Presentation on theme: "Normal cervix, cervical TZ and how to dissect a LLETZ"— Presentation transcript:
1Normal cervix, cervical TZ and how to dissect a LLETZ Dr Michael CouttsConsultant Gynaecological PathologistWest Kent Gynae Oncology Centre, Maidstone, UKand Centre Hospitalier Universitaire, Nice, France
20Examination of cervical punch biopsies Colposcopically directed punch biopsies to enable histological diagnosis of suspect areasBiopsies usually 2-4mm and may be on cardRecord number, maximum dimension and colourBiopsies >5mm may be bisectedCheck the pot and under the lid for tissueWrap small fragments in filter paper/wire basketThree levels stained with H & E as routine
23Slicing 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 facebut needs fresh tissue and assessment of narrow end of wedge shaped block may be difficult
24Slicing the loop or cone biopsy Option two:Transverse method – transversely slice across long axis of slit-shaped osGood for fixed tissue and sections usually come out well. Difficult to map to clock face
25Cervical 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.
26Conclusions The location of the SCJ changes with age It is important to recognise the histology of normal squamous metaplasia of the cervixColposcopic punch biopsies may be received to confirm a diagnosis of CIN, CGIN or cancer before definitive treatmentLoop 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