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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,

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Presentation on theme: "Normal cervix, cervical TZ and how to dissect a LLETZ Dr Michael Coutts Consultant Gynaecological Pathologist West Kent Gynae Oncology Centre, Maidstone,"— Presentation transcript:

1 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

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3 Simple hysterectomy

4 Normal cervix

5 Normal ectocervix (stratified squamous mucosa)

6 Normal cervix

7 Normal endocervix (simple glandular mucosa)

8 Normal cervix

9 The squamocolumnar junction

10 Physiological change in cervix

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12 Reserve cell hyperplasia

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14 Immature squamous metaplasia

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16 Residual endocervical cells overlying immature squamous metaplasia

17 Immature squamous metaplasia

18 Immature squamous metaplasia (non-glycogenated)

19 Mature squamous metaplasia in TZ

20 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

21 Cervical loop biopsy (LLETZ)

22 Gross appearance of a loop biopsy

23 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

24 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

25 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.

26 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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