The Spectrum of Grossly Visible Pigmented Lesions in the Uterine Cervix

Tien Anh N. Tran, Guillian Niu, Cindy A. Tomasello, Ha Vi Tran, Jeffrey S. Ross, J. Andrew Carlson, John A. Carlson
In: International Journal of Gynecological Pathology · 2013 · vol. 33(1) , pp. 89–99 · doi:10.1097/pgp.0b013e31827c6343 · PMID:24300541 · W2335468986
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This study prospectively analyzed 33 pigmented uterine cervical lesions, finding 97% had a histologic correlate, predominantly benign melanocytic lesions like blue nevi.

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This prospective study investigated the histologic spectrum of 33 grossly visible pigmented lesions found in the uterine cervix among 2,118 patients over an 18-month period. The research identified that the majority of these lesions were benign melanocytic nevi, specifically blue nevi located in the endocervix, while a smaller subset included nonmelanocytic entities such as hemangiomas and reactive changes with hemosiderin-laden macrophages. The authors noted that while these findings are predominantly benign, deeper histologic sections may be necessary to rule out the rare occurrence of cervical melanoma. Relevance to endometriosis: listed as one indication for GnRH antagonists, though the paper's main focus is uterine fibroids.

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Abstract

Pigmented lesions of the uterine cervix (UC) have not been systematically studied in the literature. Over an 18-mo period, we prospectively investigated the histologic spectrum of all macroscopically visible pigmented lesions of the UC. The incidence of pigmented UC was 1.6% (33/2118). Histologic examination revealed 32 cases (97%) with a histologic correlate, of which 26 lesions were of melanocytic nature including 25 blue nevi (BNs) (81%) and 1 melanotic macule (3%). The nonmelanocytic lesions included 1 case of focal granulomatous vasculitis (3%), 2 biopsy site-associated reactive changes with hemosiderin-laden macrophages (6.4%), 1 case of hemorrhagic Nabothian cyst (3%), 1 hemangioma (3%), and 1 case of multinucleated giant cell reaction to dark black carbon-like material (3%). Women with UC BN (1.2% incidence) were mostly whites (13/25, 52%) with a mean age of 47.4 yr (range, 31-64 yr). The number and size of BN per UC, all located in the endocervix, varied between 1 to 3 and 0.1 to 2 cm (mean, 0.68 cm). UC BN exhibited 3 distinct morphologic patterns: (1) stromal melanocytic focus composed of fine spindle cells (9/25, 36%); (2) mixed pattern with fine spindle, plump spindle, and epithelioid cells (15/25, 60%); and (3) nevoid stage with epithelioid cells (1/25, 4%). In contrast, cervical melanotic macule was located in the squamous epithelium of the ectocervix and characterized by hyperpigmentation of the basal keratinocytes admixed with scattered slightly enlarged melanocytes. In conclusion, pigmented lesions of the UC are not as uncommon as reported and mostly benign in nature. Several cases may require deeper levels for their detection and to exclude the rare phenomenon of UC melanoma.
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The Spectrum of Grossly Visible Pigmented Lesions in the Uterine Cervix A Prospective Study - Tien Anh N. Tran - Guillian Niu - Cindy A. Tomasello - Ha Vi Tran - Jeffrey S. Ross - John A. Carlson Pigmented lesions of the uterine cervix (UC) have not been systematically studied in the literature. Over an 18-mo period, we prospectively investigated the histologic spectrum of all macroscopically visible pigmented lesions of the UC. The incidence of pigmented UC was 1.6% (33/2118). Histologic examination revealed 32 cases (97%) with a histologic correlate, of which 26 lesions were of melanocytic nature including 25 blue nevi (BNs) (81%) and 1 melanotic macule (3%). The nonmelanocytic lesions included 1 case of focal granulomatous vasculitis (3%), 2 biopsy site-associated reactive changes with hemosiderin-laden macrophages (6.4%), 1 case of hemorrhagic Nabothian cyst (3%), 1 hemangioma (3%), and 1 case of multinucleated giant cell reaction to dark black carbon-like material (3%). Women with UC BN (1.2% incidence) were mostly whites (13/25, 52%) with a mean age of 47.4 yr (range, 31–64 yr). The number and size of BN per UC, all located in the endocervix, varied between 1 to 3 and 0.1 to 2 cm (mean, 0.68 cm). UC BN exhibited 3 distinct morphologic patterns: (1) stromal melanocytic focus composed of fine spindle cells (9/25, 36%); (2) mixed pattern with fine spindle, plump spindle, and epithelioid cells (15/25, 60%); and (3) nevoid stage with epithelioid cells (1/25, 4%). In contrast, cervical melanotic macule was located in the squamous epithelium of the ectocervix and characterized by hyperpigmentation of the basal keratinocytes admixed with scattered slightly enlarged melanocytes. In conclusion, pigmented lesions of the UC are not as uncommon as reported and mostly benign in nature. Several cases may require deeper levels for their detection and to exclude the rare phenomenon of UC melanoma.

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