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PubMed1994

The uterine cervix on in vitro and in vivo MR images: a study of zonal anatomy and vascularity using an enveloping cervical coil.

OBJECTIVE: The purpose of this study was to characterize the normal zonal anatomy and vascularity of the cervix on in vivo and in vitro MR images obtained with a receiver coil surrounding the cervix. These appearances provide a normal data base from which to interpret subtle changes in early neoplasia. SUBJECTS AND METHODS: Thirteen women of reproductive age with clinically and cytologically normal cervices were imaged with a ring-design solenoid receiver coil that was placed intravaginally and enveloped the cervix. T1- and T2-weighted axial images were obtained. Seven uterine specimens resected for benign disease were similarly studied, and imaging appearances were correlated with histologic findings. RESULTS: In the in vivo studies, the endocervical mucosa and two stromal zones surrounding the high-signal central canal were identified. Unlike the uterine body, they could be differentiated on both T1- and T2-weighted images, on which the inner ring had a low signal and the outer ring had an intermediate signal intensity. The outer zone was highly vascularized, with inflow effects from large vessels visible on single-slice scans. On administration of gadopentetate dimeglumine, the endocervical mucosa enhanced rapidly, whereas the outer stroma showed more gradual enhancement. The inner zone enhanced slowly relative to the outer zone. The parametrium was visualized up to 6 cm from the center of the coil, and adjacent colon, fat, and blood vessels were identified. Up to four lymph nodes less than 1 cm in diameter were seen in the parametrium of three subjects. In the in vitro studies, the endocervical mucosa was of high signal intensity. In the fibromuscular cervix, an inner low-signal ring correlated with a region of tightly packed stroma (fibroblasts and smooth muscle cells; cell count, 5900 +/- 2376 nuclei/mm2) and the intermediate-signal-intensity outer zone corresponded to a region of more loosely packed stroma (cell count, 2199 +/- 558 nuclei/mm2). Retention cysts were present in two multiparous cervices. CONCLUSION: These detailed appearances and enhancement patterns of the normal cervix need to be recognized so that subtle changes in locally invasive cervical neoplasia can be identified.

Adult↗
PubMed1987

Cervical priming and labor induction with vaginal application of 3 mg PGE2 in suppositories in term pregnant women with premature rupture of amniotic membranes and unfavorable cervix.

Sixty-one term pregnant women, 29 nulliparous (Group A) and 32 multiparous (Group B) with unfavorable cervix and premature rupture of the membranes (PROM) were given 3 mg PGE2 in suppository form for cervical ripening and labor induction. Five hours after starting the treatment, 12 women of the 29 in Group A and 21 of the 31 in Group B had a favorable cervix and established labor. The remaining 17 nulliparae and 11 multiparae still had an unfavorable cervix and were then given another PGE2 suppository. Until the next morning, i.e. within 24 h, 19 nulliparous and 22 multiparous women gave birth whereas a further 5 nulliparous women who now had favorable cervix but no uterine contractions were delivered after stimulation with intravenous oxytocin. The remaining undelivered women were given another PGE2 suppository. With or without additional oxytocin stimulation, all but 2 multiparous women could be delivered within a further 12 hours. The total number of instrumental deliveries in Group A was 2 caesarean sections due to disproportion (7%) and 5 ventouses. In Group B, 3 caesarean sections (9%) had to be carried out, one due to fetal distress and 2 due to failed induction. From the results of this study we conclude that vaginal application of 3 mg PGE2 in suppository form can be used to induce labor in patients with PROM and unripe cervix. However, when the results are compared with those obtained in previous studies after application of PGE2 in gel, the latter technique seems preferable.

Cervix Uteri↗
PubMed2002

[Great elongation of uterine cervix: retrospective study of 20 cases].

BACKGROUND: The aim of the study was to evaluate the safety and efficacy of the Musset Poitout surgical procedure consisting in an anterior uterosacral ligament transposition and a cervix amputation. The main indication is an uterovaginal prolapse with an isolated elongation of the cervix. METHODS: A retrospective consecutive series of 20 women with an elongation of uterine cervix undergoing Musset Poitout procedure over a 10 year period between 1990 and 2001 with analysis of per and post operative complications and success. Four Kelly urethral plications were performed in the same time. The patient's ages, time under anesthesia, change in hemoglobin, days of hospitalization, medical illnesses, complications and follow-up were assessed. Failure was defined as a symptomatic elongation of the cervix or a third degree hysterocele on examination. RESULTS: and discussion. The median age of Musset Poitout procedure was 43.9 years (range 23-83). General anaesthesia could be performed in all patients. Mean operation time was 67 minutes (range 40-130). No major per or post operative complications occurred. The average of post-operative bladder cathetherisation was 3.65 days, the average hospital stay was 6.3 days. Complications were insignificant: urinary tract infection in 2, voiding dysfunction in 2. All the patients but 2 were followed for a mean 59 months (range 6-127). There was one recurence (5.5%). CONCLUSION: In this preliminary assessment the Musset Poitout procedure offered significant avantages in a genital prolapse with elongation of the cervix.

Adult↗
PubMed1975

[Examination of the uterine cervix using the scanning electron microscope].

Scanning by electron microscopy of the cervix of the uterus allows us to study the various aspects, both normal and pathological, as well as the architecture of sections of the organ. All the same, as in all practical examinations carried out using scanning we have to beware of pictures that are but artefacts due to the method of preparation. The views obtained from a normal cervix of from pathological cervices show very different aspects. In the normal cervix the surfaces are more or less smooth and the architecture of the deeper levels shows a thick and regular texture. Infectious lesions of the outer aspect of the cervix show punched-out patterns, like craters, which penetrate more or less deeply into the sub-epithelial plane. While cervical dysplasia shows little except perhaps a more or less bossed-up epithelial surface, cancer of the cervix on the other hand shows a pavement pattern which is irregular. The pavements are formed by buds which are separated by faults which are more or less deep. In section the structures show a degree of disorientation in the texture. After treatment with radium the appearance is rather like ground glass of spiders webs and the architecture of the structures seems to be pock-marked and chaotic.

Cervix Uteri↗
PubMed2002

Interleukin 8 in the cervix of non-pregnant ewes.

Studies of cervical artificial insemination of ewes at hormone-synchronized oestrus indicate that the cervix remains relatively impenetrable to semen, in contrast to naturally breeding animals. During parturition the inflammatory response plays an important part in cervical dilation and possibly, to a lesser extent, in the non-pregnant cervix at oestrus to facilitate the transcervical transport of semen. The expression of interleukin 8 (IL-8), a pro-inflammatory cytokine in the ovine cervix, has been mapped and quantified, using semi-quantitative in situ hybridization, to ascertain the role played by inflammation in the ovine cervix during natural and artificially induced oestrous cycles. IL-8 gene expression was observed in both the luminal epithelium and fibroblastic cells of the cervix. The presence of IL-8 was confirmed using immunohistochemistry. IL-8 gene expression in the luminal epithelium varied throughout the oestrous cycle and was highest at oestrus and at day 5 of the oestrous cycle. In ewes artificially induced to ovulate, either by the withdrawal of progesterone pessaries after treatment for 12 days, or by two i.m. injections of prostaglandin 9 days apart, IL-8 gene expression at oestrus was significantly lower than it was at natural oestrus. Insemination increased IL-8 gene expression in progesterone-synchronized ewes. These data support the hypothesis that IL-8-induced inflammation is important in normal cervical function and that this process is inhibited during artificial synchronization of the oestrous cycle and is increased by exposure to semen.

Animals↗
PubMed2005

[The detection of p16 protein in uterine cervix lesions].

OBJECTIVE: The detection of p16 in oncocytology and in the surgical pathology of the uterine cervix. SETTING: Department of Pathology and Department of Gynaecology and Obstetrics, University Hospital Brno. METHODS: An imunocytochemical and immunohistochemical analysis of formalin-fixed, paraffin embedded samples of the uterine cervix (included knips biopsies) and liquid based smears was performed. The bioptic database included 7 cases of CIN II-III, 5 cases of reactive epithelial changes and 3 cases of atrophic epithelium. 36 liquid based smears, 25 cases of CIN III and 11 cases of uterine cervix without a dysplastic lesion. RESULTS: Nuclear and cytoplasmatic p16 positivity was found in 22 cases of CIN III in liquid based smears. Diffuse and intensive p16 expression was in 5 cases of knips biopsies CIN III. CONCLUSION: The detection of p16 seems to be a valuable tool in surgical pathology of the uterine cervix: possible evaluation of the surgical margins, differential diagnosis regarding reactive atypia, and it is also prospective in oncocytologic diagnosis regarding differential diagnosis of the ASCUS, or can be used in monitoring of the uterine cervix dysplasia.

Biomarkers↗
PubMed1991

[Cryosurgery of the uterine cervix. Our experience in 3,184 cases].

An analysis is made of 3,184 cases of cryosurgery of the uterine cervix treated along 18 years for diverse types of lesions: 2,050 cases of ectropion of the cervix (64.38%), 811 chronic cervicitis (25.47%), 48 eversions of the cervical canal (1.51%), 24 of cervical condyloma acuminata (0.75%) and 251 of CIN (7.88%). A nitrous oxide cryosurgical system was used. This study evaluate the features of the cryolesion, correlating the freeze time, the size of the frosted area around the probe, the size of the resulting ice-ball and the depth of the epithelial tissue necrosis microscopically measured. For this study cryosurgery was applied to the cervix of 56 women, 1 to 7 days before hysterectomy was performed for benign disease. Statistical analysis was made using regression-correlation calculations to determine the correlation coefficient (r), concluding that the freezing effect and the depth of tissue necrosis are not correlated with the freeze time, but it was demonstrated that there is a reliable correlation between the width of the frosted area around the probe and the depth of tissue necrosis. The extension of cryolesion was influenced by the type of probe, the anatomical position in the cervix, shape of the external is and freeze time, which may be related with the pressure of the gas and the possible clogging of the tubes by pollution. In this paper it is studied too the histopathologic features of the cryolesion. The results obtained in the diverse groups of treated lesions were: 1. In 92% of cases of mucous ectropion of the cervix, one treatment was enough to heal the lesion.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

[THe role of biopsy in the early diagnosis of cancer of the cervix uteri].

Among the actions of early diagnosis of uterine cervix cancers, the sequence cytologic smear, colposcopy, cervix biopsy is well-known. The authors draw the attention that in some situations the cytologic smear and colposcopy are not sufficient and it is only biopsy that defines the nature of the lesion and may give therapeutic indications. Out of a series of 55 women to whom a cervix biopsy was performed, there were 27 cases in which biopsy was justified, showing either a severe lesion or the presence of koilocytes. The authors plead for a more frequent use of cervix biopsy as a means of early diagnosis of uterine cervix cancer or of its dysplasias.

Adult↗
PubMed1987

Gap junction formation in the human uterine muscle cell of the corpus and cervix during the menstrual cycle and pregnancy.

The difference between sex steroid hormone dependency on gap junction (GJ) formation in human uterine muscle cells of the cervix and corpus was investigated using electron microscopic morphometry and steroid hormone radio-immunoassay. The results obtained are summarized as follows: The number of GJ in human uterine cervical muscles changed during the menstrual cycle and became greater in the periovulatory phase, whereas the GJ of myometrial muscle changed little in number during the menstrual cycle. During pregnancy, the number of GJ in myometrial muscle increased at delivery (before labor v.s. during labor 8.1 +/- 0.6 v.s. 12.8 +/- 1.0, n = 7-2, p less than 0.01), while the number of GJ in the cervix showed no significant change. When the number of myometrial as well as cervical muscle GJ around the third trimester was compared to that of the nonpregnant (luteal phase) status, there was a significant increase in the number of GJ (luteal phase v.s. during labor 6.6 +/- 1.2 v.s. 12.8 +/- 1.0, p less than 0.05 in the myometrium and 4.6 +/- 1.0 v.s. 9.6 +/- 0.7, p less than 0.05 in the cervix). This increase in the number of myometrial GJ correlated well with the increase in the circulating E2 to P ratio (r = 0.75, p less than 0.001), whereas a slight correlation was found between cervical GJ and these levels (r = 0.42, p less than 0.05). The results of the present study support the hypothesis of an estrogen-dependent formation of myometrial muscle GJ, although the current observations of the human cervix continue to raise the question whether or not identical mechanisms may operate in the cervix.

Cell Communication↗
PubMedDate not supplied

[Ripening processes of the uterine cervix and their significance for parturition].

The uterine cervix is to be seen as a biochemical, physical and anatomic unit with a good correlation to the uterine corpus. The function of the cervix for the protection of the pregnancy depends from many biochemical processes, in which collagen has a very important role, influenced by structural and biochemical changing of the connective tissue and by the balance of biosynthesis and destruction of collagen. The controlling function of Estrogen, Progesterone and Corticoids seems to be demonstrated. Prostaglandins have a direct influence on the ripening processes of the cervix and correlation to the oxytocic influence of the uterine contraction. In clinical management and for examination of premature labour, cervical ripeness at term and post-term situations and for indicated initiation of labour we must use a cervix-score with different evaluation of its parameters as length, consistency, position and dilatation of the cervix as well as the station of the fetal head.

Adrenal Cortex Hormones↗
PubMedDate not supplied

[Role of the cervix uteri at labor onset from ultrasound studies].

The cervix uteri is of greatest importance for the environment of the fetus. The sonographic imaging of the cervix uteri can be done by transabdominal, perineal and transvaginal route. Each of these methods are associated with specific advantages and disadvantages. During the time of gestation the cervix uteri can be measured sonographically concerning the length, the thickness, the width of the cervical canal and in addition the diameter of the internal and the external os. At the beginning of labour the cervix shows a transformation: a shortening with an increase of thickness. The phase of contraction is followed by a phase of reformation. Individual formations of the cervix regarding the a premature opening of the internal os or the external os could be demonstrable without clinical symptoms. By W. Eppel a score-like formula "Incompetence-Factor" was described for a quantification of these measurements.

Cervix Uteri↗
PubMed1994

Estrogen and progesterone receptors in normal cervix and primary cervical carcinoma.

Estrogen and progesterone receptors (ER, PR) were measured in 21 specimens of cervical cancer and in 17 specimens of normal cervix by monoclonal enzyme immunoassay (EIA). In normal cervix, 88.2% of specimens were ER-positive ( > 15 fmol/mg protein), 74.5% were PR-positive ( > 15 fmol/mg protein) and 74.5% were both ER- and PR-positive. In cervical cancer, 66.7% were ER-positive, 42.9% were PR-positive and 38.1% were both ER- and PR- positive. There was no significant difference in ER status between the normal cervix and cervical cancer (P > 0.05), but PR status and levels in normal cervix were significantly higher than those in cervical carcinoma (P < 0.05). ER levels in squamous cell carcinoma was not correlated to the tumor stage, histologic grade and menopausal status. PR levels in premenopausal patients with squamous cell carcinoma were significantly higher than those in postmenopausal patients (P < 0.01). Adenocarcinoma of the cervix contained significantly more ER and PR than squamous cell carcinoma (P < 0.01, P < 0.05). In addition, serum E2 level was also assayed in 21 patients with cervical cancer. There was significant difference in E2 levels between the premenopausal and postmenopausal patients (P < 0.01). Patients were stratified according to E2 levels, a significant difference in PR levels and in the ratio of PR/ER was noted (P < 0.05, P < 0.01).

Adenocarcinoma↗
PubMed1994

[Estrogen and progesterone receptors in normal cervix and primary cervical carcinoma].

Estrogen and progesterone receptor levels (ER and PR) were measured in 21 specimens of cervical carcinoma and in 17 normal cervix by monoclonal enzyme immunoassay (ER-EIA and PR-EIA). In normal cervix, 88.2% of specimens were ER-positive (more than 15 fmol/mg protein), 74.5% were PR-positive (more than 15 fmol/mg protein) and 74.5% were both ER and PR-positive. In cervical cancer, 66.7% of malignancies were ER-positive, 42.9% were PR-positive and 38.1% were both ER and PR-positive. There was no significant difference in ER status between the normal cervix and cervical cancer (P > 0.05), but PR status and levels in normal cervix were significantly higher than those in cervical carcinoma (P < 0.05). ER levels in squamous cell carcinoma was not correlated to the tumor stage, histologic grade and menopausal status. PR levels in premenopausal patients with squamous cell carcinoma were significantly higher than those in postmenopausal patients (P < 0.01). Adenocarcinoma of the cervix contained significantly more ER and PR than squamous cell carcinoma (P < 0.01, P < 0.05). In addition, serum E2 level was also assayed in 21 patients with cervical cancer. There was significant difference in E2 levels between the premenopausal and postmenopausal patients (P < 0.01). Patients were stratified according to E2 levels, a significant difference in PR level and in ratio of PR/ER was noted (P < 0.05, P < 0.01).

Adenocarcinoma↗
PubMed1994

Multivariate discriminant analysis of normal, intraepithelial neoplasia and human papillomavirus infection of the uterine cervix samples.

The present investigation studies the role of multivariate statistical methods on quantitative histopathological features of cells in uterine cervix epithelium to discriminate between normal and abnormal uterine cervix samples. 143 histological specimens were included in the study involving normal cervix, cervical intraepithelial neoplasia (CIN) lesions and cervical human papillomavirus (HPV) infection with and without CIN (condyloma-CIN and condyloma-NCIN groups, respectively). Deep, middle and superficial regions of the cervical squamous epithelium were morphometrically analyzed. Identification of normal cervix from pathological cases was highly achieved with a specificity of 100%. The application of discriminant statistical method within pathological specimens showed an acceptable percentage of cases correctly classified; thus, an efficiency of 83.0% and 74.6% was obtained in order to discriminate within CIN and condyloma-CIN grades respectively. These percentages increased when differentiation between each grade of CIN versus condyloma-CIN were considered, using only 1-3 morphometrical parameters. Our findings indicate that the combination of nuclear and cytoplasmic quantitative features, specially size parameters, permit a high correct percentage classification of cervix samples. The discrimination process was better when few diagnostic categories were included; however, 100% specificity for normal samples was always reached.

Cell Nucleus↗
PubMedDate not supplied

Glutathione S-transferase pi is expressed in (pre) neoplastic lesions of the human uterine cervix irrespective of their degree of severity.

BACKGROUND: Glutathione S-transferase pi (GST pi) is involved in a variety of cell detoxification processes. In the uterine cervix its presence has been associated with high grade cervical intraepithelial neoplasia (CIN), but the reports are conflicting. For this reason we immunohistochemically investigated glutathione S-transferase pi expression in a well documented sequence leading to cervical cancer. MATERIALS AND METHODS: The series of tissue samples that were examined comprised normal, metaplastic, dysplastic (CIN 1, 11 and 111) and malignant cervix. GST pi expression was examined in 15 cases of uterine cervix lined with normal epithelia, in 11 cases of CIN 1, 9 cases of CIN 11, 10 cases of CIN 111, 6-cases of squamous cell cervical carcinomas and 5 cases of adenocarcinoma of the cervix. RESULTS: Both nuclear and cytoplasmic staining reactions were noted. In normal ectocervical epithelia a moderately strong nuclear and cytoplasmic staining reaction was noted, while in immature squamous metaplasia staining was more intense. Only 50% of the endocervical cells were immunostained while almost 100% of the reserve cells stained weakly, mainly restricted to the cytoplasm. Irrespective of severity, CIN lesions showed a moderate staining intensity in both cytoplasm and nuclei. Cervical carcinoma, irrespective of their type, showed significantly less staining activity. CONCLUSIONS: GST pi occurs in normal cervical epithelium and in all stages of premalignant cervix, suggesting an important role in the detoxification process in all these stages. Its ubiquitous presence indicates, in contrast to the earlier reports, that the enzyme does not play a crucial role in the initiation of the carcinogenic cascade. However, the absence of this detoxificating enzyme in the nucleus of the majority of cervical carcinomas may indicate that xenobiotic compounds are not catabolized and may therefore exert their mutagenic activity, resulting in tumor progression.

Cell Nucleus↗
PubMed1998

Sympathetic innervation of the upper and lower regions of the uterus and cervix in the rat have different origins and routes.

The origins and routes of the postganglionic sympathetic nerve supply to the upper and lower uterus and to the cervix were investigated in the rat by using denervation procedures combined with immunohistochemistry and retrograde tracing. The sympathetic nerve fibers of the upper part of the uterus arise from the ovarian plexus nerve. They mainly originate (90%) from neurons of the suprarenal ganglia (SRG) and of the T10 to L3 ganglia of the paravertebral sympathetic chain. Fluoro-Gold injections into different regions of the upper uterus showed that the SRG neurons mainly provide innervation to the tubal extremity (52%) rather than to the uterine portion below this area (26%). Very few neurons of the celiac ganglion or the aorticorenal ganglia participated in this innervation. Most of the sympathetic innervation of the lower uterus and the cervix (90%) originates from neurons of the paravertebral ganglia T13 to S2, principally at the L2-L4 levels. By using immunocytochemistry, we show that very few tyrosine hydroxylase-positive neurons of the pelvic plexus project to these areas, where they represent only 3% of the sympathetic nerve supply. Again, very few neurons of the inferior mesenteric ganglion (IMG) supply the lower uterus and the cervix. The comparison between retrograde tracing experiments in intact animals and after the removal of the IMG shows that very few sympathetic postganglionic axons from the paravertebral chain pass through the IMG to reach the lower uterus and the cervix. In contrast, these axons mainly project to splanchnic nerves bypassing the IMG to connect with the hypogastric nerves. In addition, some axons supplying the lower uterus follow the superior vesical arteries and then reach the organ. Taken together, these results show that the upper region of the uterus receives a sympathetic innervation that is different in origin and route from that of the lower uterus and the cervix. Such a marked region-specific innervation suggests that nerve control of the myometrial activity may be functionally different between the oviduct and the cervical ends of the uterus.

Animals↗
PubMed1976

[Adequate treatment of micro-invasive carcinoma of the uterine cervix (author's transl)].

At the University Department in Heidelberg 58 micro-invasive carcinomas of the uterine cervix were found between 1965 and 1974. 8 cases were diagnosed in other institutions by directed biopsies. Three cases were detected during the microscopic examination of uteri removed for emergency indications and three cases were detected after hysterectomy for cytological findings indicative of carcinoma in situ of the uterine cervix. In 44 cases an optimal conization of the cervix was carried out. Microscopic examination of these cases showed early stromal invasion in 33 cases. In 6 cases a newtork infiltration was found und in 5 cases a plump infiltration was found. The incidence of radical Wertheim operations of 21 in this group is explained by cases in this group who had inadequate diagnosis prior to admission. In 8 cases the indication for the Wertheim radical hysterectomy was a carcinomatous lymphangiosis in the conization specimen. In none of these cases metastatic tumor was found in the lymph nodes although 13 to 44 lymph nodes were examined per case. In accordance with the newer literature it is recommended to limit treatment of micro-invasive changes of the uterine cervix to routine hysterectomy or to optimal conization of the cervix if certain prerequisites are met. The results of the follow-up examinations of the reported cases appear to justify this recommendation.

Adult↗
PubMed1976

Microinvasive carcinoma of the uterine cervix: A long-term followup study of eighty cases.

One hundred and eleven patients with microinvasive carcinoma of the uterine cervix were studied over a 21-year period. Thirty-five cases of carcinoma in situ with questionable stromal invasion were excluded. Cases with pathologic examination of less than a cervical cone or the entire cervix were not accepted. The sole pathologic criterion for inclusion was unequivocal invasion to a depth of no more than 5.0 mm. Ninety-one patients were followed for 5 years or until death, and 80 patients for 10 years or until death. One patient was lost to follow-up at 5.5 years. The two deaths officially attributed to cervix cancer prior to 10 years were signed out by nonphysician assistant coroners. Available clinical evidence indicates that at least one of these patients, and probably both, did not die of cervix cancer. From these data, simple hysterectomy would seem to be the maximal treatment indicated. Since the prognosis of microinvasive carcinoma is similar to that of carcinoma in situ, it is suggested that such cases not be included when considering the end results of Stage I cervix cancer.

Adult↗