Benign disease of the uterus and cervix doc

Chapte r 9

Benign disease of the uterus

and cervix

Epithelium1

the uterine cervix

Endometrium

103

104

Myometrium: uterine fibroids 105

OVERVIE W

Benign disease o1 the cervix and body of the uterus is extremely common. Cervical ectropion and fibroids are often present with￾out symptoms, but are also common problems encountered in almost every gynaecological outpatient clinic. Adenomyosis and.1

Endometriosis, other important benign conditions, are considered in Chapter 10.

Benign disea.se of the uterus may conveniently be

classified in terms of the tissue of origin: the uterine

cervix, the endometrium or the myonietrium.

Epithelium: the uterine cervix

The transformation zone it. a special feature of the ecto￾iervix, and corresponds to that portion of die uterine

cervix visible during speculum examination. Within this

aone the stratified squamous epithelium of the vagina

meets the columnar epithelium of the cervical canal.

The anatomical site of the squamocolumnar junction

fluctuates under hormonal influence, and the high cell

mrnover of this tissue is important in the pathogenesis

rf cervical carcinoma, discussed in Chapter 12. The

lotumnar epithelium is normally visible with the

ipeculum during the ovulatory phase of the menstrual

c»de. during pregnancy and in women taking the corn￾wed oral contraceptive pill, in whom oestrogen levels

arc elevated. In contrast, only squamous epithelium is

visible in a postmenopausal woman not taking hor￾mone replacement therapy.

Cervical ectropion

The presence of a large area of columnar epithelium on

the ectocervix can be associated with excessive mucus

secretion, leading to a complaint of vaginal discharge.

The appearance of the cervix is termed cervical ectro￾pion or, very inappropriately, a 'cervical erosion'. The

latter term is best avoided, as it conveys quite the

wrong impression of what is really a normal phenom￾enon. Ectropion can be associated with excessive but

non-purulent vaginal discharge, as the surface area

of columnar epithelium containing mucus-secreting

glands is increased. If the discharge associated wfth

cervical ectropion becomes troublesome to the patient,

discontinuing the oral contraceptive pill or, ahenn￾tively, ablative treatment under local anaesthesia using

a thermal probe can reduce it. This treatment involves

a metal probe that heats the tissue to around 100 "C,