Non-neoplastic diseases of the cervix in Nigerians: a histopathological study

Abstract

Background: Diseases of the cervix are common in young sexually active women. Non-neoplastic diseases are predominantly inflammatory and are common but there are a few publications on the subject compared to neoplastic diseases of the cervix.

Materials and methods: The surgical day books of the Histopathology department of the Obafemi Awolowo University Teaching Hospitals Complex Ile-Ife, Nigeria from the year 1990-1999 (Ten years) were studied for all cervical biopsies.

Results: Four hundred (400) cervical surgical biopsies were received during this period. 150 (37.5%) of the cases were non-neoplastic lesions. Age range was 20-69 years with peak incidence at 40-49 years. Histological distribution showed 123 cases (82%) were chronic non-specific cervicitis. Eighteen cases (12%) were chronic cervicitis with koilocytic change pathognomonic of Human Papilloma Virus (HPV) infection, two-third (12 cases) of which occur within 40-49 years. There were five cases (3.3%) of chronic granulomatous cervicitis, three cases (2.0%) of acute cervicitis and only one case (0.7%) of microglandular endocervical hyperplasia.

Conclusion: All the histological types were found within the peak age incidence of 40-49 years. Chronic non-specific cervicitis was the most common non-neoplastic cervical lesion and it occurs in all age groups of women studied. In 12% of patients it is associated with cytopathic effect of HPV. This has obvious implication for the occurrence of carcinoma of the cervix in our country. We recommend routine pap smear test in this group of patients especially, as a way of reducing the occurrence of carcinoma of the cervix.

Figure 1. Histological types according to age - groups

Keys: ACC - acute cervicitis, CNS - chronic non-specific cervicitis, SHPV - chronic non-specific cervicitis with sub-clinical HPV infection. GNC -granulomatous cervicitis, MEH-microglandular endocervical hyperplasia.

Fig. 2

Photomicrograph of the cervix showing chronic cervicitis with koilocytosis. Note the koilocytic change in the upper two-third of the epithelium and numerous mononuclear inflammatory cells in the stroma. H&E X144.

Fig 3

Photomicrogragh of the cervix showing granulomatous cervicitis. Note numerous granulomas with calcified schitosome ova (arrow heads) at the centre. The epithelium (not shown )is completely ulcerated. H&EX 58.