After the blood and mucus at the base of the tissue become adherent to the paper towel, the specimen and the paper towel are placed in buffered formalin and submitted to the laboratory accompanied by adequate demographic and clinical information. 6 After the tissue is obtained, the specimen should be placed on a piece of paper towel with the mucosal surface upward and the base of the tissue downward. Additionally, use of the hemostatic agent Monsel’s solution can cause dark brown discoloration of the tissue, also limiting morphologic interpretation, although an effective destaining technique has been described. Poor orientation with tangential sections not only precludes accurate interpretation of lesion grade or invasive extent, but also contributes to erroneous diagnoses. 5 Damage and denudation of the mucosa occur readily even with minor trauma to the cervix. Distortion and crush artifact usually result from the use of dull or small instruments. In cervical biopsy specimens, many factors lead to unsatisfactory specimens. The accuracy of histologic interpretation and diagnosis is strongly governed by the quality of tissue provided, as well as proper handling and processing of the specimen. Finally, recent updates in screening and prevention are discussed. The emphasis is on proper handling and reporting of surgical specimens, pathologic classification and criteria, and important pathologic parameters, all of which have an impact on the prognosis and management of the patient. This chapter deals primarily with cervical malignancies and precursors of squamous and glandular carcinoma. In particular, the use of immunohistochemistry has improved diagnostic accuracy. New techniques in diagnosis have helped to modify histologic classifications.
In addition to squamous and glandular neoplasms, neuroendocrine, mesenchymal, and metastatic tumors can also involve the cervix. The incidence of cervical adenocarcinoma, in contrast, has increased significantly, with a reported 22.5% increase in age-adjusted incidence between 19. Squamous cell carcinoma, which comprised more than 90% of primary cervical cancers before 1960, has decreased steadily in incidence, in large part owing to effective cytologic detection and subsequent eradication of its precursors. 3 Incidence and death rates of cervical cancer are particularly high in less developed countries, where it is the second most commonly diagnosed cancer and third leading cause of death in women based on 2012 data. 1 Worldwide, there were 527,600 new cases of cervical cancer and 265,700 cervical cancer-related deaths in 2012. 1 While the incidence of cervical cancer has been steadily decreasing in the United States, with an annual percentage change of –2.5% between 19, 2 the survival rate for cervical cancer has not improved substantially since 1975. In the United States, it is currently the third most common gynecologic cancer following those of the uterine corpus and ovary, with 12,900 new cases and 4100 deaths estimated to have occurred in 2015. In the past few decades, the epidemiology of cervical cancer has undergone some important changes.
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