What is papillary epithelial metaplasia. Intestinal metaplasia: causes, symptoms and treatment methods. II. Precancerous conditions

Content

Cervical metaplasia often leads to the appearance of cancerous tumors. If diagnosis is delayed and there is no drug therapy, negative consequences are possible. The presented pathology in most cases develops in women over 45 years of age. But sometimes patients at a young age also turn to doctors.

With the progression of cervical metaplasia, there is a possibility of malignancy in the future, so it is important to identify the disease at the initial stage. That is why it is necessary to visit your doctor regularly for examination.

Causes

Main factor of progression cervical metaplasias are pathogenic bacteria.

In most cases, patients are diagnosed with papillomavirus, which can be transmitted to the female genital organs. As a result of such exposure, papillomas and condylomas of the cervix develop.

The infection can affect the cervix for a long time without obvious signs. After bacteria penetrate the body, they can cause the development of ureoplasma, gonococci and chlamydia. The latter penetrate the cells and remain in them for a long time.

The causes of cervical metaplasia are difficult to determine, but scientists have proven that the main factor is infection by the human papillomavirus. It plays an important role in the progression of changes in cell tissues.

Risk factors

Are common

These include bad habits, alcoholic beverages, unhealthy diet, poor environmental situation and consumption of carcinogenic products. During pathological changes in the body, activity and protective reactions decrease. Morphological and functional changes occur inside the body.

Local

This group of risk factors includes early onset of sexual activity, promiscuity, infectious and inflammatory diseases of the female genital organs, frequent mechanical abortions, disruption of normal hormonal levels and traumatic injuries.

Pathogenesis

Pathological changes are observed in patients of different ages, so when the first signs appear, it is important to immediately seek help from a doctor. The healthy epithelial layer of the cervix has the following structure:

• flat stratified non-keratinizing epithelium - it is located near the vaginal canal and is its continuation;
• intermediate zone - this layer is located near the cervix;
• columnar epithelium - it lines the entire cavity of the cervix and cervical canal.

If pathogenic bacteria do not affect the cervix, then all the layers do not mix with each other, and a clear boundary is clearly visible.

After penetration of the viral agent, a disease such as cervical metaplasia begins to develop. Pathogenic bacteria penetrate inside the cells and the integrity of the nuclear membranes is disrupted. They begin chaotic division and epithelial cells with nuclear atypia appear. It is for this reason that it is important to start treatment on time.

Affected cells will not be able to ensure normal protein synthesis within the body, so dysplastic processes develop. Due to such disorders, cervical metaplasia appears.

Symptoms

In most cases, metaplasia in the cervix occurs without obvious signs and symptoms. But every woman should know the common clinical manifestations in order to detect pathological changes in the body in time and begin treatment.

Cervical metaplasia means dangerous condition and the presence of morphological changes in the body.

For this reason, it is important for women to undergo regular screening. As cervical metaplasia progresses, sexual intercourse becomes painful and discomfort appears. This is due to the fact that the dysplastic epithelium begins to be injured and bleed. During menopause, the symptoms are less pronounced and women often confuse this disease with menopause, so they do not seek help from a doctor.

Metaplasia causes the appearance of condylomas, infectious diseases and cervical erosions. In women, discharge begins to increase, having a milky tint and a cheesy consistency. At the same time, a specific and characteristic odor appears.

Forms

There are several forms of cervical metaplasia:

• immature;
• squamous;
• squamous metaplasia in combination with dyskaryosis.

To make a correct diagnosis, it is necessary to take smears from the vagina. During diagnosis, specialists note the small size of the cells and blurred boundaries. Cells of the cytoplasm are distinguished by their disturbed structure and the presence of structural elements.

Diagnostic methods

Diagnose cervical metaplasia possible during a preventive examination with a gynecologist.

A biopsy is required to confirm the diagnosis and identify malignant lesions. Doctors carefully examine all histological types of tissue. If there are no signs of malignant transformation in the epithelial tissues, then doctors may not prescribe treatment.

Treatment is prescribed exclusively on an individual basis and after a comprehensive diagnosis. It is also important to take smears to assess the condition of the cells and their boundaries. Colposcopy may be required for additional examination. The doctor will thoroughly study the structure of the cervix using a special device that displays an image on a monitor screen. Thanks to this diagnostic method, the specialist will be able to examine in detail areas of metaplasia that cannot be seen during a routine preventive examination.

Treatment methods

After confirming the diagnosis, the doctor will prescribe treatment to prevent the development of cancer.

Therapy can be conservative or surgical, Therefore, it is assigned exclusively on an individual basis.

Conservative

Metaplasia of viral origin is treated with drugs that have an antiviral effect. The drugs suppress the activity of viruses and prevent them from multiplying.

If bacteria are present in the smear, it is advisable to prescribe treatment with antibacterial drugs. Patients take complex medications - these are antibiotic and antifungal agents. Squamous metaplasia is treated with vaginal anti-inflammatory suppositories and medications that increase immunity.

Operational

If drug treatment does not bring positive results, the doctor decides on surgical intervention. It includes laser vaporization, cone exposure, electrocoagulation and cervical curettage. The choice of treatment depends on the doctor’s testimony and the results of the diagnosis.

Metaplasia refers to serious diseases that develop in the cervix. This pathology requires treatment at the initial stage of development to prevent the appearance of a cancerous tumor. As a preventive measure, it is recommended to regularly visit a gynecologist for examination.

Metaplasia is a form of regeneration when its final product is new tissue, morphologically and functionally different from the original. Thus, metaplastic healing of the epithelial surface of the bronchial tree can result in the replacement of the ciliated epithelium with ordinary columnar or even stratified squamous keratinizing epithelium (Fig.

162, 163). The formation of a scar capsule around the focus of cheesy necrosis in the lung or in the lymph node often ends with the transformation of such a capsule into bone tissue with bone marrow. Metaplasia into bone tissue can occur in the wall of blood vessels, stroma of striated muscles, aponeuroses, ligamentous apparatus, and cartilage. Metaplasia of thyroid cartilage to bone is normal in men over 40 years of age.

Rice. 161. Lush growth of osteophytes at the site of an ununited femoral neck fracture with suppuration. A huge number of bone fragments are embedded among the osteophytes. 128 days after injury. Streaks. Exhaustion. Pyemia.

The range of metaplastic processes is especially wide under various pathological conditions. This indicates that the normally observed real potentials of tissue formative variability are only a part of these potentials (Fig. 164). In other words, using examples of metaplasia taken from the field of pathology, we are convinced of how much the “prospective potency” of tissues is wider and more diverse than their “prospective value” (Ru).

In principle, in its biological essence, metaplasia is one of the manifestations of tissue plasticity, their adaptation to certain living conditions. Under normal conditions, this plasticity, its volume, is limited by the hereditary properties of tissues, the conservatism of this heredity, which determines tissue determination; tissues retain and restore the specific features of their structure and function.

Rice. 162. Metaplasia of the bronchial epithelium in influenza. There is purulent exudate on top.

Rice. 163. Leukoplakia (prosoplasia) with keratinization of the bladder epithelium in chronic cystitis. Hyperemia, inflammatory infiltrate.

In pathological conditions, one or another degree of loosening of heredity is noted, due to which the principle of determination, determined, in particular, by the belonging of tissues to one or another germ layer, is, as it were, overlapped by the principle of plasticity; this is expressed in an expansion of the volume of formative potentials, including metaplasia.

The expansion of the range of tissue plasticity during metaplasia still has certain limits, which also emphasizes the relative importance of the principle of determination. Thus, the metaplastic processes of the epithelium are expressed in the transformation of one type of epithelium into another, but not in the transformation of the epithelium into mesenchyme derivatives (and vice versa).

Rice. 164. Proliferation of reticular cells of adipose bone marrow in a free-lying fragment of the femoral head on the 16th day after injury (resection). Absence of myeloid cells.

The founder of the doctrine of metaplasia, Virchow, extremely expanded the boundaries and scope of the morphological potential of tissues. In particular, he allowed the possibility of transformation of connective tissue cells into epithelial cells.

It should be noted, however, that even now the question of the possibility of the transition of some tissues into others, for example, epithelium into connective tissue and its derivatives, cannot be considered finally resolved. At the same time, it is difficult to admit that in higher mammals and humans such phenomena as the regeneration of nerves from epidermal cells, which is observed in worms, could occur.

In whatever direction metaplastic processes develop, they always occur on the basis of the functional unity of the cellular elements that make up a given organ. That is why, when speaking about metaplasia of the skin epithelium, we also mean some kind of participation in this metaplasia of the skin as a whole, i.e. and its connective tissue substrate.

Experimental practice makes it possible to verify how one tissue influences others with regard to their metaplasia. If, for example, a piece of the bladder or renal pelvis is transferred to the subcutaneous tissue or muscle, then bone tissue appears around the resulting epithelial cysts. If the renal pedicle of a rat or rabbit is bandaged, then in the surviving part of the pelvis around the growing epithelium the connective tissue undergoes ossification [Leriche and Lucinesco (E. Lucinesco, 1935)]. The ossifying effect of the bladder epithelium can be observed when it is introduced into the peritoneal cavity.

In some cases, metaplasia is associated with some pathological process, representing a unique outcome of reparative regeneration. These are the above examples with bone formation around a tuberculous focus, with regeneration of squamous epithelium in the bronchial tree in place of the former ciliated epithelium, etc. In other cases, metaplasia occurs in the process of purely physiological tissue restructuring, without being preceded by tissue loss. Myeloid metaplasia of the spleen, lymph nodes in infectious diseases, leukemia, transformation of normal thyroid cartilage into bone are examples of such restructuring.

In the first case, metaplasia is called n e p p yam or neoplastic. In the second case, the absence of any neoformative cellular processes is emphasized and we are talking, therefore, about the transformation of one tissue into another (Virchow).

A number of authors clarify the mechanisms of metaplasia as such, pointing, in particular, to the role of undifferentiated cells, for example, basal cells of the epidermis. According to Krompecher (1923), “true metaplasia is generally a problem of basal cells.” Most authors reject direct transformation, emphasizing the factor of new formation and replacement of one structure by another. It is not at all necessary that metaplasia be based on an inflammatory process or reparative regeneration.

No matter what basis metaplasia develops, it is always physiologically determined, having an adaptive significance. In some cases, adaptive factors are depicted as purely local, in others they are associated with functional changes of a general order, although such a distinction does not always look convincing. Healing of the cheesy lesion with the help of a capsule, which then turns into bone, is observed, as a rule, in childhood, i.e.

E. when the processes of bone formation are generally very active. The transformation of thyroid cartilage into bone tissue is associated with male gender, i.e. again not just a local phenomenon. The usual judgment about the local causes of metaplastic transformation of the epithelium at the site of erosion of the vaginal portion of the uterus (inflammation, irritation) also requires correction, since shifts in the integumentary epithelium of the uterus and vagina are closely related to ovulation cycles or their various disorders. All those physiological metaplastic transformations on the part of the ovaries, the integumentary and glandular epithelium of the Müllerian ducts, as well as on the side of the stroma of the uterine mucosa, which are observed during menstruation and pregnancy, also have a hormonal basis (see Fig. 94).

The dispute about the mechanism of epithelial metaplasia in communicating hollow organs has not been resolved. Thus, the appearance of intestinal glands in the stomach is also interpreted as an in situ transformation, i.e. true metaplasia, and as epithelial transplantation from the intestine, which is less likely.

Erosion of the vaginal portion of the cervix, covered by columnar epithelium forming the glands, may be the result of congenital extension of the cervical canal to the vaginal portion, i.e. a kind of structure shift. This would not be metaplasia (see below about heteroplasia). On the contrary, the transition of the cylindrical epithelium of erosion and erosive glands into multilayered squamous epithelium, i.e. the so-called prozoplasia will indicate metaplasia in situ.

Using the method of isolating the uterine horn, E. A. Popova showed that squamous metaplasia of the uterine epithelium is indeed not associated with a shift of the vaginal epithelium.

The so-called end o m e t p i o z, i.e. proliferation of tissue such as the uterine mucosa, observed in the pelvic organs, in skin scars after laparotomy, as well as outside the peritoneum, apparently is not metaplasia, i.e. transformation of the coelomic epithelium, and represents either implantation of the uterine epithelium during retrograde menstruation, or metastasis of cells of this epithelium with engraftment in a new place.

Extensive metaplastic processes on the part of the integumentary epithelium of the mucous membranes (respiratory tract, urinary, digestive tracts), cornea are observed with vitamin A deficiency. In this case, in place of the columnar or transitional epithelium, layers of flat keratinizing epithelium are formed, the surface of the mucous membranes becomes dry. This includes the phenomenon of xerophthalmia (literally “dry eye”) followed by keratomalacia, i.e. softening and ulceration of the cornea. Similar changes in the epithelium of the vocal cords lead to hoarseness.

Metaplastic processes in the nervous system have a limited range in the form, for example, of the transformation of neuroglial syncytium cells into separate cells such as amoebocytes, i.e. into gliocytes with phagocytic functions.

From the above materials it follows that metaplasia, being an adaptive phenomenon, reflecting the close connection of shape-forming processes with the physiological state of these tissues and a given organism, in clinical terms can receive different meanings, often unfavorable. We are talking here not only about changes in the secretory properties of a particular mucous membrane, its glands, or about changes in the physiological properties of tissues, their density, elasticity or transparency (osteoplastic processes, xerophthalmia, etc.), but about the predisposition of the corresponding organs of the body to autoinfection. It can be shown experimentally that changes in the usual ratios of ciliated and secretory epithelium in the bronchial tree, and even more so squamous metaplasia of this epithelium, entail a violation of the drainage function of the bronchi, i.e. insufficient secretion of bronchial secretions, dust particles, microorganisms 1. In this regard, there is a danger of developing pneumonia.

The unfavorable side of metaplasia is that, being a product of incomplete or atypical regeneration, metaplastic tissues can experience further transformations in the direction of neoplastic ones, i.e. tumor processes in the form of cancers and sarcomas. It can be assumed that the loosening of the heredity of cellular forms in these cases reaches very high degrees, which generally removes the factor of determination of growing tissues, simultaneously distorting the entire course of plastic ones, i.e. formative processes: metaplasia turns into anaplasia. It is no coincidence that the problem of tumor growth is so closely related to the problem of metaplasia, and metaplastic processes as such are described as precancerous conditions (see Chapter VIII).

One should distinguish from true metaplasia all those changes in cell shape that are associated with purely physical factors, for example, collapse or stretching of the mucous membrane, excretory duct, pulmonary alveoli, etc. In a collapsed lung, the alveolar epithelium often takes on a cubic shape. This is described as an example of "histological accommodation", but not as a functionally determined metaplasia.

Metaplasia does not include the so-called heteroplasia, i.e. tissue developmental defects. The displacement or creep of an alien epithelial layer, for example, the squamous epithelium of the outer ear into the cavity of the middle ear due to perforation of the eardrum, should not be called metaplasia.

Cervical metaplasia is one of the precancerous diseases, which has serious consequences in the absence of treatment or incorrect diagnostic and treatment tactics. This pathology is common in women after 50 years of age, although it happens earlier. But not all women have an idea of ​​what they are talking about if this diagnosis is established. Due to the fact that cervical metaplasia, with late diagnosis, tends to become one hundred percent malignant in the future, it is better to prevent this pathology at the stage of initial changes. For this purpose, all women undergo a screening examination for metaplasia at the stage of a routine daily examination by a gynecologist.

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ICD-10 code

N87 Cervical dysplasia

Causes of cervical metaplasia

Speaking about the development of cervical dysplasia, it is very important to highlight the main risk factors and etiological reasons for the development of this process.

Among the etiological factors, that is, the probable causes of the development of pathology, infectious agents come first. Possible pathogens include both viruses and bacteria. Among viral agents, this is most often the infection of a woman with the human papillomavirus. This virus has a tropism for the female genital organs and causes the development of another disease - condyloma or cervical papilloma. But the infection may not make itself felt for a long time, and its course may be asymptomatic, and in some cases, cervical dysplasia may develop. Other possible agents are herpes viruses of all types. These viruses also have a tropism for the epithelium of the cervix and a fairly high oncogenicity, so they can be a trigger for the development of dysplastic processes in the cell.

Bacteria are less likely to play a role in the development of this disease, since they do not penetrate the nuclear apparatus of the cell and do not induce changes in the genetic material. But among possible bacterial infections, only intracellular ones are of greater importance - these are ureoplasma, toxoplasma, chlamydia, and gonococci. These microorganisms penetrate into the cell and remain there for a very long time, while protecting themselves from immune cells and maintaining a chronic focus of inflammation. This is not the true cause of dysplasia, but against its background similar changes can develop, which will lead to further dysplasia.

The exact causes of cervical metaplasia are quite difficult to establish, but today, one of the proven etiological factors is infection with the human papillomavirus, which plays a key role in the further progression of changes inside the cell.

Risk factors

Risk factors can be divided into general and local. Common ones include bad habits, smoking, drinking alcohol, eating disorders and consumption of carcinogenic products, and the influence of environmental factors. All these changes are accompanied, first of all, by a decrease in the reactivity of the whole organism, and against this background, functional and then morphological changes in organs and systems develop.

Among the risk factors for the development of cervical dysplasia are local ones - early onset of sexual activity, frequent change of sexual partners, as well as infectious and inflammatory diseases of the female genital organs, frequent surgical interventions - abortions, hormonal imbalances, traumatic injuries.

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Pathogenesis

Speaking about the process of development of dysplastic processes, it is very difficult to identify the period when they develop and the duration of such changes. Since pathology can also occur in women under 40 years of age, it is important to be alert if metaplasia is suspected.

The structure of the cervix in a healthy woman is an alternation of epithelial cover:

• flat stratified non-keratinizing epithelium - located in the endocervix closer to the vaginal canal and is a continuation of it;
• intermediate zone - located further and is the border on the way to the cervix, both types of epithelium are absent here;
• columnar epithelium - lines the cavity of the cervix and the cervical canal.

Normally, these balls do not mix and there is a clear boundary between them.

The pathogenesis of the development of cervical metaplasia begins with a triggering factor, which can be a viral agent. In this case, the virus penetrates into the cell, where its nucleic acid enters the nucleus by disrupting the integrity of the nuclear membrane.

As a result, the genetic apparatus of a normal cell is disrupted and the virus initiates the synthesis of its own proteins, which it needs for life. This disrupts the normal life cycle of the epithelial cell and its processes of division and reproduction. This forms abnormal cell divisions, which contributes to the appearance of epithelial cells with nuclear atypia. That is, the process of cell division can stop at a certain phase of mitosis, and then the development of numerous cells with an incorrect set of chromosomes can be initiated. Such cells cannot ensure normal protein synthesis and metabolism in the cytoplasm, which is the reason for the appearance of dysplastic processes in the cell. Such cells multiply and can move from their main location - for example, the columnar epithelium extends beyond the intermediate zone and zones of columnar epithelium appear among the normal squamous epithelium of the endocervix, which is the phenomenon of metaplasia. This disruption of the normal structure of the epithelial cover does not reach the basement membrane.

Today, the definition of metaplasia or dysplasia is outdated, and a new term is used - CIN - cervical intraepithelial neoplasia. This concept allows us to clarify that this process is not so much dysplastic as precancerous.

Symptoms of cervical metaplasia

Considering that this pathology is often asymptomatic, it is necessary to know the main symptoms that allow you to pay attention and suspect this problem.

Cervical metaplasia is a dangerous condition precisely for the reason that often the morphological changes that develop far outstrip the development of at least minimal clinical symptoms. This is one of the reasons for introducing mandatory screening for this pathology.

Symptoms of cervical metaplasia can appear most often due to any provoking factor. This can be with concomitant condylomas, erosions, and infectious lesions. Less commonly, the clinical picture occurs without such conditions and is characterized by pain during sexual intercourse, disruption of the normal menstrual cycle, if there are hormonal imbalances, and vaginal discharge. Discharge can be in the form of leucorrhoea - curdled, thick, white or milky discharge with an unpleasant odor, as well as in the form of bloody discharge before, after menstruation or after sexual intercourse. Local pain with metaplasia is not typical if it is a purely dysplastic process.

The first signs that appear most often and are not specific, but should alert you, are painful sexual intercourse. Unpleasant sensations arise due to injury to the dysplastic epithelium, which can also be accompanied by bloody discharge. This does not happen very often, but may be one of the first manifestations. As for older women, the first symptoms of metaplasia may often not be expressed due to involutive processes in the uterus and cervix, which suggests perimenopausal changes. So, she explains the symptoms that appear in a woman as the beginning of menopause and does not consult a doctor.

Considering that clinical symptoms are not sufficiently pronounced, it is necessary to take any changes in health status very seriously, especially for older women.

Forms

Since the epithelium of the cervix has several types of cells, metaplasia can be different. The histological picture of changes in the smear is studied to make the correct diagnosis and choose treatment tactics. In this case, not only the degree of distribution of atypical cells is indicated, but also the nature of these changes and the morphological features of the smear.

There are several types of dysplasia:

1. immature metaplasia of the cervix;
2. squamous metaplasia of the cervix with dyskaryosis;
3. squamous metaplasia of the cervix.

Concerning immature metaplasia, then this is considered the most unfavorable option, since the lower the level of cell differentiation, the more the risk of malignancy increases. The picture of immature dysplasia is characterized by the appearance in the smear of cells that are small in size, have unclear, unequal boundaries, and are also randomly located in the smear itself. As for the internal structure of cells, the cytoplasm is changed with a violation of the location and structure of the structural elements of the cell. Various mitotic changes are observed in the nucleus. Sometimes it is difficult to attribute such cells to any type of epithelium, since they do not have characteristic distinctive features.

Squamous metaplasia of the cervix with dyskaryosis is a more differentiated species compared to immature forms. Such cells already have a certain shape, the same size and sufficient size. Inside the cell, the cytoplasm is not changed, and the structural elements are located correctly, in sufficient quantities, which characterizes the cytoplasm of a normal epithelial cell. The only differences from normal cells are abnormal divisions in the nucleus in the form of pathological mitoses. This is what characterizes the term “dyskaryosis”.

Squamous metaplasia of the cervix- This is the most differentiated option, since the epithelium has all the characteristics of normal cells, with the exception of location. Thus, with squamous metaplasia of the cervix, squamous stratified epithelium is determined behind the intermediate zone in the area of ​​the cervical canal among the cylindrical epithelium.

These histological types do not affect the course of the disease, but have a different prognosis, so this classification is mandatory in a cytological study.

Diagnosis of cervical metaplasia

Since the course of this pathology is often asymptomatic, an important element of timely diagnosis and prevention of complications are preventive examinations by a gynecologist, which a woman should undergo annually. During the examination, the doctor examines the woman’s cervix in the mirrors, which makes it possible to see changes that can be seen without additional methods. Several cells of the metaplastic epithelium are usually not visible among the normal surface, so a mandatory stage of the examination is taking a smear with a special brush for histological examination and detection of dysplasia.

The correct technology must be followed - a smear is taken from three zones of the cervix - the endocervix, the intermediate zone and the cervical canal, that is, all three types of epithelium must be present. This is where the objective examination ends. Next, all smears are sent to the laboratory for cytology and histology.

The tests that the doctor receives from the laboratory allow one to suspect dysplastic changes. There are six main types of smears:

1. histological picture of a healthy woman;
2. inflammatory and benign changes in the smear;
3. cervical intraepithelial neoplasia
   1. mild metaplasia (CIN-I) - altered dysplastic cells extend deeper into no more than one third of the epithelial cover;
   2. moderate metaplasia (CIN-II) - altered dysplastic cells extend deeper into no more than two-thirds;
   3. severe metaplasia (CIN-III) altered dysplastic cells extend deep into two-thirds or more, but without invasion of the basement membrane;
4. suspected cancer;
5. uninformative smear (not all types of epithelium are represented).

If a smear comes and the woman is healthy, everything is fine, but in all other cases, the woman is called for a second consultation and further examined.

If metaplasia is suspected, that is, if the smear is of the third type, then instrumental research methods are performed.

Differential diagnosis

Since metaplasia is often asymptomatic, the main diagnosis is histological verification, which allows an accurate diagnosis. But metaplasia should also be differentiated from other precancerous conditions and benign formations of the cervix: polyps or condylomas, erosions, leukoplakia without atypia, adenomatosis.

Polyps or condylomas of the cervix are benign neoplasms of viral etiology. The cause of the development of cervical polyps, as in some cases of metaplasia, is the human papillomavirus. This neoplasm is characterized, like metaplasia, by the proliferation and proliferation of cells. But with polyps, these formations are visible to the naked eye and rise above the surface of the epithelial cover. There are flat condylomas - similar to wart-like growths on the skin, and genital warts on a cauliflower-shaped stalk.

Cervical erosions during colposcopy have a characteristic appearance - this is a defect of the mucous membrane. There are also pseudo-erosions that occur in girls under 25 years of age, as a result of hormonal imbalance. In any case, they have a bright red color and slight swelling due to the inflammatory component.

Leukoplakia is the appearance of keratinizing epithelium in areas where it should not be. This is a form of dysplasia, but in this case, it is not intraepithelial neoplasia. These areas look like whitish islands among the epithelial cover. Histological examination allows one to establish the presence of cell atypia and accurately distinguish leukoplakia from neoplasia.

Considering all the possible changes in the epithelium of the cervix, the morphological study of the epithelial smear comes to the fore for an accurate diagnosis, which also allows for differential diagnosis with other precancerous diseases.

Treatment of cervical metaplasia

Treatment of cervical metaplasia is mandatory and must be carried out as early as possible and in a timely manner, since this is a precancerous disease and there is a high probability of malignancy. As for the treatment method, the choice depends on the degree of CIN and the type of smear. With the second type of smear, the woman is given etiological therapy and symptomatic anti-inflammatory therapy. With the third type of smear (CIN-I), when dysplastic cells occupy up to one third of the epithelial cover, treatment can be conservative using medications and local medications. If CIN-II, CIN-III or the fourth and fifth types of smear are determined, treatment is only surgical, since conservative treatment increases the risk of malignancy.

Conservative treatment of cervical metaplasia involves complex treatment using various directions.

The regimen for this disease is general, dietary recommendations are without any special features, a healthy diet is recommended. During the period of treatment it is necessary to refrain from sexual activity.

As for medications, to carry out etiological treatment it is necessary to determine the human papilloma virus, which is most often found in metaplasia, and use antiviral drugs. Today, there are two main drugs that are used to influence the virus - “Genferon” and “Panovir”. These drugs inhibit the activity of the virus by affecting the nucleic acid and disrupt the process of reproduction of viral particles.

If concomitant bacterial flora is detected in the smear, antibacterial therapy is mandatory. Preference is given to complex drugs that contain not only an antibiotic, but also a corticosteroid and an antifungal drug. Such complex drugs include “Neotrizol”, “Terzhinan”. Course doses are used with further additional research after treatment.

Symptomatic anti-inflammatory therapy is also carried out in the form of vaginal anti-inflammatory suppositories.

The treatment package also includes immunomodulatory drugs.

Surgical treatment of cervical epithelial dysplasia is carried out for CIN-II and CIN-III. This tactic is due to the fact that conservative treatment at this level is ineffective, and during this time malignancy is possible.

There are several methods of surgical treatment: laser vaporization, cone excision, scraping of the cervical canal, electrocoagulation.

Scraping the cervical canal is the most “rough” method and can be used if there are no technological capabilities of other treatment methods or there are concomitant conditions that require this method.

Cone excision is the cutting out of the cervical epithelium in the form of a cone, depending on the depth of the lesion. This method has its advantages, since the risk that any cells will remain deeper is minimal, since the area is cut out to the basement membrane or even deeper if necessary. But this method is more invasive and traumatic than others. After excision, the material is sent for histological examination and cell atypia can once again be excluded.

Electrocoagulation is the use of an electrical charge to create a high temperature that can coagulate protein and thus destroy dysplastic cells.

Laser vaporization works on the same principle as electrocoagulation, but it uses laser energy.

The choice of treatment method depends mainly on the technological capabilities of the hospital and does not prioritize one method over another. It is also necessary to focus on the volume of affected tissue and the depth of changes.

Traditional treatment of cervical metaplasia

People have many methods for treating this pathology, and they all have some justification. But it is necessary to remember that this disease is quite serious and requires the same approach to treatment, therefore alternative treatment can be carried out only for CIN-I and in combination with medications.

There are many recipes for treating cervical metaplasia with folk remedies. Basic methods:

1. Treatment with pine - you need to pour half a glass of pine buds with hot water, leave, and then boil for five minutes, after which you can douche with the warm solution twice a day. This treatment can be carried out for a long time until complete recovery.
2. The juice from nettle leaves must be squeezed into a glass, then soak a tampon in this juice and insert it into the vagina for a few minutes, repeat this procedure once a day for a month.
3. Aloe leaves, which have a pronounced anti-inflammatory and regenerating effect, are squeezed into a glass and, after wetting a tampon, inserted into the vagina, repeating the procedure once a day for a month.
4. Propolis - use propolis ointment, which is prepared by boiling ten grams of propolis in one hundred grams of olive oil, then cool and make vaginal tampons.

The treatment of cervical metaplasia with celandine deserves special attention. They use an infusion of celandine: half a glass of dry leaves of celandine is poured with a liter of boiling water and two teaspoons are taken orally twice a day.

You can also make an alcohol tincture and take 10 drops for ten days.

Douching can be done with a boiled solution.

Homeopathic medicines, which are used in the treatment of cervical metaplasia, act mainly on the possible etiological factor, and also stimulate epithelial regeneration and reduce inflammatory manifestations. These drugs include Allokin-alpha, vaginal suppositories “Papillokan” and “Immunovita”. The latter drug also has a local immunomodulatory effect.

Squamous (squamous) metaplasia is a term used to describe cellular, noncancerous changes in the epithelial lining of certain internal organs, such as the bladder, cervix, and lungs. Metaplasia occurs when persistent stress or irritation causes a reversible process in which differentiated epithelial cells of one type are converted into epithelial cells of another type. In squamous metaplasia, various epithelial cells are replaced as a result of the adaptation mechanism of squamous epithelium.

Changes in cell type can lead to decreased epithelial function. When abnormal stimuli are removed, the metaplastic cells return to their original form and function. The persistence of physiological stressors in areas susceptible to metaplasia can lead to dysplasia or.

Dysplastic cells, in the absence of timely elimination of the stressor or irritant, can transform into cancer cells.

The epithelium is made up of layers of different epithelial cells such as columnar, cuboidal and squamous cells. Columnar epithelial cells are elongated, cylinder-shaped cells that form the lining of the cervical canal (endocervix), intestines and stomach. Columnar cells whose nuclei are at different heights are called pseudostratified epithelial cells. Cuboidal epithelium is formed from cells resembling squares. Such cells are commonly found in exocrine glands and renal tubules. Flat epithelial cells, in turn, form smooth epithelium.

The process of development of squamous metaplasia and the resulting neoplastic cell changes can be clearly seen using the example of cervical metaplasia. The mucosa of the cervical canal, which is a cavity in the cervix, is usually formed by columnar epithelial cells. Estrogen and chronic exposure to acidic pH levels in the vagina provoke the process of squamous metaplasia, affecting the epithelium of the cervical canal. In response to irritating pH levels, fragile columnar epithelial cells begin to be replaced by stronger squamous cells.

Squamous metaplasia of the cervical canal also occurs as a result of fusion with the adjacent ectocervix.

Squamous cells of the ectocervix begin to fill the endocervix area, replacing columnar epithelial cells. When carcinogenic factors such as the presence of human papillomavirus act as irritants or stressors on metaplastic epithelial cells, cervical cancer is formed. A similar metaplastic process occurs when cigarette smoke persistently irritates the pseudostratified epithelial cells of the lung mucosa.

Cigarette smoke is a stressor that converts pseudostratified cells into much tougher squamous cells. However, even squamous cells, such as those in the bladder, can undergo squamous metaplastic changes. The bladder trigone, or inner triangular region, includes the squamous epithelial cells that form the lining of this area. When adult squamous cells of the bladder undergo chronic inflammation, metaplastic change occurs in these cells.

One of the most common female pathologies is squamous metaplasia of the cervix. Few people know what it is, therefore, upon hearing the diagnosis, many panic.

What is a disease

Squamous metaplasia of the cervix occurs in patients of climatic age, usually after 50 years. If squamous cell metaplasia of the cervix is ​​diagnosed, what is it and how can the pathology be explained to a woman in simple language? The disease is a precancerous condition. In the absence of proper treatment, an oncological malignant tumor develops. In general, metaplasia is a pathological process in which the glandular epithelium that normally covers the cervix is ​​replaced by flat epithelium.

To make it clear what is happening inside, it must be said that the internal organs of a woman, more precisely, the uterus and its appendages, have a clear alternation of epithelium:

• closer to the vaginal canal there is flat stratified epithelium;
• the intermediate zone between the cervix and the vaginal canal is characterized by a complete absence of epithelium;
• columnar epithelium lines the uterine cavity and the cervical canal.

Normally, these types of epithelium do not shift at all; there is a clear boundary between them.

Metaplasia often develops in places where there is erosion, infectious lesions, inflammatory processes and other chronic diseases. Metaplasia, which is complicated by keratinization of cells, is especially dangerous for women if it develops in the cervical canal and the glandular epithelium is replaced by cylindrical epithelium.

In such cases, treatment should be carried out immediately to avoid dysplasia and tumor formation. In the initial stages, there is no need to treat metaplasia; the doctor simply monitors the course of the disease. If there are changes for the worse, drug therapy is started.

Symptoms and causes of the disease

Before prescribing treatment, doctors must not only conduct a thorough diagnosis, but also establish the reasons that led to the pathological process. If you eliminate only the visible symptoms, the disease cannot be completely cured, and after some time, signs of metaplasia will appear again.

Among the most common provocateurs of the disease are genital warts and papillomas, which are caused by the human papillomavirus. The virus can lie dormant for a long time and, when activated, provoke growths on the internal organs of the woman’s reproductive system. If they are left unattended, they will soon degenerate into dysplasia and cancer. It should also be noted that the herpes virus can lead to inflammation of the cervical epithelium and its replacement.

Bacteria also play an important role in the appearance of metaplasia. Among them are:

• chlamydia;
• ureaplasma;
• gonococci;
• toxoplasma.

These bacteria penetrate the nuclei of epithelial cells and change their structure, causing dysplasia.

There is a certain risk group, which includes patients who:

• smoke;
• abuse alcohol;
• have chronic diseases of the genitourinary system;
• started having sex early;
• often change sexual partners;
• have undergone surgery on the genitals;
• had abortions;
• suffer from frequent miscarriages;
• have hormonal imbalances;
• were subjected to dramatization of the organs of the genitourinary system.

The pathology itself is not accompanied by any visible symptoms, but there are a number of signs that should alert a woman and cause her to see a doctor.

Some of these warning signs include:

• pain during sexual intercourse and bleeding;
• heavy bleeding during menstruation;
• menstrual irregularities;
• atypical vaginal discharge;
• rotten smell from the genitals;
• hormonal disorders;
• lower abdominal pain;
• general weakness and decreased performance;
• loss of appetite;
• sleep disorders;
• itching in the genital area;
• frequent urination and pain.

The first signs, as a rule, affect sexual intimacy - with active movements, the partner’s penis irritates the epithelial cells that are involved in the pathological process. There is discomfort during sexual intercourse, mild pain and blood.

Women during menopause need to be especially careful about their health. It must be said that a number of the above symptoms in women of climatic age can provoke natural changes in the body, and not bacteria and viral infections.

Diagnosis and principles of treatment of metaplasia

Taking into account the fact that in most cases the disease occurs without symptoms, diagnosis plays a huge role in the effectiveness of treatment. Every adult woman should understand the advisability of preventive examinations with a doctor. Only with a visual examination using mirrors will the doctor be able to see changes in the normal state of the epithelium on the cervix. After this, a smear is taken with a special brush and a histological examination is performed. The smear should be taken from three zones of the cervix, that is, from the endocervix, the intermediate zone and the cervical canal itself. Each smear should contain different epithelial samples.

If a pathological process occurs, the woman is referred for simple and extended colposcopy. This diagnostic method differs from examination with mirrors in that the colposcope magnifies the image 23 times. If the examination was unproductive, curettage from the cervix may be performed. Sometimes diagnostics are carried out for the presence of TORCH infections and papillomavirus by taking blood from a vein for PCR.

Based on the results of the examination and tests, treatment begins.

Throughout the course of therapy, a woman must completely abstain from sexual intercourse, since treatment will be carried out with antibacterial drugs and other agents that, if pregnant, can cause fetal pathologies.

The attending physician will select medications on an individual basis. The first group of drugs that will be used to eliminate the pathology are antiviral in nature; Genfron and Panavir are most often used. The second group of drugs that are used for complex treatment are antibiotics. They are used if there is a suspicion of chlamydia, ureaplasma or toxoplasma. The drugs Neotrizol and Terzhinan have a good effect.

Metaplasia can also be treated by using local anti-inflammatory suppositories. It is also recommended to eat the right foods, which contain a huge amount of vitamins.

Surgery

In case of advanced disease, surgical intervention is performed. There are several methods of performing the operation:

• laser vaporization;
• cone excision;
• scraping the cervical canal;
• electrocoagulation.

The roughest method is considered to be scraping out the cervical canal; it was the very first used to treat metaplasia; it is used if there is no appropriate equipment within the clinic.

Cone excision is an operation during which the epithelium is removed in the form of a cone. The advantage of the method is the minimal risk of re-formation of metaplasia. After the operation, the biomaterial is sent for histological examination to determine the presence of atypical cells that can cause cancer.

Electrocoagulation is the application of electric current to the affected area, during which the charge can coagulate protein and destroy dysplastic cells. Laser coagulation is the newest treatment method and the most gentle. Already half an hour after the operation, the woman can go home.

After surgery, doctors recommend douching with medicinal herbs, pine buds and propolis. This will speed up the regeneration of normal epithelial cells and, accordingly, will restore the woman’s body faster.

The choice of treatment method is a purely individual process, which is determined taking into account many factors. In general, the prognosis for a complete cure is quite high; the main thing is to seek help in a timely manner and follow all the doctor’s recommendations.

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