Symptoms and treatment of cervical intraepithelial neoplasia (CIN)
Cervical deciduosis - a disease affecting pregnant women. It does not manifest itself in all and is considered a very rare pathology. This disease is not dangerous, and does not require treatment if it was found on time and it resolved. But sometimes the lesions become malignant, in which case treatment is necessary. The main thing in time to identify the focus.
Groups of decidual cells outside the endometrium are called "decidua", and this condition was first defined by Walker in 1887. Most often the disease is localized in the ovary.
It is believed that peritoneal decidosis develops as a result of metaplasia of subnerosal stromal cells with an increase in the production of the hormone progesterone during pregnancy, and it regresses within 4-6 weeks after pregnancy with decidual involution. Therefore, it does not require therapeutic intervention, disappears on its own and without complications after delivery
The disease is a proliferation of tissue located between the vaginal fornix and the neck. Its shape resembles a polyp or papilloma; it may have a pink, yellow or white shade. The lesion increases with increasing gestational age.
Also, the disease may have a tumor shape. Therefore, it is necessary to conduct a differential diagnosis. Decidioses can be confused with mesothelioma, metastatic carcinoma, and malignant melanoma, so the definition of decidual tissue is important from a clinical and pathological point of view.
The pathogenesis of ectopic decidual reactions has not yet been fully studied. This question is still controversial. Doctors believe that the disease develops with such comorbidities as uterine fibroids, hyperandrogenism, with low placentation.
The most common theory is the metaplasia of subcelomic pluripotent mesenchymal cells with the effect of progesterone. The fact that decidosis passes after childbirth after some time confirms this theory.
After this pathology, 21% of women develop dysplasia and cervical cancer. These deviations are treated. If detected in a timely manner, you can prevent the terrible consequences.
Scientists investigated 7 women, whose age was in the region of 31–43 years, gestational age - 33–39 weeks. There was no history of endometriosis or any symptoms in the clinical history of patients. The biopsy was taken from a lesion, which looked like a small knot in the peritoneum during cesarean section in three cases. In other cases, the defeat looked like spikes.
Microscopic analysis of samples showed single decidualized cells that were large polygonal and eosinophilic. No nuclear pleomorphism, hyperchromicity or mitotic activity was detected in the decidual cells. Two cases had mild lymphocytic infiltration, but no granulomatous structure was observed.
Immunohistochemical evaluation showed positive decidual cell staining with vimentin in the cytoplasm, and positive progesterone receptor antibody staining in the nucleus of the decidual cells, while the results of calretinin, keratin and HMB-45 were negative in differential diagnosis.
Microscopically, decidual cells are usually found under the mesothelium, in the subcoelomic mesenchyme, or in adipose tissue. Lesions are found as small cell groups or clusters of a single cell in the peritoneum in 97% of cases, while they are in the form of widespread deciduosis, which completely fills adipose tissue in 3% of cases.
Deciduosis of the CMM does not manifest itself. Detection of damage is possible only with a gynecological examination.
Sometimes the disease develops in late pregnancy when the gynecologist does not examine the cervix. In this case, the disease is detected after birth, when a woman comes to the doctor because of scarlet discharge after sex, frequent bleeding and severe itching in the vagina.
Deciduosis may indicate the presence of human papillomavirus, therefore, when diagnosing it, tests for the detection of this pathology are also performed.
To diagnose the disease and start treatment, a woman needs to undergo a pelvic examination with the help of mirrors. The doctor also sends the patient for cytology, colposcopy and biopsy.
In some cases, decidual cells are taken as atypical, and an incorrect diagnosis is made. In such a situation it is recommended to visit several doctors and repeat the analysis. And so cytologists should be warned about the duration of pregnancy.
Each diagnostic method has side effects. Be sure to check this factor with the doctor so that when a reddish discharge appears, do not immediately run to the doctor.
Deciduosis is not treated. Lesions usually resolve on their own after the birth of the crumbs in a few weeks. A woman does not feel any pain or discomfort, she will not feel at all that the disease has disappeared. This can be learned only when conducting a pelvic examination or colposcopic examination.
Deciduosis can degenerate into a malignant tumor. If, after testing, the doctors discovered cancer, surgery is required. The operation is performed using a laparoscope or abdominal method.
In the event of rebirth into a malignant tumor, the patient is also prescribed radiation therapy. This is necessary so that cancer cells do not spread. Radiation can be external or intracavitary.
Anatomical and physiological features of a healthy cervix
The cervix outside (visible part of the gynecologist's eye) is covered with stratified squamous epithelium (exocervix), and inside it is the cervical canal (endocervix) that connects the vagina with the uterus, and it is covered with a cylindrical epithelium, where the glands that produce the secret are located.
Both epithelium are connected in the joint zone, it is called, also a transformation zone, and more often the pathological dysplastic process begins to develop in it.
What is cervical dysplasia?
Another name for dysplasia is cervical intraepithelial neoplasia (CIN). This is a pathological process in which atypical cells (unusual for this type of epithelium) appear in the thickness of the mucous epithelium of the cervix, as a result of which the sequence of the arrangement of the layers of the cervical mucosa changes. But atypical cells can behave uncontrollably, multiplying and increasing in volume, changing their shape.
Ultimately moving to cancer cells. This process can be both fulminant and develop over many years, again, depending on the associated factors. Dysplasia is a laboratory diagnosis confirmed after examining the cells (tissues) of the affected epithelium; apparently, the doctor can only suspect its presence.
Not to be confused with erosion, since it does not occur morphological changes in the cells, but only a defect in the surface epithelium of various etiologies is detected. So when making a diagnosis, a gynecologist can tell you about the presence of cervical erosion, and when examining taken cells or tissues from the affected area and confirming microscopically, already the presence of dysplasia.
The pathological process involves different layers of cells of the stratified squamous epithelium of the cervix, depending on this, the degrees of cervical dysplasia (CIN) are distinguished:
- Mild dysplasia (CIN 1). Weakly pronounced changes in the cells themselves. The process involves the lower third of the stratified squamous epithelium of the cervix.
- Moderate dysplasia (CIN 2). Modified cells are observed in the lower and middle third of the stratified squamous epithelium of the cervix.
- Severe dysplasia (non-invasive cancer or CIN 3). When the altered cells are detected throughout the entire layer of squamous multi-layered epithelium. Accordingly, the next stage of the already pathological cancer process will be invasion (implantation) deeper into the tissue - muscles, vessels, nerves and other nearby organs.
Symptoms of cervical dysplasia:
Usually, neoplasia of the cervical epithelium is asymptomatic. And it is often detected during routine checkups at the gynecologist. And even with the usual examination in the mirrors may not be visible, and detected only with cytological (taking material with a brush) or histological examination (taking a biopsy).
Or suspected during colposcopy (examination of the cervical mucosa under microscopic equipment and staining with special solutions). With the combination of dysplasia with infection of the genital organs, there can be abundant various mucous discharges, also spotting is possible on the background of erosive processes of the cervix or using tampons, syringes.
Occasionally, there is a clinic of colpitis (inflammation of the vagina), cervicitis (inflammation of the cervix) with the appropriate clinic. Cervical dysplasia is often combined with the presence of genital warts of the external genital organs. Very rarely, pain is present. Neoplasia itself can regress (go away) against the background of treatment for concomitant pathology, but more often it has a progressive nature that turns into cancer.
Methods for the diagnosis of cervical dysplasia
- Examination of the cervix in the mirrors. Conducted during preventive examinations. The doctor may pay attention to the modified epithelium of the mucous membrane of the cervix - staining, spots, ulceration, etc.
- Using colposcopy. An optical device that enhances the image of the cervical mucosa. At the same time, there may be visible - changes in color, affected areas of the mucous membrane, pathological vascular changes (steep vessels). And also with the implementation of diagnostic tests using acetic acid and Lugol, which changes the color of mucosal tissue and visible pathological processes on the cervix.
- Cytological examination. Using a special diagnostic brush, cells are taken from the mucous membrane of the surface of the multilayered epithelium and cervix and the cylindrical epithelium of the cervical canal. The resulting material is examined under a microscope and abnormal atypical cells are detected.
- Histological examination. A biopsy of the pathologically altered portion of the cervix is performed and this tissue is examined under a microscope. The last two methods are the most informative for making a diagnosis - cervical dysplasia.
- Immunological study by PCR (polymerase chain reaction) to detect the DNA of human papillomavirus. When a virus is detected, the type of oncogenicity and its quantity is determined. In the case of a positive result, this examination is carried out and sexual partner, and the question of tactics treatment of dysplasia in women.
- Screening for sexually transmitted infections.
- Scraping of the cervical canal is carried out with the identification of a suspicious lesion in the cervical canal, more often with confirmation of atypia of the cells of the cylindrical endocervical epithelium.
Cervical dysplasia during pregnancy
When registering for pregnancy in the antenatal clinic, a gynecologist, when examining a pregnant woman, takes smears on the flora and always performs a cytological examination.
During pregnancy, a woman's hormones change and under the action of hormones and an immunodeficiency state (which is normal when pregnancy occurs, so that the mother's body does not recognize the fetus as an alien and does not have a miscarriage), cell atypia processes that occurred before pregnancy can be activated , but not like they did not show up.
Condylomas of the genital organs may appear and progress, which, when aggravated by the process, may interfere with the delivery through the natural genital tract. In practice, there was a case in which at 20 weeks of pregnancy under general anesthesia it was necessary to remove huge overgrown condylomas of the vagina and vulva. The presence of HPV infection in its clinical and laboratory manifestations can harm the newborn.
If dysplasia is suspected, the doctor may suggest colposcopy and diagnostic tests with acetic acid and Lugol solution. It is absolutely not harmful during pregnancy. A biopsy is performed only when cytology confirms moderate or severe dysplasia, since during pregnancy there is a risk of bleeding. Scraping the cervical canal is not performed.
The tactics of management of pregnant women with cervical dysplasia is as follows:
- When CIN 1-2, colposcopy is performed, in the presence of cell atypia, cytology is repeated. With a satisfactory result of colposcopy, a biopsy is not required, but only cytology every three months.
- With CIN 3, a biopsy with histology is performed and, when atypia is confirmed, each month, cytology and colposcopy are monitored. As a rule, it does not progress. Final treatment after delivery. Such women are observed together with an oncologist.
Tactics of childbirth is individual. But more often through the birth canal, followed by postpartum observation.
Treatment of cervical dysplasia
Before starting treatment, anti-inflammatory therapy is carried out, and, if necessary, the treatment of a specific infection, if HPV is detected, antiviral therapy using antiviral vaccines (cervix), normalization of hormonal background and restoration of microflora.
Methods of treatment of cervical dysplasia:
- Electrical excision (diathermocoagulation), cauterization of dysplasia with current, is practically not used at present due to the formation of coarse scars, subsequently preventing the opening of the cervix during labor.
- Cold destruction (cryodestruction, cryoconization), is performed using liquid nitrogen. Often after it, prolonged watery discharge is observed - the healing process and the release of lymph from the coagulated lymphatic vessels of the cervix.
- Laser coagulation (cauterization). A side effect is overheating and burn of tissues.
- Radio wave coagulation using high frequency currents.
- Argon plasma coagulation. Impact on tissue plasma producing argon. The method is contactless, with a clear control of the depth of impact on the center. Leaves no scars. The most modern and reliable method to date.
- Amputation of the cervix (knife, ultrasound) or conization. Excision of tissue with a scalpel.
In case of mild and moderate dysplasia, women are observed and cytology is performed every 3 months; in cases of confirmation of the diagnosis, laser, radio wave, argon plasma therapy or cryotherapy is offered 2 times in a row. If severe dysplasia occurs, the woman is observed together with an oncologist, with the obligatory removal of the affected area, up to conization or amputation of the cervix.
So, we figured out that cervical dysplasia is a reversible process. And there is a chance to be healthy with timely detection of the disease and treatment! Do not lose it, visit every six months - the year of your gynecologist and be healthy!
What is deciduosis?
This pathology is a proliferation of internal tissue, which is located in the region of the vaginal fornix and uterine cervix. It may look like papilloma and have a shade of white, pink or yellow. The shape is oval or round. Size ranges from 1 mm to 6-8 mm. With an increase in the duration of pregnancy, the focus itself also increases. There is a formation near the outer orifice of the canal or a little bit further. Foci are usually several, from 2 to 5. In rare cases, single foci are found. The tumorous lesion has roll-like edges, which are separated by a narrow groove from the smooth surfaces of mucous membranes. It is covered with flat multi-layer epithelial tissue. In the center there are lesions that have small depressions.
These tumors are similar to polyps of various sizes. Often they are numerous, located in the very depths of the cervical canal or above. The tissue of the shoots has a pinkish tinge, with a white coating on their ends. On the formation you can see the branching of the blood vessels. These affected areas are very similar to cancer. It is impossible to make a diagnosis without additional diagnostic measures.
To sum up, the disease has 2 forms: tumor-like and polypous.
Often, deciduosis is confused with malignant neoplasms, especially when the lesions are multiple and merge with each other.
Causes of decidosis
An increase in progesterone levels serves as a trigger for the onset of the disease.
Pathology can occur in women who have hormonal imbalance. And in pregnant women, it definitely exists, which provokes the onset of pathology. At the same time there are associated diseases, in the form of:
- uterine leiomyoma,
- low placentation.
21% of pregnant women after decidosis have dysplasia and cervical cancer. But do not despair, because the timely identified deviation can prevent the most terrible consequences and complications.
This pathology usually does not inform about itself. An obstetrician-gynecologist can observe the deviation during a gynecological examination. Обычно на поздних сроках беременных не смотрят, поэтому заболевание выявляют в первом триместре и начинают детальнее обследовать пациентку.
In rare cases, scarlet or white discharge from the genital tract may occur (they appear most of all after sex). If, in addition to decidiois, an inflammatory process is present, then uterine bleeding and severe itching appear.
Sometimes the appearance of this disease indicates the presence of HPV. During hormonal adjustment, the human papillomavirus makes itself felt first and foremost. If you lose this sight, do not pass the examination, then there will be a degeneration of cells into a malignant tumor.
Consequences of decidosis for pregnancy and childbirth
For pregnant women, decidosis is normal. During pregnancy, the disease will progress. Negative impact on the fetus or any complications during gestation is not observed. His disappearance will be observed after delivery or abortion. First, the affected areas will decrease, most of them disappear. Where education has occurred, erosion may occur.
Childbirth pass naturally. If there are still any pathologies, the woman has a weak labor activity, then stimulation may be necessary. Sometimes a cesarean section is done, but that's another story.
Methods for diagnosing decidosis
Diagnose cervical deciduosis using different methods. Initially, a woman is examined in a gynecological chair using mirrors. The doctor gives directions to:
- cytological examination
- biopsy (if necessary, done in stationary conditions, but in extreme cases).
Deciduosis is very similar to cervical cancer. In order for everything to be clarified, a sample of the material is needed for conducting research in the laboratory.
This pathology does not need to be treated. Everything goes by itself after the woman gives birth. All formations dissolve after a few weeks, while the woman does not feel pain or discomfort. After a certain time after the recovery of the body after delivery, the lady needs to come for a colposcopic examination in the hospital.
If the lesions still remain, then do cytology, biopsy (rarely). If the survey results showed that education is of a benign nature, then it’s not worth worrying about. You just need to wait a bit until all the tumors themselves leave. If degeneration into a malignant tumor has occurred, then serious treatment begins later. In order to get rid of cancer you need to gain strength and patience.
Usually oncology is treated with radical methods. Laparoscopy or abdominal surgery may be performed. An ordinary surgical scalpel is not necessarily used, often surgeons use a laser or electrosurgical unit.
Radiation therapy that inhibits cancer cells is also advisable. If the beam is directed specifically to the affected area, then numerous organs will not respond. Irradiation is external and intracavitary. Two can be used simultaneously.
Chemotherapy will also have to be resorted to, as it effectively fights against the ailment and does not allow disease cells to spread further.
To end cancer, doctors use a combination treatment. To do this, use several methods.
Since the disease is a tumor-like and polypoid lesion, prevention will be based on various aspects.
In order to protect yourself and prevent the development of various tumors on the genitals, you need:
- stop eating foods that contain hormones, dioxide,
- fully, rationally and balancedly to eat,
- travel more often to places with clean air (if possible, move to the territory where there is good ecology),
- do not supercool, do not sit in the cold,
- have a regular partner
- talk to a partner so that he is not rude during sexual intercourse (this can lead to vaginal injury)
- less nervous, avoid stressful situations, behave vigorously,
- play sports that will not allow stagnant blood in the pelvic organs (do exercises, go swimming, shaping, fitness or prefer cycling),
- do not self-medicate (if you have any abnormalities in the reproductive organs, immediately go to the gynecologist),
- not to take birth control pills on your own (only the doctor can choose the appropriate drug for the patient),
- every six months to come for a routine examination to the gynecologist.
If you adhere to all the above rules, then the lady will very rarely be bothered by any problems regarding the female genital organs. Including cervical deciduosis.
Uterine cervix deciduosis is a disease that occurs in some pregnant young ladies. Every month, the affected areas will increase, but the woman will not feel discomfort about this. The treatment of the disease does not require, since after delivery everything goes away by itself. At the site of formations may appear erosion, which also gradually resolves. If this does not happen, the doctor will prescribe cauterization or other methods of treatment.
A completely different outcome would be if the benign cells were reborn and the doctor diagnosed oncology. Here various methods of treatment will be used. Modern medicine works wonders, so even cancer can be cured, after which a woman will live happily ever after. The main thing in time to identify such a deviation, because the treatment in the later stages is no longer so successful.