  CAS  PubMed  Google Scholar 

  56. Weir MM, Bell DA, Young RH. Transitional cell metaplasia of the uterine cervix and vagina: an underrecognized lesion that may be confused with high-grade dysplasia. A report of 59 cases. Am J Surg Pathol. 1997;21:510–7.

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Pathology, University of Medicine, Pharmacy, Sciences and Technology, Targu Mures, Romania

    Simona Stolnicu

  2. Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Deborah Goldfrank

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  1. Simona Stolnicu
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  2. Deborah Goldfrank
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Editors and Affiliations

  1. Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Robert A. Soslow

  2. Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Kay J. Park

  3. Department of Pathology, University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, Targu Mures, Romania

    Simona Stolnicu

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Stolnicu, S., Goldfrank, D. (2021). Anatomy, Histology, Cytology, and Colposcopy of the Cervix. In: Soslow, R.A., Park, K.J., Stolnicu, S. (eds) Atlas of Diagnostic Pathology of the Cervix. Springer, Cham. https://doi.org/10.1007/978-3-030-49954-9_1

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  • DOI: https://doi.org/10.1007/978-3-030-49954-9_1

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