Histopathological Evaluation of Cervical Lesions in Tertiary Based Hospital with Review of Literatures

Author(s):

Ozor NS, Ogbu CC, Enesi AS, Ike EG and Osonwa CN

Background: This is the first base line retrospective study to review morphology of different patterns of cervical lesions in Histopathology department, Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi since the institution of the hospital. Aims: This research is aimed at reviewing all cervical lesions in the department of Histopathology NAUTH, Nnewi. Methods: The pathology report forms in histopathology department were retrieved and relevant information such as age, histologic number, specimen sites, type of surgery, clinical and histological diagnosis were extracted. A total of 166 cases of cervical lesions were obtained within the 5-year study period of which 160 cases fulfilled inclusion criteria and therefore were analysed. The processed tissue and the slides stained with regular histochemical stain (Haematoxylin and eosin) technique in this study period were reviewed by the above researchers using multi-headed microscope (®CARL ZEISS). Cervical tumours seen were classified according to the World Health Organization (WHO) tumour book (edition 2020). Results: Of these 160 cases, 89 were malignant, 17 were benign tumours and tumour-like lesions, 34 were premalignant lesions while 20 cases were non-neoplastic lesions. The malignant cervical lesions were far more common & accounted for 55.6% of the entire cervical lesions, of which 83 cases (51.9%) were invasive Squamous Cell Carcinoma (SCC). The second commonest malignancy was adenocarcinomas with just 6 cases (3.75%). Among these invasive SCC, large cell non-keratinising variants predominate with 39 cases (24.4%) followed by large cell keratinising SCC with 34cases (21.3%) and 6 cases (3.8%) of small cell non-keratinizing SCC, while clear cell SCC were just 3 cases (1.88%). In premalignant lesions, High Grade Squamous Intraepithelial Lesions (HSIL) were commonest with 27 cases (16.9%) which included CIN2:15 cases (9.4%) and CIN3:12 cases (7.5%) making High Grade Squamous Intraepithelial Neoplasm (HSIL) far higher than Low Grade Intraepithelial Lesion (LSIL or CIN1) which were just 7 cases (4.4%). In benign-neoplastic lesions or tumour-like lesions; endometrial polyp were 7 cases (4.4%) making it the commonest benign lesion followed by benign epithelial lesion of which Squamous metaplasia and Nabothian cyst were 4 cases each (2.5%) while cervical Leiomyomatous polyp were 2 cases with a frequency of 1.25%. In non-neoplastic cases, all the lesions were inflammatory with chronic non-specific cervicitis being the commonest with 19 cases (11.9%) of which 12 cases occurred in UV-prolapse followed by one case of plasma cell granuloma (0.6%). The mean age of cervical cancer as observed by this index study was 57.76 ± SD 12.63 which correspond with the mean ages of high grade squamous intraepithelial neoplasm; CIN3 & CIN2 having 59.92 ± SD 11.74 and 60.20 ± SD 11.21 respectively. Conclusion: Invasive cervical SCC is quite common in our environment with an alarming rate of its premalignant lesion (HSIL). There is need for continuous cervical screening exercise among sexually active young females and the need for government to implement preventive measures such as HPV vaccine as routine immunization plan for every born Nigerian male and female to eliminate these premalignant lesions.