Benign Diseases of the Cervix

Abstract

This chapter begins with a brief review of the gross anatomy of the cervix including its blood supply and lymphatic drainage. It then discusses the normal histology and physiology of the cervix including a description of the immunohistochemical staining patterns of the different cell types. The size and configuration of the cervix, as well as the localization of specific types of epithelial cells on the mucosal surface and their degree of differentiation, change during a woman’s lifetime. These changes play a fundamental role in the development of several pathological conditions including cervical cancer. An important anatomical landmark is the squamocolumnar junction. This is the dividing line between the native squamous epithelium of the outer portion of the cervix and the mucus secreting columnar epithelium of the endocervical canal. The location of the squamocolumnar junction migrates during a woman’s lifetime. The squamocolumnar junction is important because it contains specialized epithelial cells that appear to be the cell of origin of invasive squamous cell carcinomas. The majority cervical precancers involve this region. Benign changes that occur in the cervical epithelium include metaplastic changes including tubal metaplasia and transitional cell metaplasia, responses to high levels of hormones resulting in the Arias-Stella reaction and pseudodecidual reactions, inflammatory conditions and infections, as well as pseudoneoplastic glandular conditions. Pseudoneoplastic glandular lesions such as florid mesonephric hyperplasia and lobular endocervical glandular hyperplasia are particularly challenging since they are relatively uncommon and can be mistaken for endocervical adenocarcinoma. The chapter concludes with a description of a number of benign tumors, cysts, and tumor-like conditions that the practicing surgical pathologist can encounter.