Cervix and Vagina

Abstract

The cervix is covered by a nonkeratinized squamous epithelium that merges into the surrounding vaginal wall. The vulva is a keratinized skin surface that has similar pathologic processes. Cervical biopsies are common and nearly always performed for the purpose of evaluating squamous or glandular dysplasia. Usually the patient will have a history of an abnormal Pap test or a prior abnormal biopsy finding. The old three-tier system for classifying dysplasia has been condensed into a two-tier system that reflects the Bethesda system for cytology; this applies to biopsy material from the entire anogenital tract. What was once called CIN-1 is now called LSIL (low-grade squamous intraepithelial lesion) and represents the viral cytopathic changes of HPV infection. LSIL lesions may contain either low-risk or high-risk HPV subtypes. Exophytic LSIL lesions may also be called condyloma. This chapter covers the criteria for squamous intraepithelial lesions and squamous carcinoma, as well as glandular lesions.