Definition/General
Introduction:
Cervical cervicitis is a general term for inflammation of the cervix involving both endocervical and ectocervical components
It represents a broad category of inflammatory conditions affecting the entire cervical structure.
Origin:
Results from various causes including infections (bacterial, viral, fungal), chemical irritants, mechanical trauma, autoimmune processes, and hormonal factors affecting cervical tissues.
Classification:
WHO Classification categorizes as inflammatory cervical condition
Classified as acute (neutrophil-predominant) or chronic (lymphoplasmacytic-predominant) based on duration and cellular infiltrate.
Epidemiology:
Very common in reproductive-age women
Affects up to 40% of sexually active women
Associated with STIs, contraceptive use, and various environmental factors.
Clinical Features
Presentation:
Variable presentation from asymptomatic to significant symptoms
Common findings include abnormal vaginal discharge, cervical friability, and post-coital bleeding.
Symptoms:
Mucopurulent vaginal discharge
Post-coital bleeding
Intermenstrual bleeding
Pelvic pain or pressure
Dysuria
May be completely asymptomatic.
Risk Factors:
Sexual activity
STIs (Chlamydia, Gonorrhea, HSV, HPV)
Multiple sexual partners
Douching
Contraceptive use
Smoking
Immunosuppression.
Screening:
Routine pelvic examination
Pap smear showing inflammatory changes
STI testing
Colposcopy if indicated
Clinical assessment of discharge.
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Gross Description
Appearance:
Erythematous, edematous cervix with surface irregularity
Mucopurulent discharge from cervical os
Friable tissue with contact bleeding.
Characteristics:
Variable appearance from mild erythema to severe inflammation
Edematous, congested appearance
Increased vascularity
Friable consistency.
Size Location:
May involve entire cervix or be localized to specific areas
Commonly affects transformation zone
Can extend to upper vagina.
Multifocality:
Often diffuse involvement of cervical structures
May have focal areas of more severe inflammation
Bilateral involvement common.
Microscopic Description
Histological Features:
Mixed inflammatory infiltrate in cervical stroma and epithelium
Combination of acute and chronic inflammatory cells
Reactive epithelial changes in both squamous and glandular components.
Cellular Characteristics:
Lymphocytes, plasma cells, neutrophils, and histiocytes
Reactive epithelial cells with enlarged nuclei
Increased mitotic activity
Squamous metaplasia common.
Architectural Patterns:
Preserved overall architecture with inflammatory changes
Surface erosions and ulcerations may be present
Stromal edema and vascular congestion.
Grading Criteria:
Benign inflammatory condition (no formal grading)
Severity assessed as mild, moderate, or severe based on extent and intensity of inflammation.
Immunohistochemistry
Positive Markers:
CD3 positive T-lymphocytes
CD20 positive B-lymphocytes
CD68 positive histiocytes/macrophages
CD138 positive plasma cells.
Negative Markers:
p16 variable (negative unless HPV-associated)
High-risk HPV variable depending on etiology
Neuroendocrine markers negative.
Diagnostic Utility:
Primarily morphological diagnosis
IHC may help characterize inflammatory cell populations
p16 testing if HPV-related cervicitis suspected.
Molecular Subtypes:
No specific molecular subtypes
May be categorized by causative agent (infectious vs non-infectious) and inflammatory pattern.
Molecular/Genetic
Genetic Mutations:
No specific genetic mutations
Represents inflammatory response to various stimuli
Normal cellular genetics with reactive changes only.
Molecular Markers:
Elevated inflammatory cytokines (IL-1, IL-6, TNF-α)
Increased chemokine expression
NF-κB pathway activation
Normal p53 expression.
Prognostic Significance:
Generally excellent prognosis with appropriate treatment
May increase risk of ascending infection
Can affect fertility if severe and untreated.
Therapeutic Targets:
Cause-specific therapy (antimicrobials for infections)
Anti-inflammatory measures
Removal of irritating factors
Hormonal therapy if indicated.
Differential Diagnosis
Similar Entities:
Cervical intraepithelial neoplasia
Reactive epithelial atypia
Cervical carcinoma
Endometriosis
Adenomyosis of cervix.
Distinguishing Features:
Cervicitis: inflammatory infiltrate, preserved architecture
CIN: dysplastic changes, p16 positive
Carcinoma: malignant features, invasion.
Diagnostic Challenges:
Distinction from reactive atypia
Differentiation from early neoplastic processes
Identification of specific causative agents.
Rare Variants:
Granulomatous cervicitis
Eosinophilic cervicitis
Lymphocytic cervicitis
Xanthogranulomatous 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]