
CERVICAL EROSION
Female Genital Tract
CERVICAL EROSION
Cervical erosion, also known as cervical ectropion or cervical eversion, refers to the condition in which the delicate, glandular tissue (endocervical columnar epithelium) from the inner part of the cervix is exposed on the outer surface (ectocervix) due to a shift in the normal anatomy. This condition is commonly seen in young women and women who are using oral contraceptives, as hormonal changes influence the cervix’s appearance.
Gross Appearance:
On visual examination, the cervix may appear as follows:
1. Red or inflamed area: The ectropion presents as a reddish or inflamed area around the cervical os (opening). This is because the columnar epithelial cells are more vascular than the normal squamous epithelium that covers the ectocervix.
2. Mucous discharge: There might be an increased discharge or mucus from the cervix, as the glandular cells produce more secretions.
3. Erythematous (reddened) surface: The exposed endocervical epithelium might look bright red or inflamed compared to the normal smooth, pink squamous epithelium.
4. Ectropion's shape: The area may be localized or diffuse, and in some cases, the ectropion may be small and asymptomatic. In others, it may involve a larger area around the cervix.
Microscopic Appearance:
Under a microscope, cervical erosion or ectropion is characterized by the following features:
1. Endocervical columnar epithelium: The inner cervix, which is lined by columnar epithelium (glandular cells), is exposed on the outer cervix. These cells are typically found in the endocervical canal but can appear on the ectocervix in cases of cervical erosion.
2. Mucus-secreting glands: The exposed columnar epithelium often has mucus-producing cells. These cells may show prominent mucus secretion, which contributes to the increased vaginal discharge.
3. Inflammatory changes: Mild inflammation may be seen in the tissue. This could include an increased number of inflammatory cells such as lymphocytes and neutrophils, especially if there is any accompanying infection or irritation (like from HPV or bacterial vaginosis).
4. Squamous metaplasia: The squamous epithelium (the outer layer of the cervix) may show a regenerative response, where the squamous cells may begin to proliferate and differentiate in response to the columnar epithelium's exposure. This can result in areas of squamous metaplasia.
5. No distinct abnormality: In many cases, cervical erosion may not show significant pathology apart from the presence of exposed columnar epithelium, and these areas may appear normal under the microscope aside from their location.
Clinical Significance:
• Asymptomatic: Many cases of cervical erosion do not cause symptoms and are discovered incidentally during routine pelvic exams.
• Symptoms: Some women might experience increased vaginal discharge, spotting, or bleeding after intercourse (post-coital bleeding), though this can also be attributed to other cervical conditions, such as infections or polyps.
• Infection risk: The exposed columnar epithelium can be more prone to infections, especially if there is a bacterial or viral cause. It may also be associated with an increased risk of cervical dysplasia if there is chronic irritation or infection, such as with HPV.
Treatment is generally not required unless symptoms are severe, or if there is concern for underlying pathology (like a persistent infection or dysplasia).