Early physiologic squamous metaplasia of the cervix: light and electron microscopic observations

A light and electron microscopic study was undertaken of the early phases of cervical squamous metaplasia. A study of areas of columnar epithelium with one row of subcolumnar cells revealed a spectrum of squamous differentiation ranging from cytologically undifferentiation to more characteristically basal type squamous cells. With increasing differentiation, squamous characteristics, such as tonofibrils and desmosomes, became qualitatively and quantitatively more evident in the cells. Ultrastructural examination also revealed cells in the subepithelial stroma with prominent basal lamina and hemidesmosome-like structures along the periphery. From a light and electron microscopic viewpoint, the most likely origin for the subcolumnar progenitor cells appears to be the subepithelial stromal cells. The resemblance of these subepithelial stromal cells to the subcolumnar cells in very early stages of metaplasia is often striking.

Problems in cervicovaginal cytology: fine structure as an aid to diagnosis

The ultrastructure of cytologically abnormal, thick cell groups and epithelial fragments in cervical and vaginal scrape material was investigated and found to be useful in differentiating between carcinoma in situ, invasive nonkeratinizing squamous carcinoma and adenocarcinoma of the endocervix and also in confirming the presence of cytologically suspected vault deposits of recurrent endometrial adenocarcinoma. It was demonstrated that although accurate evaluation of these thick groups in smear preparations is often not possible, thick sections of similar, plastic-embedded material showed some features which enabled a distinction to be made between squamous and glandular lesions and that these differences were more pronounced at the ultrastructural level. The squamous lesions were characterized by wide intercellular spaces with microvilli and tonofibrils within the cytoplasm while glandular lesions showed narrow intercellular spaces, prominent Golgi zones and endoplasmic reticulum together with mucus droplets in some cells.

[A scanning electron microscope study of the fine angioarchitecture of "punctation" and "atypical vessels" (author's transl)]

The present study was aimed to evaluate the correlation of histologic findings with colposcopic findings of "punctation" and "atypical vessels". The stereoscopic angioarchitectures of "punctation" and "atypical vessels" were observed clearly by scanning electron microscope, utilizing cast formation technique of blood vessels on hysterectomy specimens. Scanning electron microscopy revealed following characteristic findings. 1) The angioarchitecture of "punctation" is composed of three strata. (a) subepithelial capillary network, (b) capillaries rise into the stromal papillae from subepithelial capillary network. (c) stromal vessels ending in subepithelial capillary network. 2) Stratum (b) is observed as "punctation" on colposcopy. 3) Stratum (b) alterate morphologically as follows; hairpin-like capillaries correspond to "punctation" in inflammation, gathered & twisted hairpin-like capillaries in dysplasia, asparagus-like vessels in C.I.S., cauliflower-like vessels in early invasive cancer, respectively. 4) The mesh of stratum (a) become denser as the lesions advance, and in early invasive cancer, the destruction of stratum (a) begin to appear. 5) The branchings of stratum (c) increase as the lesions advance. 6) Chaotic angioarchitecture is observed in invasive cancer, with complete destruction of stratum (a). 7) The morphologic alteration of stratum (b) is the most remarkable in three strata. Colposcopically, these alterations of angioarchitecture are observed as follows; in "punctation", "red spot" become larger and irregularity increase both in size, shape and arrangement, as the lesions advance, in "atypical vessels", "vascular pattern" increase irregularity both in shape, caliber, continuation and arrangement. As a result, by analysing these scanning electron microscopic pictures and comparing them with their colpophotographs and histologic findings, it can be emphasized that, it might be possible to make histologic diagnosis merely by colposcopy.

Cushing's syndrome with small cell carcinoma of the uterine cervix

A 28 year old white women was found to have a cervical tumor in the 25th week of pregnancy. Pathologic examination revealed a nonkeratinizing small cell carcinoma. After delivery by cesarean section, pelvic lymph node exploration was carried out, and all 15 nodes were free of tumor. Her condition was staged as II-A, and she was treated with local radiation. Metastatic disease became manifest almost a year later and was histologically similar to her primary disease. A Cushingoid appearance was noticed and plasma cortisol levels were elevated. Twenty-four hour urinary 17-hydroxycorticosteroid (17-OHCS) and 17-ketosteroid (17-KS) levels were elevated and failed to suppress with dexamethasone. Plasma adrenocorticotropin (ACTH) level was elevated. Electron microscopic examination of the tumor tissue revealed neurosecretory granules. Immunoperoxidase stains for ACTH were positive. The patient's course was one of progressive decline and eventual death. A literature review revealed two other cases in which carcinoma of the uterine cervix was considered to be the source of ectopic ACTH. Some small cell carcinomas of the cervix may arise from cells of the APUD series. Small cell carcinoma of the uterine cervix may behave differently from the more commonly encountered keratinizing and large cell nonkeratinizing carcinomas of the cervix and may not respond as well to standard therapy. Ectopic hormone production, production of abnormal peptides or of vasoactive amines may be more common in small cell carcinoma of the cervix than is currently recognized, and these products may be clinically useful as tumor markers.

Glassy-cell carcinoma of the cervix: case report with a light and electron microscopy study

A case of glassy-cell carcinoma of the cervix is reported. In the literature this tumor is regarded as an undifferentiated form of mixed carcinomas of the cervix. At the light microscopic level the tumor cells are characterized by a moderate amount of cytoplasm of ground-glass appearance that stains faintly blue with hematoxylin, a distinct cell wall that stains with eosin or with periodic acid-Schiff (PAS), and large vesiculated nuclei with prominent nucleoli. In the cytoplasm of very few tumor cells, a minute amount of Alcian blue-positive material is demonstrated. At the electron microscopic level the tumor cells show distinct cell borders with interdigitating cytoplasmic projections that contain many desmosomes. Cytoplasmic tonofilaments were demonstrated in few tumor cells. The nuclei show a euchromatic appearance with prominent mesh-basket nucleoli. The cytoplasm contains abundant ribosomes, polyribosomes, and round to oval mitochondria with transverse cristae. Some cells contain a prominent Golgi apparatus with many lysosomelike structures. A very few cells have small intracytoplasmic lumina with microvilli and annulate lamellae. The assumption that the glassy-cell carcinoma of the cervix represents a poorly differentiated adenosquamous carcinoma finds support from our ultrastructural study.

Ultrastructural and morphometric study of diethylstilbestrol-associated lesions diagnosed as cervical intraepithelial neoplasia III

Investigations were carried out to characterize diethylstilbestrol (DES)-associated squamous lesions and to assess their biological significance. Five DES-associated cervical lesions displayed architectural features which were diagnosed as cervical intraepithelial neoplasia (CIN) III, such as full-thickness replacement by atypical squamous cells with vertical orientation and absence of normal polarity. Electron microscopic examination revealed only one of the five to be consistent with the generally recognized ultrastructural picture of non-DES CIN III. In the remaining four lesions, the moderate-to-large numbers of tonofibrils and well-developed desmosomes distinguished them from the true CIN III lesions. Morphometric studies indicate the five DES-associated lesions in this study as a group to be significantly different from normal squamous epithelium, from maturing metaplasia, and from non-DES-related CIN III in the parameters of differentiation studied. Their intermediary position between maturing metaplasia and non-DES CIN III suggests that they are more differentiated than CIN III and less differentiated than maturing metaplasia. Nuclear area measurements indicate the increased nuclear-cytoplasmic ratio observed in the DES-associated CIN III lesions of this study is due to a decrease in cytoplasmic volume, as opposed to an increased nuclear size.

A neurilemmoma of the cervix

We present a case of neurilemmoma of the cervix which is the first to be reported in the English literature. The characteristic histological features are described and its differentiation from a leiomyoma is confirmed by electron microscopic studies.

Ultrastructure of 16 cases of clear cell adenocarcinoma of the vagina and cervix in young women

Sixteen cases of clear cell adenocarcinoma of the cervix and vagina in young women were studied by electron microscopy and the observations were compared with the light microscopic appearance. Ultrastructurally, the neoplastic cells were found to be of the same basic type, regardless of whether light microscopy disclosed a solid or tubulocystic tumor pattern, and whether the cells were clear, hobnail, flat or of a nonspecific müllerian appearance. Cytoplasmic glycogen and short, blunt, surface villi were the outstanding features. Less consistent findings included prominent Golgi apparatuses and numerous mitochondria. The fine structural characteristics were similar to those reported for clear cell adenocarcinoma of the endometrium and ovary in older women. This study disclosed no difference between 14 tumors that arose in patients with confirmed histories of prenatal exposure to diethylstilbestrol (DES) or dienestrol, and reported cases of clear cell carcinoma in which there were no histories of such exposure. No specific ultrastructural features could be identified as prognostic indices for the neoplasms.

Argyrophil cell carcinoma of the uterine cervix with ectopic production of ACTH, beta-MSH, serotonin, histamine, and amylase

The case of a 38-year-old female with primary argyrophil cell carcinoma of the uterine cervix is reported. Two years after operation the patient developed widespread metastases with typical Cushing's syndrome. Microscopically, the tumor consisted of solid anaplastic cells, adenocarcinoma, and squamous cells. The plasma levels of ACTH and cortisol were elevated. Many cells of both the primary and metastatic tumors showed argyrophilia. Almost all the cells of the metastases contained numerous round secretory granules measuring about 117 micrometers in diameter. Small rod-shaped or larger round secretory granules, measuring 250 and 430 micrometers respectively, were also found in a few of these cells. The tumors in the right lung, pancreas, and kidney contained high levels of ACTH, beta-MSH, serotonin, histamine, and amylase. This is the first report of ectopic production of these five substances from argyrophil cell carcinoma of the uterine cervix.

Small cell tumor of cervix with neuroepithelial features: ultrastructural observations in two cases

Two cases of small cell tumor of the uterine cervix are reported in which electron microscopic studies indicated that the tumor cells were of neural crest origin. Both tumors behaved aggressively, and metastatic involvement of pancreas was demonstrated in one patient, while the second patient developed liver metastasis. The need to distinguish these neoplasms from squamous cell carcinoma of the cervix is stressed. The tumors are compared with small cell neuroepithelial neoplasms previously reported as adult neuroblastomas.

Carcinoid of the uterine cervix: a case report with light and electron microscopic studies

The case of a 33-year-old woman with primary carcinoid of the uterine cervix is reported. Primary carcinoid tumor is well known to occur in organs such as the gastrointestinal tract, lung and gonads. However, its occurrence in the uterine cervix is rare. To our knowledge, primary carcinoid of the uterine cervix has not been reported from the United States, although it has been well documented by non-American authors. Light microscopically, the tumor was characterized by formation of solid nests, trabeculae and glands. The cells therein showed argyrophil granules but were negative for argentaffin reaction. Electron microscopy revealed the presence of numerous neurosecretory granules and microfilaments. On the basis of light microscopic ultrastructural and cytochemical properties, the tumor is believed to arise from the normal argyrophil cell of the cervix and is regarded as an endocrine tumor, a member of the group of neoplasms called apudomas.

Blue naevus of the cervix: report of two cases and review of the literature

Two cases are described of blue naevi occurring in the uterine cervix. These showed a histological appearance identical to that seen in the commoner cutaneous examples. Electron microscopy of both lesions showed the presence of melanosomes in the dendritic cells. No Schwann cell elements were identified. Previous reports of cases are reviewed and discussed.

The morphology of the earliest invasive cell in low genital tract epidermoid neoplasia

The light and electron microscopic characteristics of the distinct eosinophilic microinvasive cell in the lower genital tract epidermoid neoplasia are described. The eosinophilic quality of the invasive cell is associated with an accumulation of contractive protein seen at the ultrastructural level. The presence of these differentiated cells near the basement membrane should be viewed with more concern as they contain the cytoplasmic machinery with which to invade.

Koilocytosis in dysplastic and reactive cervical squamous epithelium. An ultrastructural study

Koilocytosis was studied in eight cases of dysplasia and reactive atypia with conventional transmission electron microscopy. The ultrastructural features were compared to the process of maturation of normal cervical epithelium. Koilocytosis was observed as abnormal karyopyknosis as represented by irregular nuclei, coarse chromatin clumping, the less dense ellipsoid perinuclear zone, and the increased tonofilament bundles in the outer zone of the cytoplasm accentuating the margin of the perinuclear zone of the cells.