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Normal cervix , cervical TZ and how to dissect a LLETZ

Normal cervix , cervical TZ and how to dissect a LLETZ. Dr Michael Coutts Consultant Gynaecological Pathologist West Kent Gynae Oncology Centre, Maidstone, UK a nd Centre Hospitalier Universitaire, Nice, France. Simple hysterectomy. Normal cervix.

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Normal cervix , cervical TZ and how to dissect a LLETZ

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  1. Normal cervix, cervical TZ and how to dissect a LLETZ Dr Michael Coutts Consultant GynaecologicalPathologist West Kent GynaeOncology Centre, Maidstone, UK and Centre Hospitalier Universitaire, Nice, France

  2. Simple hysterectomy

  3. Normal cervix

  4. Normal ectocervix (stratifiedsquamousmucosa)

  5. Normal cervix

  6. Normal endocervix (simple glandularmucosa)

  7. Normal cervix

  8. The squamocolumnarjunction

  9. Physiologicalchange in cervix

  10. Physiologicalchange in cervix

  11. Reserve cell hyperplasia

  12. Reserve cell hyperplasia

  13. Immature squamousmetaplasia

  14. Immature squamousmetaplasia

  15. Residual endocervical cellsoverlying immature squamousmetaplasia

  16. Immature squamousmetaplasia

  17. Immature squamousmetaplasia(non-glycogenated)

  18. Mature squamousmetaplasia in TZ

  19. Examination of cervical punch biopsies • Colposcopicallydirected punch biopsies to enablehistologicaldiagnosis of suspect areas • Biopsies usually 2-4mm and maybe on card • Record number, maximum dimension and colour • Biopsies >5mm maybebisected • Check the pot and underthe lid for tissue • Wrapsmall fragments in filterpaper/wire basket • Threelevelsstainedwith H & E as routine

  20. Cervical loopbiopsy (LLETZ)

  21. Gross appearance of a loopbiopsy

  22. Slicing the loop or cone biopsy Option one: • Radial method– incise at 12 o’clock, open out and cutclock face slices to maplesionaroundclock face • but needsfresh tissue and assessment of narrow end of wedgeshaped block maybedifficult

  23. Slicing the loop or cone biopsy Option two: • Transverse method– transversely slice across long axis of slit-shaped os • Good for fixed tissue and sections usually come out well. Difficult to map to clock face

  24. Cervical loop in multiple pieces • An intact loopmaybereceivedwith a second separate endocervical piecefrom the apex (‘top hat’). Treatbothseparately and label which blocks they are placedinto. • Multiple separateirregularpiecesmaybereceived: measureeach, trasversely slice and label which blocks they are placedinto. • Process all of the tissue for each case. • Avoidplacing more than one slice of a loop in each block.

  25. Conclusions • The location of the SCJ changes withage • It is important to recognise the histology of normal squamousmetaplasia of the cervix • Colposcopic punch biopsies maybereceived to confirm a diagnosis of CIN, CGIN or cancer beforedefinitivetreatment • Loop or cone biopsies are performed as treatment for CIN or CGIN (and somesmall cancers) and the transverse slicingmethodissuggested, withprocessing of all tissue pieces

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