Inflammation Case Studies


CASE 7: Chronic cervicitis


Clinical History:

A 42-year-old woman underwent hysterectomy because of pelvic pain and irregular menstrual cycles associated with heavy menstrual bleeding. She also complained of an intermittent, whitish mucoid vaginal discharge between menstrual periods for several months.
  1. What is the gross appearance of the cervix?

    2. The epithelium is red (hyperemic) with dilated blood vessels.

  2. The section shows uterine cervix at the squamocolumnar junction. The ectocervix is lined by glycogen rich, non-keratinizing stratified squamous epithelium. The endocervical canal is lined by a layer of columnar mucinous epithelial cells. At the squamocolumnar junction, the mucinous epithelium exhibits focal squamous metaplasia. What do you see adjacent to this area in the fibromuscular stroma?

    3. There is a moderate chronic inflammatory cell infiltrate. This infiltrate consists of lymphocytes, plasma cells, macrophages, and a few neutrophils.

  3. Why is there metaplasia?

    4. The columnar epithelium has undergone squamous metaplasia in response to the chronic irritation. This process is reversible.

  4. What is the diagnosis?

    5. Chronic cervicitis. This inflammation led to the discharge noted by the patient. Etiologic agents could include: yeast (Candida), trichomonas, Gardnerella, chlamydia, or N. gonorrheae.