Definition/General

Introduction:
-Cervical ectocervicitis is inflammation of the ectocervix (vaginal portion of cervix) characterized by inflammatory infiltrate in the squamous epithelium and underlying stroma
-It may be acute or chronic in nature.
Origin:
-Results from irritation, infection, or trauma to the ectocervical squamous epithelium
-Common causes include STIs, chemical irritants, mechanical trauma, and hormonal changes.
Classification:
-WHO Classification categorizes as inflammatory condition of squamous epithelium
-May be acute (neutrophilic predominance) or chronic (lymphoplasmacytic predominance).
Epidemiology:
-Common in sexually active women of reproductive age
-Associated with STIs, douching, contraceptive use
-Often coexists with endocervicitis and vaginitis.

Clinical Features

Presentation:
-Cervical erythema and friability on examination
-Abnormal vaginal discharge
-Post-coital bleeding
-May be asymptomatic and detected on routine examination.
Symptoms:
-Vaginal discharge (mucopurulent or bloody)
-Post-coital bleeding
-Dyspareunia
-Pelvic discomfort
-Vulvar irritation
-Often asymptomatic.
Risk Factors:
-Sexual activity
-Multiple partners
-STIs (Chlamydia, Gonorrhea, HSV)
-Douching
-Chemical irritants
-Hormonal changes
-Immunosuppression.
Screening:
-Speculum examination shows cervical erythema and friability
-Pap smear may reveal inflammatory changes
-STI testing recommended.

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Gross Description

Appearance:
-Erythematous, edematous ectocervix
-Surface irregularity with possible erosions
-Friable tissue with contact bleeding
-Mucopurulent discharge.
Characteristics:
-Red, inflamed appearance
-Edematous surface
-Increased vascularity
-Friable consistency
-May have surface ulceration or erosions.
Size Location:
-Involves ectocervical squamous epithelium around external os
-May extend to transformation zone
-Variable extent from focal to diffuse involvement.
Multifocality:
-Usually diffuse involvement of ectocervix
-May have areas of varying severity
-Can be associated with vaginal inflammation.

Microscopic Description

Histological Features:
-Inflammatory infiltrate in ectocervical squamous epithelium and stroma
-Acute form shows neutrophil predominance
-chronic form shows lymphoplasmacytic infiltrate.
Cellular Characteristics:
-In acute: neutrophils, edema, vascular congestion
-In chronic: lymphocytes, plasma cells, histiocytes
-Squamous epithelium shows reactive changes.
Architectural Patterns:
-Preserved squamous epithelial architecture with inflammatory changes
-Surface erosion or ulceration may be present
-Reactive epithelial hyperplasia.
Grading Criteria:
-Benign inflammatory condition (no grading system)
-Severity assessed by degree of inflammation (mild, moderate, severe) and epithelial changes.

Immunohistochemistry

Positive Markers:
-CD3 positive T-lymphocytes
-CD20 positive B-lymphocytes
-CD68 positive histiocytes
-CK5/6 positive in squamous epithelium.
Negative Markers:
-p16 typically negative (unless HPV-related)
-High-risk HPV negative in non-viral etiology
-Neuroendocrine markers negative.
Diagnostic Utility:
-Usually morphological diagnosis
-IHC may help characterize inflammatory infiltrate
-p16 testing may be done if HPV suspected.
Molecular Subtypes:
-No specific molecular subtypes
-Classification based on causative agent (infectious vs non-infectious) and chronicity.

Molecular/Genetic

Genetic Mutations:
-No specific genetic alterations
-Represents inflammatory response to external stimuli
-Normal cellular genetics with reactive changes.
Molecular Markers:
-Elevated pro-inflammatory cytokines (IL-1β, TNF-α, IL-6)
-Increased NF-κB signaling
-Normal p53 expression pattern.
Prognostic Significance:
-Excellent prognosis with appropriate treatment
-May predispose to ascending infection if left untreated
-Generally resolves with therapy.
Therapeutic Targets:
-Antimicrobial therapy for infectious causes
-Removal of irritants
-Hormonal therapy if indicated
-Anti-inflammatory measures.

Differential Diagnosis

Similar Entities:
-Cervical intraepithelial neoplasia (CIN)
-Reactive squamous atypia
-Squamous cell carcinoma
-Herpes simplex virus infection
-Pemphigoid.
Distinguishing Features:
-Ectocervicitis: inflammatory infiltrate, preserved maturation
-CIN: dysplastic changes, loss of maturation
-SCC: invasion, malignant features.
Diagnostic Challenges:
-Distinction from reactive atypia in inflammatory setting
-Differentiation from early neoplastic changes
-Identification of causative agent.
Rare Variants:
-Eosinophilic ectocervicitis
-Granulomatous inflammation
-Plasma cell-rich variant
-Necrotizing inflammation.

Sample Pathology Report

Template Format

Sample Pathology Report

Complete Report: This is an example of how the final pathology report should be structured for this condition.

Specimen Information

[specimen type], measuring [size] cm in greatest dimension

Diagnosis

[diagnosis name]

Classification

Classification: [classification system] [grade/type]

Histological Features

Shows [architectural pattern] with [nuclear features] and [mitotic activity]

Size and Extent

Size: [X] cm, extent: [local/regional/metastatic]

Margins

Margins are [involved/uninvolved] with closest margin [X] mm

Lymphovascular Invasion

Lymphovascular invasion: [present/absent]

Lymph Node Status

Lymph nodes: [X] positive out of [X] examined

Special Studies

IHC: [marker]: [result]

Molecular: [test]: [result]

[other study]: [result]

Prognostic Factors

Prognostic factors: [list factors]

Final Diagnosis

Final diagnosis: [complete diagnosis]