Definition/General

Introduction:
-Cervical endocervicitis is a chronic inflammatory condition affecting the endocervical glands and stroma
-It represents a persistent inflammatory response that may be infectious or non-infectious in origin.
Origin:
-Results from chronic irritation, infection, or immune-mediated inflammation of the endocervical epithelium and underlying stroma
-May follow acute cervicitis or develop as a chronic process.
Classification:
-WHO Classification categorizes as chronic inflammatory condition
-May be classified as infectious (bacterial, viral, fungal) or non-infectious (autoimmune, chemical) based on etiology.
Epidemiology:
-Common in reproductive age women (20-40 years)
-Associated with multiple sexual partners, STIs, douching, and IUD use
-Often asymptomatic and discovered incidentally.

Clinical Features

Presentation:
-Often asymptomatic
-May present with abnormal vaginal discharge, cervical friability, or abnormal Pap smear
-Post-coital bleeding occasionally reported.
Symptoms:
-Mucopurulent cervical discharge (most common)
-Intermenstrual bleeding
-Post-coital spotting
-Pelvic discomfort
-Often completely asymptomatic.
Risk Factors:
-Multiple sexual partners
-Sexually transmitted infections
-Intrauterine device use
-Douching
-Hormonal contraceptives
-Immunosuppression.
Screening:
-Detected during routine pelvic examination
-Visible on speculum examination as cervical erythema
-Pap smear may show inflammatory changes.

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Gross Description

Appearance:
-Cervical erythema and edema
-Mucopurulent discharge from cervical os
-Cervical friability with contact bleeding
-Surface irregularity.
Characteristics:
-Erythematous cervical surface
-Edematous appearance
-Mucopurulent secretions
-Increased vascularity
-Friable consistency.
Size Location:
-Involves endocervical canal and transformation zone
-May extend to ectocervix
-Diffuse involvement common
-May be focal or multifocal.
Multifocality:
-Usually diffuse involvement of endocervical canal
-May have focal areas of more intense inflammation
-Bilateral involvement typical.

Microscopic Description

Histological Features:
-Chronic inflammatory infiltrate in endocervical stroma predominantly composed of lymphocytes and plasma cells
-Endocervical glands show reactive changes with increased secretory activity.
Cellular Characteristics:
-Dense lymphoplasmacytic infiltrate in stroma
-Reactive endocervical epithelium with enlarged nuclei
-Increased mitotic activity
-Squamous metaplasia common.
Architectural Patterns:
-Preserved glandular architecture with reactive changes
-Chronic inflammatory infiltrate in stroma
-Surface erosion and ulceration may be present.
Grading Criteria:
-Benign inflammatory condition (no grading required)
-Severity assessed by degree of inflammation (mild, moderate, severe) and extent of tissue involvement.

Immunohistochemistry

Positive Markers:
-CD3 positive T-lymphocytes
-CD20 positive B-lymphocytes
-CD138 positive plasma cells
-CK7 positive in glandular epithelium.
Negative Markers:
-p16 typically negative (unless HPV-related)
-High-risk HPV negative in non-viral causes
-Neuroendocrine markers negative.
Diagnostic Utility:
-Usually diagnosis is morphological
-IHC may help identify specific inflammatory cell populations
-CD138 highlights plasma cell component in chronic inflammation.
Molecular Subtypes:
-No specific molecular subtypes
-May be classified by causative organism if infectious etiology identified.

Molecular/Genetic

Genetic Mutations:
-No specific genetic alterations
-Represents inflammatory response rather than neoplastic process
-Normal chromosomal complement.
Molecular Markers:
-Elevated inflammatory markers (IL-1, TNF-α)
-Normal p53 expression
-Low Ki-67 proliferation index
-Cytokine-mediated inflammatory response.
Prognostic Significance:
-Generally good prognosis with appropriate treatment
-May predispose to ascending infection
-Can be associated with fertility issues if severe.
Therapeutic Targets:
-Antimicrobial therapy if infectious cause identified
-Anti-inflammatory treatment
-Removal of irritating factors (IUD, chemicals).

Differential Diagnosis

Similar Entities:
-Acute cervicitis
-Cervical intraepithelial neoplasia
-Reactive atypia
-Cervical adenocarcinoma
-Endometrial adenocarcinoma extending to cervix.
Distinguishing Features:
-Endocervicitis: Chronic inflammation, preserved architecture
-CIN: Dysplastic changes, p16 positive
-Adenocarcinoma: Malignant features, invasion.
Diagnostic Challenges:
-Distinction from reactive atypia
-Identification of causative organism
-Differentiation from early neoplastic changes.
Rare Variants:
-Granulomatous endocervicitis
-Eosinophilic cervicitis
-Lymphocytic cervicitis
-Follicular cervicitis.

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]