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Vesicular lesions of the uterine cervix
Volume 110 Number6
Communications
Fig. 1. Hasson-Eder
of the procedure, the abdominal wall is closed in layers. The new open method eliminates certain flaws of the blind method: ( 1) The use of a needle or sharp trochar directed blindly and forcibly to puncture the abdominal wall is deleted; (2) placing the gas consistently into the peritoneal cavity is assured, since the peritoneum is incised under vision in every case; (3) the inaccessible tear caused by the blind insertion of a sharp trochar is avoided by a planned fascial and peritoneal incision which is anatomically repaired at the end of the procedure. The modified instrument has functioned well in 14 cases performed as described.
Vesicular
lesions
LAURENCE JOHN
I. R.
of the uterine BURD,
ESTERLY,
cervix
M.D. M.D.
Laboratory of Pathology, The Chicago Lying-in-Hospital, The University of Chicago, and the Department of Obstetrics and Gynecology, Michael Reese Hospital, Chicago, Illinois.
VIRUSES, BACTERIA, TRAUMA, and a wide variety of idiopathic dermatoses may be manifest as epidermal vesicles. In contrast, bulla within or beneath the ectocervical epithelium have attracted little attention, although presumably they may also represent a diversity of disorders. Recently, we have examined a number of
in brief
887
cannula.
these
lesions
and
attempted
to trace
their
patho-
genesis. Cervical vesicles were identified in the histologic slides from 11 of 1,500 consecutive cases, including biopsy, cone, and hysterectomy specimens. The 11 patients ranged in age from 2 1 to 50 years. One patient was nulliparous; the parity of the others ranged from one to 8. The diagnoses were chronic cervicitis, dysplasia, and intraepithelial carcinoma, and, in each, the cysts were an incidental finding. The largest bulla measured 4 mm. in diameter, but the majority were considerably smaller. Multiple lesions were found in 4 of the 11 specimens. The vesicles were intraepithelial in 6 cases and subepithelial in the remaining 5 cases (Figs. 1 and 2). They contained variable numbers of inflammatory cells and eosinophilic, Schiffreactive material. In addition, all of the subepithelial lesions also contained red cells and a somewhat greater proportion of polymorphonuclear neutrophils. Their lining had the appearance of attenuated squamous cells. However. in many cases no limiting epithelium was seen, and the cystic defects could be distinguished from histologic fracture artifacts only on the basis of the contents. Adjacent endocervical glands were noted in all but two specimens; their occasional endocervical apertures were lined by columnar or thickened metaplastic squamous cells. A chronic inflammatory infiltrate was present in the stroma in all of the cases. Intra. . . eplthehal mflammation was found in only one but it was not prominent near the cystic cief~~ct. No specific degenerative changes were seen, and there was no evidence of viral inclusions.
888
Communications
in brief
Fig. 1. Intraepithelial vesicle. Serial demonstrated connection with an underlying cervical gland in this 21-year-old patient. toxylin and eosin. Original magnification
Amer.
sections endo(Hemax150.)
Serial or step sections were prepared on all specimens. In some, the lesion was present in few or none of the subsequent slides. However, in 4 of the intraepithelial vesicles and 2 subepithelial defects, the lesion was traced and in every instance communicated with an underlying obstructed gland. By extrapolation, some of the other vesicles could be associated with deeper, dilated glands with similar contents. The mechanism of repair of cervical injury is a time-honored controversy in gynecologic pathology. Although the process as described by Meyer’ differs in numerous details from that expressed by Fluhmann,2 both clearly state that glands are found in the ectocervix during healing. Persistent or recurrent inflammation results in gland obstruction, evident as Nabothian cysts and, as clearly described by Schottlaender,3 secondary duct formation and entry into the squamous epithelium. In the present cases, the communication with glands suggests that the epithelial vesicles represent the distal portion of these secondary channels which have dissected under or within the epithelium.
July 15, 1971 J. Obstet. Gynec.
Fig. 2. Subepithelial vesicle. Dissection under the epithelium was usually associated with blood and an acute inflammatory exudate. The specimen was from a para 9, 46-year-old patient with cervical dysplasia. (Hematoxylin and eosin. Original magnification x60.)
The frequency of these lesions is unknown. Their apparent association with inflammation, however, suggests that they are not uncommon. It is not possible to determine the incidence in this study since the observations were based on routine histologic material in which the vesicular lesions were always incidental to the surgical procedure. Bullae have been noted previously in herpetic lesions of the cervix.4 Our observations do not exclude viral or other factors from an etiologic role in the formation of cervical vesicles. The present findings, however, show that many cervical vesicles are related to obstructed endocervical glands.
REFERENCES
1. 2. 3. 4.
Meyer, R.: Arch. Gynaek. Fluhmann, C. F.: AMER. 82: 970, 1961. Schottlaender, J.: Mschr. 26: 1, 1907. Naib, Z. M., Nahmias, A. Cancer 19: 1026, 1966.
91: 658, 1910. J. OBSTET. GYNEC. &burtsh. J., and
Gynaek. Josey,
W.:
Communications
Fig. 1. Hasson-Eder
of the procedure, the abdominal wall is closed in layers. The new open method eliminates certain flaws of the blind method: ( 1) The use of a needle or sharp trochar directed blindly and forcibly to puncture the abdominal wall is deleted; (2) placing the gas consistently into the peritoneal cavity is assured, since the peritoneum is incised under vision in every case; (3) the inaccessible tear caused by the blind insertion of a sharp trochar is avoided by a planned fascial and peritoneal incision which is anatomically repaired at the end of the procedure. The modified instrument has functioned well in 14 cases performed as described.
Vesicular
lesions
LAURENCE JOHN
I. R.
of the uterine BURD,
ESTERLY,
cervix
M.D. M.D.
Laboratory of Pathology, The Chicago Lying-in-Hospital, The University of Chicago, and the Department of Obstetrics and Gynecology, Michael Reese Hospital, Chicago, Illinois.
VIRUSES, BACTERIA, TRAUMA, and a wide variety of idiopathic dermatoses may be manifest as epidermal vesicles. In contrast, bulla within or beneath the ectocervical epithelium have attracted little attention, although presumably they may also represent a diversity of disorders. Recently, we have examined a number of
in brief
887
cannula.
these
lesions
and
attempted
to trace
their
patho-
genesis. Cervical vesicles were identified in the histologic slides from 11 of 1,500 consecutive cases, including biopsy, cone, and hysterectomy specimens. The 11 patients ranged in age from 2 1 to 50 years. One patient was nulliparous; the parity of the others ranged from one to 8. The diagnoses were chronic cervicitis, dysplasia, and intraepithelial carcinoma, and, in each, the cysts were an incidental finding. The largest bulla measured 4 mm. in diameter, but the majority were considerably smaller. Multiple lesions were found in 4 of the 11 specimens. The vesicles were intraepithelial in 6 cases and subepithelial in the remaining 5 cases (Figs. 1 and 2). They contained variable numbers of inflammatory cells and eosinophilic, Schiffreactive material. In addition, all of the subepithelial lesions also contained red cells and a somewhat greater proportion of polymorphonuclear neutrophils. Their lining had the appearance of attenuated squamous cells. However. in many cases no limiting epithelium was seen, and the cystic defects could be distinguished from histologic fracture artifacts only on the basis of the contents. Adjacent endocervical glands were noted in all but two specimens; their occasional endocervical apertures were lined by columnar or thickened metaplastic squamous cells. A chronic inflammatory infiltrate was present in the stroma in all of the cases. Intra. . . eplthehal mflammation was found in only one but it was not prominent near the cystic cief~~ct. No specific degenerative changes were seen, and there was no evidence of viral inclusions.
888
Communications
in brief
Fig. 1. Intraepithelial vesicle. Serial demonstrated connection with an underlying cervical gland in this 21-year-old patient. toxylin and eosin. Original magnification
Amer.
sections endo(Hemax150.)
Serial or step sections were prepared on all specimens. In some, the lesion was present in few or none of the subsequent slides. However, in 4 of the intraepithelial vesicles and 2 subepithelial defects, the lesion was traced and in every instance communicated with an underlying obstructed gland. By extrapolation, some of the other vesicles could be associated with deeper, dilated glands with similar contents. The mechanism of repair of cervical injury is a time-honored controversy in gynecologic pathology. Although the process as described by Meyer’ differs in numerous details from that expressed by Fluhmann,2 both clearly state that glands are found in the ectocervix during healing. Persistent or recurrent inflammation results in gland obstruction, evident as Nabothian cysts and, as clearly described by Schottlaender,3 secondary duct formation and entry into the squamous epithelium. In the present cases, the communication with glands suggests that the epithelial vesicles represent the distal portion of these secondary channels which have dissected under or within the epithelium.
July 15, 1971 J. Obstet. Gynec.
Fig. 2. Subepithelial vesicle. Dissection under the epithelium was usually associated with blood and an acute inflammatory exudate. The specimen was from a para 9, 46-year-old patient with cervical dysplasia. (Hematoxylin and eosin. Original magnification x60.)
The frequency of these lesions is unknown. Their apparent association with inflammation, however, suggests that they are not uncommon. It is not possible to determine the incidence in this study since the observations were based on routine histologic material in which the vesicular lesions were always incidental to the surgical procedure. Bullae have been noted previously in herpetic lesions of the cervix.4 Our observations do not exclude viral or other factors from an etiologic role in the formation of cervical vesicles. The present findings, however, show that many cervical vesicles are related to obstructed endocervical glands.
REFERENCES
1. 2. 3. 4.
Meyer, R.: Arch. Gynaek. Fluhmann, C. F.: AMER. 82: 970, 1961. Schottlaender, J.: Mschr. 26: 1, 1907. Naib, Z. M., Nahmias, A. Cancer 19: 1026, 1966.
91: 658, 1910. J. OBSTET. GYNEC. &burtsh. J., and
Gynaek. Josey,
W.: