The Spectrum of Grossly Visible Pigmented Lesions in the Uterine Cervix

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.

Blue nevus presenting as an endocervical polyp

“…Surprisingly, however, the immunohistochemical features described in latest edi- tion of a gynecopathology textbook were different from our findings and previous reports; that is, this textbook stated that endocervical blue nevi are usually negative for HMB45 and MART-1 [10]. Certainly, two reports described that endocervical blue nevi were negative for HMB45 [8,9], but no report has stated MART-1 negative. We could not find the reason why the textbook explained that MART-1 was usually negative.…”

“…Histological findings were completely the same as previously reported, but immunohistochemical findings were in partial disagreement with those described in some previous publications [8,9,10]. We discuss possible reasons for this discordance.…”

Prevalence and Importance of Hemosiderin Pigments in Uterine Cervix Stroma

“…Nonmelanotic causes include vascular lesions, vasculitis, hemorrhagic cysts, and stromal hemosiderin-laden macrophages. 2 Studies focusing on the prevalence, histologic patterns, and significance of hemosiderin pigments in the stroma of uterine cervix are relatively scarce. 3,4 We conducted a retrospective study to investigate the prevalence of this phenomenon in cervical specimens and to highlight the practical diagnostic utility and clinical and pathologic importance, if any, of cervical stromal hemosiderin pigments.…”