Study Of Metaplastic Lesions Of Different Parts Of The Female Genital Tract: A Prospective Study

摘要

Objective: To study the pattern and relative incidence of metaplastic lesions of different parts of the female genital tract and the relationship of different metaplastic lesions with age. Method: A total of 200 female genital tract samples in the form of hysterectomy specimens, endometrial curettings, pap smears and cervical biopsies were subjected to gross and microscopic examination and the metaplastic changes observed were recorded. Among all the samples, 57.5% were hysterectomy specimens, 20% were pap smears, 15% were endometrial curettings and 2.5% were cervix biopsies. Maximum number of patient (73%) was in the age group of 30-49. Results: Among 200 patients enrolled in the study, 120 (60%) were found to be positive for different types of metaplasias. Among the cervical metaplasias, 60.2% were showing squamous metaplasia of the cervix, followed by Ciliated and Microglandular metaplasia with a frequency of 25.5% and 20.4% respectively with the highest frequency in the age group of 40-59 years. Among the endometrial metaplasias Ciliated, Mucinous and Eosinophilic metaplasias were found to be the commonest with a frequency of 28.5%, 25.5% and 25.5% respectively. In the study, it was also observed that the metaplastic lesions of the endometrium and that of the cervix co-existed with each other in 74% of the cases Conclusions: From these observations, squamous metaplasia of the cervix was the commonest metaplastic lesion observed on histological examinations, followed by ciliated and microglandular metaplasia, where as in the endometrium ciliated (tubal) metaplasia was the commonest followed by eosinophilic and mucinous metaplasia.. A large number of metaplastic lesions of the cervix co-existed with each other and also with that of the endometrium. Introduction The adult nulliparous uterus is a hollow, pear shaped organ that weights 40 – 80 grams and measures 7 to 8 cm along its longest axis. It is divided into the corpus and the cervix. The cervix is the lower portion of the uterus and is divided into a portion that protrudes into the vagina (portio vaginalis) and one that lies above the vaginal vault (supravaginal portion). The outer surface of the portio vaginalis is known as the exocervix or ectocervix and the portion related to the endocervical canal corresponds to the endocervix.1 The endometrium lines the uterine cavity above the level of internal os. During the first half of the menstrual cycle, all the components of the endometrium including glands, stroma and blood vessels, proliferate under the influence of estrogens and during the later half, these elements respond to progesterone with the production of glandular secretions and there are stromal and vascular alterations.2 Most of the exocervix is covered by non-keratinizing squamous epithelium while as the glandular mucosa of the endocervix is formed by a layer of columnar mucous secreting cells. The area where the squamous and glandular epithelia meet is known as the squamo-columnar junction. This is a very unstable region, in which replacement of one epithelium for another repeatedly occurs, a process that Robert Meyer referred to as “the fight of the epithelia”. Today this area is more prosaically known as the transformation zone.1 Metaplasia is a condition in which there is a change of one type of differentiated tissue into another type of similar differentiated tissue3 or as the abnormal transformation of an adult, fully differentiated tissue of one kind into a differentiated tissue of another kind.4 The mullerian derived epithelium which lines most of the female genital tract is well known for its capacity to differentiate into various types of epithelium such as, ciliated, mucinous, endometrioid, transitional and squamous types.5 The metaplasias of the uterine corpus and cervix are the most common sites of metaplasia. Metaplasia occasionally can occur in other parts of the female genital tract such as mucosa of the fallopian tube and the vagina. Mucinous l