The Histologic Spectrum of Grossly Visible Pigmented Lesions of the Uterine Cervix: A Prospective Study
Tien Anh Tran, Guilian Niu, Cindy Anne Tomasello, Havi Tran, Jeffrey S Ross, J Andrew Carlson. Florida Hospital, Orlando, FL; Albany Medical College, Albany, NY
Background: Pigmented lesions of the uterine cervix (UC) are rarely encountered and represent a wide spectrum of congenital, reactive and neoplastic conditions.
Design: We conducted a prospective study of 2,118 consecutive hysterectomy specimens from 02/2010 to 08/2011which uncovered by routine gross inspection a total of 32 pigmented lesions of the UC.
Results: Of the 32 grossly visible pigmented lesions of the UC, routine histology revealed 31 histologic correlates including 25 (81%) blue nevi, 1 (3%) lentigo / melanosis, 1 (3%) focal vasculitis, 2 (6.4%) previous biopsy site reactive lesions with hemosiderin-laden macrophages, 1 (3%) hemorrhagic Nabothian's cyst, 1 (3%) hemangioma, and 1 (3%) case of multinucleated giant cell reaction to India-ink like material. Almost one third of the cases required deeper levels to reveal the nature of the pigmented lesions (9/31). The overall incidence of blue nevus in the UC was 1.2 %. More than half of the patients were Caucasians (13/25, 52%). The mean age of the UC blue nevus patients was 47.4 years (range 31 to 64 years). The number of blue nevi per UC varied between 1 to 3 and the size ranged from 0.1 cm to 2 cm (mean : 0.68 cm). All UC blue nevi were located in the stroma of the endocervix. These blue nevi of the UC appeared to evolve through 3 distinct morphologic phases: 1- stromal melanocytic foci composed of fine spindle cells (9/25, 36%), 2- mixed phase with fine spindle, plump spindle, and epithelioid cells (15/25, 60%), and 3- nevus-like with epithelioid cells (1/25, 4%). Of note, all (100%) of UC blue nevi cases were not reported in the original hysterectomy surgical pathology report or were misinterpreted as biopsy site. Compared to blue nevus, lentigo of the cervix was significantly less common and located in the squamous mucosa of the ectocervix. Lentigo of the UC was characterized by hyperpigmentation of the basal keratinocytes admixed with scattered slightly enlarged melanocytes.
Conclusions: This study demonstrates that most grossly visible pigmented lesions of the UC are benign and have a histologic correlate. Therefore, careful macroscopic and microscopic examination, in many cases with the help of deeper levels, is required to characterize these pigmented lesions and facilitate the exclusion of a more ominous pathologic process such as UC malignant melanoma.
Category: Gynecologic & Obstetrics
Wednesday, March 21, 2012 1:00 PM
Poster Session VI # 185, Wednesday Afternoon