Cervical erythroplakia is a defect, damage to the flat epithelium of the cervix on its vaginal part around the external pharynx. It occurs more often as a result of endocervicitis and other inflammatory diseases of the genital area, hormonal disorders in the female body. The course may be asymptomatic or manifest itself with pathological secretions of a mucopurulent, sometimes bloody nature, pulling pains in the sacrum. It is a risk factor for cervical neoplasms (polyps, cancer). The main ways to diagnose cervical erosion are cervical examination in mirrors and colposcopy. Methods of diathermocoagulation, laser vaporization and cryodestruction, as well as the radio wave method can be used in the treatment
N87 Cervical dysplasia
Erythroplakia is an extremely rare and insufficiently studied disease. It got its name because of the peculiarities of its appearance (translated from Greek “erythroplakia” means “red spot”). It can be detected both in patients of childbearing age, and during menopause and postmenopause. In girls, it is usually not diagnosed before the onset of the first menstruation. Erythroplakia is often combined with inflammatory processes (cervicitis, colpitis).
The relevance of timely diagnosis of this pathology is due to its belonging to precancerous conditions. Since adequate treatment ensures complete recovery of the patient, timely detection of erythroplakia can reduce the incidence of malignant neoplasia of the cervix.
The etiology of the disease has not been definitively established. It is assumed that the normal maturation and renewal of exocervix epithelial cells is disrupted when exposed to one or more risk factors. These include:
- Chronic colpitis and cervicitis. As a result of inflammation, the processes of necrobiosis and desquamation occur in the multilayer squamous epithelium of the exocervix. The risk of atypia is especially high when infected with human pappiloma virus in association with chlamydia, cytomegalovirus or herpes infection.
- Burdened heredity. Statistical data reliably confirming the connection of erythroplakia with gene and chromosomal aberrations does not yet exist. However, according to the observations of specialists in the field of gynecology, the likelihood of the disease increases if it is present in the next of kin.
- Injuries. The physiological development of the epithelium can be disrupted after micro-injuries and ruptures of the cervix, suffered during childbirth and abortions, hysteroscopies, diagnostic curettage and other invasive procedures. The basis for atypical changes in such cases are nutritional disorders and tissue innervation.
- Chemical effects. Precancerous transformation of the cervical epithelium is provoked by aggressive chemical agents (spermicides, low-quality latex of contraceptives, douching fluids, etc.). With their constant use, the likelihood of violations increases.
- Immune and endocrine pathology. Erythroplakia is more often observed in patients with an imbalance of estrogens (increased estradiol content) and an increased concentration of oxygenated 17-ketosteroids. In addition, the degree of dysplastic changes is directly proportional to the level of immunosuppression.
Involutive atrophy of the genitals may play a certain role in the development of the disease. Like other precancerous processes of the cervix, erythroplakia is more often detected in women who have started sexual life early and often change sexual partners. An additional risk factor is the presence of nicotine addiction in many patients – there is evidence that the risk of erythroplakia is associated with the number of cigarettes smoked and the duration of smoking.
With erythroplakia of the cervix, the natural processes of renewal, maturation and rejection of exocervix cells are disrupted. There is an imbalance between the cells of different layers of the epithelial membrane. The mucous membrane of the vaginal part of the cervix is significantly thinned due to atrophy of the predominantly superficial and intermediate epithelial layers. At the same time, the basal and parabasal layers grow, signs of atypia appear. The changes are focal in nature, the affected areas are surrounded by a normal multilayered squamous epithelium. The specific appearance of the affected exocervix is due to the translucence of stroma vessels through the thinned mucosa. The vascular network is full-blooded, with areas of lymphoid infiltration.
Symptoms of cervical erythroplakia
The disease is usually asymptomatic and becomes an accidental finding during a gynecological examination. Only in cases when the affected areas reach large sizes, contact bleeding appears. After sexual intercourse or douching, there is a small amount of bloody discharge. Extremely rarely, more intense bleeding occurs. If erythroplakia has developed against the background of colpitis, endocervicitis or cervicitis, the symptoms of the underlying disease prevail. The patient is concerned about mucous or mucopurulent vaginal whiteness, abdominal pain, itching and burning in the area of the external genitals.
Erythroplakia is classified as a precancerous condition of the cervix. Its most formidable complication is malignancy — the degeneration of altered benign exocervix cells into malignant ones. With large sizes of pathological foci and repeated exposure to damaging factors (frequent douching, rough sexual acts), constant pickling and even prolonged bleeding may occur. In such cases, anemia is possible. Although erythroplakia itself does not provoke the development of inflammatory processes, its foci are able to maintain chronic inflammation of the cervical mucosa.
Erythroplakia is often detected by accident. Due to the characteristic external manifestations, it does not present any particular difficulties in diagnosis. Confirm the diagnosis and exclude the oncoprocess allow:
- Examination on the chair. On the unchanged surface of the exocervix, maroon or bright red areas are determined. The foci have an irregular shape, clear boundaries. When the probe is touched, the affected mucosa may bleed.
- Extended colposcopy. The epithelial membrane is thinned, the stroma of the cervix shines through it. When treated with Lugol (Schiller test), the foci do not stain, when applying a 3% solution of acetic acid, they turn pale.
- Cytology of cervical scraping. The study reveals hyperplasia of basal cells with signs of atypia. With a large number of atypical cells, a conchotomic or targeted biopsy of the cervix and histological analysis of the material are indicated.
If erythroplakia is combined with infectious processes, microscopy and smear seeding for flora, PCR diagnostics, serological research methods ( ELISA, etc.) are additionally prescribed. Ultrasound screening is shown to assess the general condition of the reproductive organs. In difficult cases, an oncogynecologist is involved in the diagnosis. The disease is differentiated with cervical cancer, background and precancerous conditions:
- benign, papillary, precancerous transformation zones;
- true erosion;
Treatment of cervical erythroplakia
There are no conservative methods of therapy. Taking into account the size of the erythroplakia focus, histological examination data, the patient’s age and her reproductive plans, one of the surgical techniques aimed at destroying or removing the affected area is shown:
- Minimally invasive organ-preserving interventions. During surgery, damaged tissues are destroyed by physical factors. Cryodestruction (exposure to low temperature), diathermocoagulation (cauterization with high frequency current) or laser vaporization (destruction by laser beam) are usually performed. With large foci, radioexcision of the cervix is possible, followed by histological examination of the tissues.
- Conization of the cervix. The pathological site is excised cone-shaped together with a part of healthy tissues. This approach is justified when erythroplakia is combined with damage to the tissues of the cervical canal. Depending on the immediate technique of execution, knife, laser, loop radio and electroconization are distinguished. Classical surgery with tissue excision with a scalpel is used extremely rarely, the most common is the loop method.
Surgical treatment is often supplemented with antibacterial agents, followed by the appointment of eubiotics that stabilize the vaginal microflora. Drugs to increase reactivity (immune stimulants, vitamin and mineral complexes) are shown.
Prognosis and prevention
With timely treatment, the prognosis of the disease is favorable. Erythroplakia is extremely rare, relapses after surgery are practically not observed. The patient is recommended colposcopic, cytological and bacteriological monitoring a month after the intervention, and then every three months for a year. For preventive purposes, it is necessary to be regularly monitored by a gynecologist, timely treat inflammatory diseases of the female genital area, plan pregnancy, refrain from unprotected sex and frequent changes of sexual partners. Therapeutic and diagnostic invasive interventions should be prescribed strictly according to indications.