1. Normal cervix, cervical TZ and how to dissect a LLETZ
Dr Michael Coutts
Consultant Gynaecological Pathologist
West Kent Gynae Oncology Centre, Maidstone, UK
and Centre Hospitalier Universitaire, Nice, France

3. Simple hysterectomy

4. Normal cervix

5. Normal ectocervix (stratified squamous mucosa)

6. Normal cervix

7. Normal endocervix (simple glandular mucosa)

8. Normal cervix

9. The squamocolumnar junction

10. Physiological change in cervix

11. Physiological change in cervix

12. Reserve cell hyperplasia

13. Reserve cell hyperplasia

14. Immature squamous metaplasia

15. Immature squamous metaplasia

16. Residual endocervical cells overlying immature squamous metaplasia

17. Immature squamous metaplasia

18. Immature squamous metaplasia (non-glycogenated)

19. Mature squamous metaplasia in TZ

20. Examination of cervical punch biopsies
Colposcopically directed punch biopsies to enable histological diagnosis of suspect areas
Biopsies usually 2-4mm and may be on card
Record number, maximum dimension and colour
Biopsies >5mm may be bisected
Check the pot and under the lid for tissue
Wrap small fragments in filter paper/wire basket
Three levels stained with H & E as routine

21. Cervical loop biopsy (LLETZ)

22. Gross appearance of a loop biopsy

23. Slicing the loop or cone biopsy
Option one:
Radial method – incise at 12 o’clock, open out and cut clock face slices to map lesion around clock face
but needs fresh tissue and assessment of narrow end of wedge shaped block may be difficult

24. Slicing the loop or cone biopsy
Option two:
Transverse method – transversely slice across long axis of slit-shaped os
Good for fixed tissue and sections usually come out well. Difficult to map to clock face

25. Cervical loop in multiple pieces
An intact loop may be received with a second separate endocervical piece from the apex (‘top hat’). Treat both separately and label which blocks they are placed into.
Multiple separate irregular pieces may be received: measure each, trasversely slice and label which blocks they are placed into.
Process all of the tissue for each case.
Avoid placing more than one slice of a loop in each block.

26. Conclusions The location of the SCJ changes with age
It is important to recognise the histology of normal squamous metaplasia of the cervix
Colposcopic punch biopsies may be received to confirm a diagnosis of CIN, CGIN or cancer before definitive treatment
Loop or cone biopsies are performed as treatment for CIN or CGIN (and some small cancers) and the transverse slicing method is suggested, with processing of all tissue pieces