Cervical ectopia is an atypical arrangement of a cylindrical (cubic) epithelium lining the cervical canal from the inside, on the vaginal portion of the cervix, normally covered with a flat epithelium. Uncomplicated ectopia of the cervix does not give a clinic; with complicated, there are white spots, contact spotting, itching in the genital area, dyspareunia. Ectopia of the cervix is detected during gynecological examination; the diagnosis is clarified with the help of extended colposcopy, cytological examination of scraping, if necessary, biopsy. Treatment of uncomplicated ectopia is not carried out; in complicated forms, etiotropic therapy is prescribed, the destruction of altered foci is performed.
ICD 10
N86 Erosion and ectropion of the cervix
General information
Gynecology often uses the terms pseudoerosion, false erosion, endocervicosis, glandular muscle hyperplasia to refer to ectopia of the cervix. Normally, the vaginal part of the cervix, accessible to examination in mirrors, is covered from the outside by a multilayer flat epithelium, whereas from the inside the cervical canal has a lining of cylindrical epithelium. With ectopia of the cervix, the border of the transition of the cylindrical epithelium to the flat one shifts to the area of the external pharynx, located along its circumference or locally.
Cervical ectopia is detected in 40% of women; in 11.3% of patients, this feature is congenital. The maximum frequency of cervical ectopia (40-50%) is observed in women under 30 years of age. By itself, ectopia never turns into cervical cancer, but against its background, the probability of developing a malignant process increases.
Causes
In the pubertal and early reproductive period, ectopia of the cervix is regarded as a functional feature, which is based on relative hyperestrogenism. The detection of pseudoerosion during pregnancy is also considered a physiological condition caused by a change in the hormonal function of the ovaries. Various theories explaining the occurrence of ectopia of the cervix associate this process with dishormonal, inflammatory, immunological, traumatic factors.
- Theory of inflammation. The formation of ectopia is explained by recurrent vaginitis and endocervicitis caused by streptococci, E. coli, pathogens of STIs (mycoplasmosis, gardnerellosis, ureaplasmosis, chlamydia, papillomavirus infection), etc. Pathological secretions affecting the vaginal part of the cervix cause desquamation of the squamous epithelium with the formation of true erosion in its place. Within 1-2 weeks, the epithelium of the endocervix spreads to the surface of erosion, covering it, and an ectopic area forms in place of the latter. Infection of the cervix is promoted by: birth injuries, cervical injuries during medical abortions, traumatization when using barrier contraception and spermicidal agents.
- Immunological theory. Considers as the leading etiological moment a decrease in general protective functions. Early sexual life, frequent change of sexual partners, the presence of chronic extragenital pathology (diabetes mellitus, etc.), multiple births, smoking predispose to the formation of acquired ectopia of the cervix.
- Hormonal concept. Connects the development of cervical ectopia with ovarian dysfunction. It is noted that ectopia of the cervix is often found in endometriosis, fibroma, ovarian stroma hyperplasia, menstrual cycle disorders, early menarche, etc. conditions caused by hyperestrogenism.
Pathomorphology
Histologically, there are glandular, papillary ectopia of the cervix and pseudoerosion with squamous metaplasia. Glandular ectopia reveals clusters of glands with an extensive network of glandular passages, signs of inflammation. With papillary ectopia, there is an overgrowth of stroma components and the formation of papillary structures covered with cylindrical epithelium.
The healing of ectopia of the cervix is accompanied by the reverse replacement of the cylindrical epithelium by cells of the mature squamous epithelium, i.e. the formation of a transformation zone. Reserve cells are involved in this process, which, as a result of differentiation, first turn into immature, and then mature metaplastic epithelium.
Colposcopy allows you to distinguish between unfinished and finished transformation zones. With adverse effects, cellular metaplasia can break off, leading to a recurrence of cervical ectopia. In the case of overlapping with a metaplastic layer of cells of the mouth of the cervical glands, retention cysts of the cervix (nabothian cysts) are formed.
Classification
By origin, there are congenital and acquired ectopia of the cervix. In case of violation of the relationship between the epithelial and stromal elements of the cervix, ectopia is treated as ectropion. The nature of the course of pseudoerosion may be recurrent; the clinical form is uncomplicated and complicated.
- Uncomplicated. Modern colposcopic nomenclature considers uncomplicated ectopia of the cervix as normal data and a variant of the physiological state.
- Complicated. This course of cervical ectopia is usually associated with colpitis and cervicitis caused by infection.
Symptoms of cervical ectopia
Uncomplicated ectopia of the cervix does not cause symptoms and, as a rule, is diagnosed during a preventive examination by a gynecologist. In 80% of cases, complicated forms of cervical ectopia are observed, combined with inflammation or precancerous changes (dysplasia, leukoplakia, cervical polyps). In the presence of endocervicitis or colpitis, there is a discharge of whites, itching, dyspaurenia, contact bleeding. Primary disorders leading to ectopia of the cervix can cause menstrual disorders or infertility.
Diagnostics
The presence of congenital ectopia of the cervix, as a rule, is established at the initial visit to the gynecologist. In the case of diagnosis of acquired pseudoerosion, its formation on the previously unchanged surface of the cervix is taken into account.
- Gynecological examination. Upon visual examination, a bright red ectopic focus with irregular outlines is visible on the chair in the area of the external pharynx. Touching the pseudoerosion area with a tool can cause mild bleeding.
- Colposcopy. If ectopia of the cervix is detected, an extended colposcopy is indicated. During the study, an atypical site is revealed, represented by a cylindrical epithelium and transformation zones. In 40% of cases, during the Schiller test, an abnormal colposcopic picture is determined: leukoplakia, mosaic, punctuation, iodine negative zones. The detection of these signs dictates the need for an in-depth examination of the patient.
- Analyzes. During the diagnosis, microscopy, bacteriological seeding, PCR examination of the separated cervix is performed. A cytological examination of the scraping is mandatory for ectopia of the cervix, which allows you to identify the presence of flat and cylindrical epithelial cells, signs of inflammation.
- Biopsy. In case of detection of an abnormal colposcopic and cytological picture, a cervical biopsy or separate diagnostic curettage with histological examination is required.
To study the function of the ovaries, functional tests are performed, the hormonal status is examined. When hormonal disorders are detected, a gynecologist-endocrinologist is consulted. Differential diagnosis of ectopia is carried out with true erosion and cervical cancer.
Treatment of cervical ectopia
In uncomplicated congenital ectopia of the cervix, treatment is not carried out; dynamic monitoring is established for the patient, which allows timely detection of abnormalities in the development of pseudoerosion. Treatment of complicated forms of cervical ectopia is carried out taking into account the existing changes. Etiotropic antiviral and anti-inflammatory therapy is prescribed, a competent selection of contraception is performed, correction of immune and hormonal disorders is performed.
After stopping the infectious process, the destruction of foci of cervical ectopia is performed by cryogenic exposure, radiosurgery, laser coagulation, diathermocoagulation, chemical coagulation. When detecting ov. Nabothi performed an autopsy of cervical cysts. In case of detection of leukoplakia, dysplasia, polyps, endometriosis of the cervix, appropriate treatment of these conditions is indicated.
Prognosis and prevention
When pseudoerosion is detected, regular colpocytological monitoring is shown to exclude the development of pathological precancerous processes. With ectopia of the cervix, the prognosis is favorable. Preventive medical examinations, correction of disorders of immune and hormonal homeostasis, timely treatment of sexual infections and inflammations, increasing the culture of sexual relations, sparing gynecological manipulations can prevent the development of ectopia of the cervix.
