Normal cervix, cervical TZ and how to dissect a LLETZ

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Normal cervix, cervical TZ and
how to dissect a LLETZ
Dr Michael Coutts
Consultant Gynaecological Pathologist
West Kent Gynae Oncology Centre, Maidstone, UK
and Centre Hospitalier Universitaire, Nice, France
Simple hysterectomy
Normal cervix
Normal ectocervix (stratified squamous mucosa)
Normal cervix
Normal endocervix (simple glandular mucosa)
Normal cervix
The squamocolumnar junction
Physiological
change in cervix
Physiological
change in cervix
Reserve cell hyperplasia
Reserve cell hyperplasia
Immature squamous metaplasia
Immature squamous metaplasia
Residual endocervical cells overlying
immature squamous metaplasia
Immature squamous metaplasia
Immature squamous metaplasia
(non-glycogenated)
Mature squamous metaplasia in TZ
Examination of cervical punch biopsies
• Colposcopically directed punch biopsies to enable
histological diagnosis of suspect areas
• Biopsies usually 2-4mm and may be on card
• Record number, maximum dimension and colour
• Biopsies >5mm may be bisected
• Check the pot and under the lid for tissue
• Wrap small fragments in filter paper/wire basket
• Three levels stained with H & E as routine
Cervical loop biopsy (LLETZ)
Gross appearance of a loop biopsy
Slicing the loop or cone biopsy
Option one:
• Radial method – incise at 12 o’clock, open out
and cut clock face slices to map lesion around
clock face
• but needs fresh tissue and assessment of
narrow end of wedge shaped block may be
difficult
Slicing the loop or cone biopsy
Option two:
• Transverse method – transversely slice across
long axis of slit-shaped os
• Good for fixed tissue and sections usually
come out well. Difficult to map to clock face
Cervical loop in multiple pieces
• An intact loop may be received with a second
separate endocervical piece from the apex (‘top
hat’). Treat both separately and label which blocks
they are placed into.
• Multiple separate irregular pieces may be received:
measure each, trasversely slice and label which
blocks they are placed into.
• Process all of the tissue for each case.
• Avoid placing more than one slice of a loop in each
block.
Conclusions
• The location of the SCJ changes with age
• It is important to recognise the histology of normal
squamous metaplasia of the cervix
• Colposcopic punch biopsies may be received to
confirm a diagnosis of CIN, CGIN or cancer before
definitive treatment
• Loop or cone biopsies are performed as treatment
for CIN or CGIN (and some small cancers) and the
transverse slicing method is suggested, with
processing of all tissue pieces
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