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Pathology Atlas: Cervix


Squamocolumnar Junction

Photomicrograph (low power) of the epithelial lining at the junction of the cervix and vagina in the human. The glands of the cervix are definitely evident. There are no glands underlying the squamous epithelium of the vagina. (After R. Shroder.)

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Reserve Cell Hyperplasia

Histologic section showing reserve cell hyperplasia and squamous metaplasia of the endocervix (Hematoxylin and eosin, × 260). Inset. Reserve cell hyperplasia and squamous metaplasia of the endocervix. The cells are small and monomorphic, with finely distributed chromatin.(Papanicolaou, × 360).

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Condyloma

Condyloma acuminatum. Papillary eqithelial proliferation with koilocytes and parakeratosis are seen in the periphery of the epithelium and vascular connective tissue cores in the center. (Hematoxylin-eosin, ×300.)

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CIN I

Cervical intraepithelial neoplasia grade 1. Nuclear atypia, increased mitoses, nuclear crowding, and occasional binucleated forms are seen on the parabasal cell layers. Koilocytotic changes are prominent in the upper cell layers. (Hematoxylin-eosin, ×500.)

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Squamous Cell Carcinoma

Squamous cell carcinoma, large cell keratinizing type. Malignant squamous cells form irregular nests invade the stroma. In the center of the nest, laminated keratin pearl is present. Individual cells have abundant eosinophilic keratinized cytoplasm.(Hematoxylin-eosin stain, original magnification 200.)

Squamous cell carcinoma, large cell nonkeratinizing type. Tumor cells have abundant eosinophilic cytoplasm and distinct cell borders to suggest individual cell keratinization. The irregular, large nuclei contain multiple nucleoli.(Hematoxylin-eosin stain, original magnification 400.)

Squamous cell carcinoma, small cell nonkeratinizing type. The tumor cells have small round-to-oval nuclei, finely granular chromatin, and small nucleoli. Most of the tumor cells contain a small amount of eosinophilic cytoplasm. Mitotic figures are abundant.(Hematoxylin-eosin stain, original magnification 400.)

Papillary squamous carcinoma. ( A) Multiple papillary fronds are supported by delicate fibrovascular cores. ( B) Irregular nests of invasive squamous cells at the base of papillary structures. Desmoplastic reaction occurs around the tumor cells.(Hematoxylin-eosin stain, original magnification A: 40, B: 40.)


Squamous carcinoma, spindle cell type. Elongated tumor cells are arranged in bundles simulating spindle cell sarcoma. Immunohistochemical stain for cytokeratin is positive to confirm carcinoma (not shown).(Hematoxylin-eosin stain, original magnification 200.)

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Adenocarcinoma

Adenocarcinoma in situ, endocervical type. ( A) The neoplastic glands retains the branching and budding pattern of normal endocervical glands. These glands have smooth borders and are surrounded by normal fibromuscular stroma without desmoplastic reaction. At the base of tumor, malignant cells replace normal endocervical cells. ( B) Higher magnification to reveal tall columnar neoplastic cells with nuclear stratification, hyperchromasia, elongation, and irregularity.(Hematoxylin-eosin stain, original magnification A: 40, B: 100.)

Microinvasive adenocarcinoma forms multiple, irregular tongue-like protrusions from the periphery of endocervical glands involved by adenocarcinoma in situ. These protrusions are associated with fibrotic stroma and chronic inflammation ( right two thirds ). In contrast, adenocarcinoma in situ retains smooth borders ( left one third ).(Hematoxylin-eosin stain, original magnification 200.)


Adenocarcinoma, endocervical type, moderately differentiated. Tumor cells form small irregular glands and solid nests. The cytoplasm is vacuolated and mucinous in appearance. Nuclear atypia is apparent.(Hematoxylin-eosin stain, original magnification 100.)

Minimal deviation adenocarcinoma, endocervical type. ( A) Neoplastic cells form branching, budding glands resembling normal endocervical glands. Tumor cells extend into the deep margin of conization specimen. ( B) Individual cells also closely mimic normal endocervical cells, having tall columnar configuration and abundant mucinous cytoplasm and basally located, small nuclei. On closer examination, nuclear irregularity and small nucleoli become evident.(Hematoxylin-eosin stain, original magnification A: 40, B: 400.)

Villoglandular adenocarcinoma, endocervical type. ( A) On the surface are multiple papillary projections consisting of columnar cells and fibrovascular cores. ( B) The base of tumor has smooth borders without infiltrative pattern.(Hematoxylin-eosin stain, original magnification A: 100, B: 100.)

Adenosquamous carcinoma, mature, well-differentiated type. Large malignant squamous cell carcinoma with abundant eosinophilic cytoplasm ( right ); neoplastic columnar cells form glandular lumens ( left ).(Hematoxylin-eosin stain, original magnification 200.)

Adenosquamous carcinoma, signet-ring type. ( A) Neoplastic squamous cells have abundant eosinophilic or clear cytoplasm and distinct cell borders. In addition, there are cells with basophilic cytoplasm. ( B) Higher magnification reveals signet-ring cells with basophilic vacuolated cytoplasm.(Hematoxylin-eosin stain, original magnification A: 100, B: 400.)

Adenocarcinoma of the cervix (From Operational Obstetrics & Gynecology - 2nd Edition, The Health Care of Women in Military Settings, CAPT Michael John Hughey, MC, USNR, NAVMEDPUB 6300-2C, Bureau of Medicine and Surgery, Department of the Navy, 2300 E Street NW, Washington, D.C. 20372-5300, January 1, 2000. Original image courtesy CAPT Richard Stock, MC, USN)

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Other Cervical Malignancies

Small cell anaplastic carcinoma. ( A) A diffuse infiltrative pattern by sheets and cords of malignant cells. The crush artifact with smudged nuclei is also characteristic of this neoplasm. ( B) The small nuclei are hyperchromatic and have coarsely granular compact chromatin. The nucleoli are not visible nor inconspicuous. The cytoplasm is scant, resulting in nuclear molding. Mitotic activity is high.(Hematoxylin-eosin stain, original magnification A: 100, B: 400.)

Large cell neuroendocrine carcinoma. ( A) Tumor cells have large oval of elongated hyperchromatic nuclei which contain coarsely granular chromatin. The nucleoli are small or absent. There is a small amount of eosinophilic cytoplasm. ( B) Tumor cells are arranged in cords and ribbons. ( C) Same tumor as in A. Diffuse cytoplasmic deposit of chromogranin indicative of neuroendocrine differentiation. ( D) Neuroendocrine carcinoma ( right lower field) coexists with adenocarcinoma ( left upper field ).(Hematoxylin-eosin stain, original magnification A: 400, B: 200, D: 100; C: immunohistochemical stain for chromogranin, original magnification 400.)

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