Background diseases of the cervix

True erosion is a defect of stratified squamous epithelium on the vaginal portion of the cervix. It is believed that true erosion occurs as a result of -inflammatory processes, leading to necrobiosis of stratified squamous epithelium in the acidic environment of the vagina, which, as a result of mechanical injury, is exfoliated from the underlying membrane. At the same time, the basal layer of the cells is at least partially preserved and, consequently, the potential for healing. True erosion is epithelialized within 3-7 days. She does not have a specific clinical picture, and very often the patient does not consult a doctor. Beli or other pathological discharges, itching, as a rule, are caused by transient inflammatory changes, exocervicitis, and colpitis. During colposcopy, erosion looks like a portion of the ectocervix of bright red color, irregular shape, not covered by epithelium (Fig. 15.46). The treatment is aimed at eliminating contamination (local antibacterial therapy) and normalizing the vaginal microflora (using eubiotics – lactobacterin *, etc.), stimulating regeneration (solcoseryl *). With hormonal disorders and the absence of proper treatment, epithelialization of erosion is possible with the formation of a cylindrical epithelium (ectopia) of the cervix, not layered flat.

Ectopia of the cervix involves the displacement of the cylindrical epithelium on the vaginal portion of the cervix. Congenital and acquired ectopia (pseudo-erosion) is distinguished.

If in the pubertal period there is no regular displacement of the junction of 2 types of cervical epithelium to the external pharynx, then in the reproductive period there is congenital ectopia – when the colposcopy around the external pharynx is determined, the ovum of the cylindrical epithelium is rounded, red, with a velvety surface. From the point of view of histogenesis, congenital ectopia can be considered as a variant of the physiological norm, therefore, patients with uncomplicated congenital ectopia are subject to observation.

Acquired ectopy may occur as a result of epithelialization of true erosion with the formation of a cylindrical epithelium, the source of which may be reserve cells. Predisposing factors are urogenital infections, including viral, hormonal disorders. In patients with ectopia, as a rule, there are no complaints, sometimes whites, contact bleeding are observed, which usually happens with concomitant exo- and endocervicitis. During a gynecological examination, ectopia looks like a portion of irregular shape of bright red color, often located asymmetrically on the anterior or posterior lip of the cervix against the pale mucous membrane of the ectocervix. In colposcopy, ectopia consists of areas covered with many rounded or oblong red papillae (a velvety surface).

The bright red color is due to the vessels of the underlying stroma, translucent through one row of cylindrical cells (Fig. 15.47). Sometimes the colposcopic picture can complement the “transformation zone”, which reflects the processes of replacing the cylindrical epithelium of the ectopia with the stratified flat – the metaplassed and immature stratified squamous epithelium, the open and closed ducts of the glands that are formed when the crypts in the ectopia overlap by the stratified squamous epithelium are visualized.

The tactics of management of patients with ectopia is determined by the results of “colposcopy, cytology, examination of human papillomavirus (HPV), if necessary, biopsy. In uncomplicated ectopia in non-deliverable women, observation has been shown, in the case of persistent inflammatory process, HPV after anti-inflammatory and antiviral treatment, cryodestruction, laser coagulation, and radiosurgical effect (surgitron) are used. In patients who have performed reproductive function, destruction of the ectopic zone or conization of the cervix is ​​shown by one method or another.

Ectropion is a combination of ectopia and cervical deformity. During pregnancy, as a result of hormonal changes and exposure to progesterone, cervical ectopia increases, during childbirth (less often with abortions), serum of the mucous membrane of the cervical canal occurs as a result of ruptures of the circular muscle fibers of the cervix. There are no pathognomonic complaints in patients. When viewed on the deformed cervix with a gaping or slit-like outer throat, red areas of the cylindrical epithelium are visible, often with a transformation zone. The method of treatment is chosen depending on the degree of deformation of the cervix of the uterus, taking into account the age and demand for the patient’s reproductive function: cryodestruction, laser coagulation, radiosurgical effect – diathermoelectro conization.

Leukoplakia of the cervix (in translation from the Greek. – “white spot”) is a local process of keratinization of the stratified squamous epithelium of different severity – paoakaeoatoz. hysschrkeratosis, acanthosis with the formation of lymphohistiocytic infiltrates around the vessels of the underlying stroma. According to modern concepts, leukoplakia refers to dyskeratosis. Simple leukoplakia (background process) and proliferating with cell atypia, with increased mitotic activity, and atypical cells in the basal and parabasal layers of the stratified squamous epithelium are distinguished. Cell atypia leukoplakia is referred to as cervical precancer and is classified according to the degree of atypia. In the occurrence of leukoplakia, viral, to a lesser extent endocrine, immune, infectious (chlamydia) factors play a role.

Leukoplakia is not accompanied by any symptoms. When examining patients with leukoplakia with clinically severe forms, one can see towering white plaques on the ectocervix with the naked eye or they are detected only by colposcopy. The colposcopic picture of leukoplakia may look like an iodine-negative zone in the form of a whitish shiny film with a smooth or bumpy surface as a result of the development of the stratum corneum of the epithelium (Fig. 15.48). Multiple red dots at the base of leukoplakia (punctuation) and lines forming polygons in the fields of leukoplakia (mosaic) are caused by blood vessels in the connective tissue papillae and outgrowths that enter the epithelial layers for the indicated disease. In leukoplakia sites, there are no intermediate cells accumulating glycogen, which leads to a negative Schiller test. Cytological examination does not reliably differentiate simple leukoplakia and leukoplakia with atypia, since cells taken from the surface of the epithelium do not reflect the processes occurring in the basal layers; requires a biopsy of the cervix with histological examination.

local_offerevent_note May 2, 2019

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