Atypia of the flat epithelium on the background of acute coleitis. Glandular hyperplasia

The term " cervical hyperplasia"Primarily refers to the epithelium and refers to the proliferation and overgrowth of cells. This process is diagnosed only by histological examination and has no clear clinical manifestations. Since the cervix lining two types of epithelium - stratified flat and glandular, and hyperplasia can be of two types.

Cervical hyperplasia is a compensatory-adaptive response related to background precancerous processes. The risk of tumor transformation in women of reproductive age is extremely low. In women in pre- and menopause, any stimulation of cell growth is dangerous, which requires greater alertness. When detecting morphological signs of atypia, the process should be attributed to the tumor.

Glandular cervical hyperplasia

Most common cause  The development of glandular hyperplasia is a dyshormonal disorder, in particular, an increase in the level of estrogen in a woman's body. Estrogens stimulate synthetic processes and directly control cell proliferation. Hyperplasia of the glandular epithelium is most common in young girls, this is due to the formation of hormonal background. In the reproductive age, an increase in the level of estrogens is usually observed with cysts and hormone-producing ovarian tumors, as well as obesity and hormone replacement therapy. Hyperplastic mucosa forms papillae of various sizes, and sometimes. The progression of the process may lead to displacement of the glandular epithelium on the outer part of the cervix with the formation of the so-called papillary. Active proliferation of the epithelium can lead to the development of microglandular hyperplasia - a condition in which the glandular epithelium begins to form multiple small glands. Sometimes the glands can stretch out in secret and form cysts, in which case the term “cystic hyperplasia” is used. Often, microglandular hyperplasia of the cervix develops simultaneously with cancer of the body of the uterus, especially in peri-and menopausal women. This is due to the fact that estrogens affect all target organs, including the endometrium. When detecting glandular hyperplasia of the cervix, it is necessary to conduct a full examination of the female genital tract.

Glandular hyperplasia is diagnosed only by histological examination of the material, i.e. if a cervical biopsy or a curettage of the cervical canal was performed. Treatment should be based on the exclusion of the main process, since proliferation of the cervical epithelium is only a consequence. After removal of excess mucous membrane, duphaston is usually prescribed to neutralize the estrogen effect. Duphaston refers to the preparations of the gestagenous action and is an antagonist of estrogen.

Hyperplasia of the squamous epithelium of the cervix

This type of hyperplasia refers to reactive changes in the squamous epithelium that covers the outer part of the cervix. The proliferation of squamous epithelial cells is characterized by thickening of the epithelial layer and expansion of the basal growth layer - basal cell hyperplasia. Among the causes can be identified chronic inflammation and viral damage of the epithelium, especially the defeat of the human papilloma virus. The epithelium can also thicken in response to any irritation, whether physical, mechanical or chemical. With the exclusion of all provoking factors, hyperplasia of the squamous epithelium passes without a trace. In the morphological diagnosis, it is important to differentiate the basal-cell hyperplasia with impaired maturation of the squamous epithelium, as this may be due to dysplasia. Sometimes these processes are combined, because at grade 1, the growth of the germ zone with active proliferation and cell atypia also occurs.

The photo on the left shows flat epithelium in norm, on the right - hyperplasia, characterized by expansion of the basal germ layer, an increase in cell size and density.

Findings:

1. Uterine cervical hyperplasia is a benign reactive process, but with a long-term course it can be a source of tumor growth.
  2. Elevated levels of estrogen and chronic inflammation is the main cause of the development of hyperplastic processes of the cervix uterus.
  3. Treatment should be comprehensive and aimed at finding the main pathology.

Glandular hyperplasia is characterized
proliferation of glandular structures in the cervix. The development of the cylindrical epithelium on the vaginal part of the cervix is ​​denoted by various terms: ECTOPY, pseudo-erosion, endocervicosis, ectropion. Due to the fact that visually during this process, there are red areas on the cervix, sometimes this condition is called “erosion”. This term is not entirely legitimate, since "erosion" (or true erosion) is a defect in the mucous membrane (lat. Erosion - erosion). The source of the cylindrical epithelium on the vaginal portion of the cervix is ​​considered to be the epithelium of the endonerviks and polypotent "reserve cells", which have the ability to develop both in the direction of the flat (with squamous metaplasia) and glandular epithelium. These same cells form the basis of the so-called microglandular hyperplasia. Due to the fact that they are cells of the germinative type, various reasons can lead to an incorrect differentiation of these cells, as well as to their atypical proliferation.

The task of cytological research is not so much to state the presence of glandular epithelium on the vaginal portion of the cervix, but to carefully examine the smears in order not to miss the pathological changes (atypia) in the glandular, metaplastic or flat epithelium. A differential cytological diagnosis between superficial endocervicosis (physiological ectopia, ectopia associated with inflammation, hormonal imbalance) and proliferating (progressive) endocervicosis is not always possible. Ectopia is more characteristic of “calm” cells of a cylindrical epithelium of normal size and shape, located in the form of a “honeycomb” or one- or two-row “strips”. In proliferating endocervicosis, the cells are arranged in groups or glandular structures, sometimes bilayer. Nuclei are enlarged, nucleoli are found in separate cells. Chromatin is evenly distributed, there is a slight hyperchromia of the nuclei. The nuclei are located predominantly eccentric. The cytoplasm is abundant, basophilic or light frothy. The cells in the structures are somewhat layered on each other, differ in size within the structures and smear (Fig. 85, 86, a). When healing endocervicosis, a large number of metaplassed cells are also found in smears.

In many medical institutions of the country, it is customary to “cauterize” (to carry out cryo,

Fig. 85. Hyperplasia of the glandular epithelium: a - a glandular-like structure of cylindrical epithelium cells with a lumen in the center (indicated by an arrow). The nuclei are located eccentrically, the cytoplasm is abundant (goblet cells). Papanicolau staining. x500; (b) papillary-like structure of cylindrical epithelium cells (indicated by an arrow) and scattered glandular cells with enlarged nuclei. Smear with vaginal portions of the cervix. Coloring according to Pappenheim. x500

electro-, or laser coagulation of all "erosion". This leads to the fact that many women with ectopia carried out unjustified surgical intervention. In addition, such interventions are fraught with the danger of development under coagulated sites in the depth of the remaining glands and sites of the immature epithelium of dysplasias. Such dysplasia can develop for quite a long time without cytological manifestations, since its surface is covered with normal epithelium.
   After electrocoagulation of the cervix, which has so far been performed on endocervicoses, changes in the epithelium occur due to reparative processes and the immune response. For about two months, cells with enlarged nuclei, coarse chromatin, and basophilic cytoplasm are found in the cytograms. There are also “contact light cells,” resembling lymphocytes, rounded, with a narrow rim of cytoplasm, and fine-grained chromatin. Some patients also find “cell breakdown fields” consisting of unaltered and degeneratively altered cells, lysed nuclei surrounded by rounded cells of the second type. Usually, patients with “cell disintegration fields” have a rapid return to the normal state of the epithelium.
   It is also very important to correctly assess the state of the cylindrical epithelium of the cervical canal, note the signs of hyperplasia, atypical proliferation, intra-epithelial neoplasia of the endocervix (dysplasia of the glandular epithelium).

Fig. 86. Glandular hyperplasia: a - scraping from the vaginal portion of the cervix (histologically - proliferating endocervicosis). The cells are piled on top of each other, the nuclear-cytoplasmic ratio is shifted towards the nucleus. x200; b - cervical polyp polyp (swab from a polyp) - elongated cells, oval nuclei, chromatin structure uniformly granular, single, small nucleoli. Cytoplasm of elongated shape, in part of the cells vacuolation. Coloring according to Pappenheim. x1000

Reproductive function is affected by almost all organs and systems. But still especially important is given to the genitals. Everyone knows that frequent inflammatory diseases  Without effective treatment  can go into a chronic process. In this case, the symptoms do not appear so clearly, which makes a woman believe that she has no problems. But not only chronitization such processes are dangerous. At the site of inflammation, hyperplasia of the cervical glandular epithelium often occurs. This pathology affects women of all ages when there are predisposing factors in the form of inflammation and other causes.

But the most dangerous thing is that this disease tends to degenerate into cancer. Moreover, the more years the patient, the higher the risk. How to protect yourself from the disease and prevent the occurrence of cancer processes? To do this, it is enough to understand what hyperplasia is and when to start sounding the alarm.

Why do extra cells appear?

This disease is characterized by pathological proliferation of glandular cells, which ultimately leads to thickening of the walls and volume of the uterus. The mechanism of such a process as epithelial hyperplasia is explained by enhanced proliferation or division of endometrial cells. Naturally, any cell growth above the norm is pathological, but hyperplasia itself is a benign disease.

The photo shows the layout of the uterus of a woman

But this does not mean that you can “close your eyes” to the pathology and not carry out treatment. The whole danger of the condition lies in the very high risk of degeneration of glandular cells into cancer cells. That is, this disease is a provoking factor for cancer diseases and, therefore, requires timely treatment and long-term follow-up after it.

Thus, it can be concluded that timely diagnosis of such pathology as endometrial hyperplasia of the cervix and the inner layer is the prevention of cancer. It should be noted that young girls with this pathology have practically no malignancy, whereas in the period of menopause the risks are very high, which is explained by a large number of provoking factors, such as reduced immunity, slowing down of metabolic processes, deterioration of many organs and systems and so Further.

Knowing what it is, you can easily understand what is the impetus for the development of pathology. As a rule, this is a change in hormone levels. This explains the fact that most often the first signs of the disease appear at the age of 14-20 and after 45. It is at this time that young girls experience a dramatic change in the hormonal level due to puberty, and in women the menopause and the changes associated with it begin.

In addition, pathology is more often diagnosed in women with a history of inflammatory processes  genital organs, abortions, use of intrauterine devices of contraception, surgery on the pelvis, and even a sharp rejection of hormone-containing drugs. All this violates the natural processes in the body and with a certain set of circumstances leads to increased cell growth, that is, hyperplasia. Among the common causes that can affect the development of such pathologies as hyperplasia of the endocervix and endometrium, include smoking, obesity, metabolic disorders, diabetes, hypertension, uterine myoma, cystic lesions, and so on.

Forms of pathology and its signs

Depending on exactly what changes occur in the endometrium, pathology can be divided into the following forms:

• Glandular cystic
• Ferrous
• Atypical
• Focal.

The first is characterized by the growth of glandular epithelium with the formation of a large number of cysts. With the defeat of the cervical canal, the appearance of brushes is observed along its course and in the area of ​​the throat. It is important to note that most often cervical hyperplasia occurs simultaneously with endometrial lesion, which requires a more thorough diagnosis in order to carry out treatment aimed at all areas of the lesion. The second form proceeds with an increase in glandular cells, which may differ in both size and localization on the endometrial mucosa.

The atypical form is the most dangerous, since every tenth woman is reborn into cancer. As for the focal form, it is characterized by the complexity of diagnosis, since changes in the tissues are located only in some areas. The rest of the endometrium is not affected. That is, when performing a biopsy, there is a probability of taking material from the unaffected part of the endometrium, which will give false negative results. At the same time, glandular hyperplasia of the cervix of a focal form is rather easily diagnosed by visible polyps on the pharynx and in the cervical canal.

The pathology clinic includes uterine bleeding and problems in conceiving a child. As a rule, no other complaints of the patient do not show. In addition, pathology is often detected during prophylactic examinations in the absence of any symptoms.

More details about the causes of cervical abnormalities are described in the video:

Diagnosis and treatment of the disease

If during the examination the gynecologist has a suspicion that there is hyperplasia of the cervical endometrium or the inner layer of the uterus, an ultrasound scan is ordered first. Thanks to him, the thickness of the organ is determined, which normally should be no more than 9 millimeters. In addition, it is possible to determine the nature of the lesion, since in the photo the glandular and glandular-cystic forms have a uniform change of tissues, and the focal, in contrast to them, is represented by normal endometrium with areas of hyperplasia.

Almost always, treatment begins with curettage of the uterus and the cervical canal under the control of hysteroscopy, which eliminates focal hyperplasia, which is often localized in the corners of the uterus. After that, a course of hormonal therapy is selected, aimed at restoring the endometrium, normalizing menstrual cycle  and reproductive functions. In women over 45, the goal is to achieve persistent menopause.

After completing the course, the patient should be at a dispensary for a long time and undergo an ultrasound examination twice a year to prevent recurrence of the pathology. Only when all the recommendations are followed can the risk of developing cancer of the uterus and cervix be completely excluded.