QUESTION: Cervical biopsy results 
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 QUESTION: Cervical biopsy results

I wonder if anyone can enlighten me on this situation. My gynecologist
also has not encountered this before in practice and does not know what
it means.

I am a 46 yr old with one 13 yr. old boy. 5 mos. ago my pap smear was
reported as ASCUS so I was treated with a {*filter*}l sulfa drug. At the
repeat pap smear 1 mo. ago, the report was still ASCUS. So, I had a
colposcopy. The chief pathologist at the hospital reported that the
results showed a large amount of columnar epithelial cells in the
transformation zone instead of mature squamous cells. There was
certainly no dysplasia and no infection that could be seen.

I understand that this situation with a large amount of the columnar
cells is usually only seen in infants and at puberty.

Why is this seen now and is there anything that should/could be done
about it? The only medication I take is Synthroid 0.1 mg per day for
hypothyroidism. I have had a number of odd situations before: I had to
have a hymenotomy because of a thick and inelastic hymen at 20, repair
of hernias caused by ripping of the fascia of the oblique and stomach
muscles during pregnancy (instead of stretching), miscarriage, and 3 1/2
yrs. ago a juvenile pilocytic astrocytoma (benign brain tumor) which is
usually discovered in the first decade of life.

I am not in menopause and have regular (too frequent!) normal periods.
My luteal phase has been short since the birth of my son. My cycles
range from 13 to 26 days. I did have an endometrial biopsy in April
which showed cells affected by estrogen and not progesterone. This has
been the situation for 13 years so no surprise.

I am a medicinal chemist by training, so I am interested in any thoughts
on biological mechanisms involved here also. Thanks for any ideas on
these questions.



Sun, 21 Mar 1999 03:00:00 GMT
 QUESTION: Cervical biopsy results

What was the colposcopic impression?
If the pap smear shows atypical glandular cells, colposcopy may not be
sufficient and a cone biopsy may be necessary to rule out a pathology in
the endocervical canal.



Sun, 21 Mar 1999 03:00:00 GMT
 QUESTION: Cervical biopsy results


Quote:
>I am a 46 yr old with one 13 yr. old boy. 5 mos. ago my pap smear was
>reported as ASCUS so I was treated with a {*filter*}l sulfa drug. At the
>repeat pap smear 1 mo. ago, the report was still ASCUS. So, I had a
>colposcopy. The chief pathologist at the hospital reported that the
>results showed a large amount of columnar epithelial cells in the
>transformation zone instead of mature squamous cells. There was
>certainly no dysplasia and no infection that could be seen.

ASCUS stands for Atypical Squamous Cells of Undetermined Significance and
implies that the cells taken from the cervix during the pap smear are
atypical, but that the cytologist and pathologist aren't sure why.  Sometimes
this is from infection, too much air-drying of the slide,  or from actual
dysplasia (where the cells are actually abnormal and *may* become cancerous,
although with ASCUS paps this is usually quite unlikely).  Pap smears are
performed to pick up *pre-cancer* of the cervix (and not the ovary, uterus,
tube, etc) so that this "dysplasia" can be treated before becoming severe or
even cancer.  

Quote:
>I understand that this situation with a large amount of the columnar
>cells is usually only seen in infants and at puberty. Why is this seen now

and is there anything that should/could be done about it?

Actually, this is not the case, as described below.  The cervix is composed of
both columnar cells, which are found in the os, or "hole" of the cervix.  They
secrete mucous to protect the uterus from infection and to help (or sometimes
hinder) the {*filter*}.  The other cells are the flat, or squamous cells, which
compose the majority of the outside of the cervix.  The are protective cells
(after all, the cervix has a pretty rough job sometimes).  Most dysplasia and
cancer occur at the junction of these two cell types, since the columnar cells
are transforming into squamous cells (called squamous metaplasia, a benign and
physiologic condition), so the squamocolumnar junction is where we take the
Pap smear.  The presence of a large amount of columnar cells on the cervix is
called an "ectropion", and is usually seen in women of reproductive age (i.e.
those having periods), and in pregnancy.  Both of these situations lead to
hormonal stimulation, which causes proliferation of the columnar cells.  This
is a benign finding and is usually asymptomatic, although it can lead to a
mucousy discharge.  However, some women who were exposed to DES
(diethylstilbestrol) while in-utero can have a large ectropion. They can also
have "adenosis" where cervical columnar cells are found in the {*filter*}l tissue
near the cervix.  The incidence of dysplasia, infertility, pregnaqncy loss,
uterine and cervical anomalies, and clear-cell cancers are higher in
DES-exposed women.   DES was used in the '50s and 60's to prevent miscarriage,
but was banned in 1971 after the above problems were noted.  It may be
worthwhile to investigate if your mother may have taken DES.  

Finally, the finding of cervical glandular tissue on the cervix is usually a
physiologic finding and of no great concern.  Since you are still
menstruating it is not surprising to find columnar cells of the cervix.  A Pap
is indicated every year, and if an abnormal finding is noted, then colposcopy
(looking at the cervix with a magnifying lens) as you have had, is necessary.  
Patients with DES exposure should also have an exam every 6 months to 1 year
and some should have colposcopy during each exam.  Good luck.

Ashley Hill
D. Ashley Hill, M.D.

Orlando, FL



Mon, 22 Mar 1999 03:00:00 GMT
 
 [ 4 post ] 

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