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A Study of Histopathological Spectrum of Lesions in Cervix Biopsies in a Tertiary Care Hospital

Introduction: Uterine cervix is prone to numerous infections, inflammations and malignancy. cervical cancer is the most common cancer in women which may be detected early with the aid of doing screening examination. Aim: This study was done to examine and analyze the histopathological lesions of cervix and to evaluate the frequency of these lesions, to understand the spectrum of various neoplastic and nonneoplastic cervical lesions and to study the incidence and frequency of various cervical lesions in different age groups so as to target them for various diagnoses, early detection and raising awareness. Study Design: Retrospective cross-sectional study. Place and Duration of Study: The study was conducted for a duration of 15 months from January 2019 to March 2020 retrospectively. Different types of pathological lesions in cervix were analyzed in the department of Pathology at Saveetha medical college. Methodology: This study consists of a total of 534 cases, Patients’ available clinical profile and the histopathologic diagnosis were noted from the registers and all cases of cervical biopsies over the above time period were included for this study. The diagnoses were then classified into nonneoplastic, pre-invasive and invasive lesions and statistical analysis was done using IBM SPSS statistical package version 23 and JASP statistical package version 0.13.1. Original Research Article Kerthi and Chander; JPRI, 33(64B): 47-53, 2021; Article no.JPRI.75838 48 Results: In this study, 534 cases are studied. The most common age group associated with the occurrence of cervical lesions were 41-50 years, among them the most common non-neoplastic lesion was chronic cervicitis and the most common malignant lesion observed was squamous cell carcinoma. Conclusion: In this study, non-neoplastic lesions were more common as compared to neoplastic lesions, adding to that chronic cervicitis being the most common. Histopathological examination and tissue biopsy help in the early detection and diagnosis of malignant and premalignant conditions. These prognostic measures could help the patients to have better treatment options and can at times reduce the fatality rate.


INTRODUCTION
The uterine cervix is bounded above by internal os and below by external os. The mucosa lining of cervix differs from body of the uterus by the absence of a submucosa [1]. Anatomically the cervix is differentiated into the ectocervix and the endocervical canal. The ectocervix is covered by a mature squamous epithelium. The endocervix is lined by columnar epithelium, mucus-secreting epithelium. In this squamocolumnar junction, the epithelium is variable and changes with age and hormonal influence. The "transformation zone" that is where squamous and columnar meets predispose to highly susceptible infections with HPV and neoplasms [2]. Thus, this acts as a "gateway" for various infections, cervical precursor lesions, which affects the cervix [3]. The cervical lesions are characterized as nonneoplastic, preinvasive and invasive neoplastic lesions [4]. Several Bacterial, viral, protozoan and fungi microorganisms cause infective forms of acute and chronic cervicitis. Recent studies indicate that chronic granulomatous cervicitis, though rare, is mostly caused by tuberculosis [5,6]. HPV cervicitis predisposes to pre-invasive cervical intraepithelial neoplasia (CIN I, II, III) and eventually to invasive cervical carcinoma [5,7]. The various measures towards a proper diagnosis of the patient involve categorization, recognition and familiarization of the cervical non-neoplastic lesions with their histomorphologic findings [5]. This type of cervical lesion is due to a reduction in immunity and hormonal replacement therapy [8]. Cervical cytology, histopathological and colposcopic examination are some of the diagnostic utilities used for cervical lesions [9].

MATERIAL AND METHODS
This study consists of a total of 534 cases, collected retrospectively from the department of Histopathology, Saveetha Medical College, Chennai over a period of 15 months from January 2019 to March 2020. Patients' available clinical profiles and the histopathologic diagnosis were noted from the registers and all cases of cervical biopsies over the above time period were included for this study. Scanty and autolyzed specimens were excluded from this study.
The diagnoses was then classified into nonneoplastic, pre-invasive and invasive lesions and statistical analysis was done using IBM SPSS statistical package version 23 and JASP statistical package version 0.13.1.

Results
This study included a total of 534 cases, with ages ranging from 21 years to 95 years with a mean of 46.1 years and SD of 11.888 which showed a normal distribution [ Fig. 1].

Distribution of non-neoplastic lesions
In our present study, the most common lesion was chronic cervicitis which was common in 41-50 years age group individuals, comprising a total of 491 cases (91.95%).      Cervical low-grade intraepithelial lesion (LSIL) was noted in 4 cases (0.75%), Cervical highgrade intraepithelial lesion (HSIL) was found in 3 cases (0.56%).

Fig. 1. Age distribution of cervix biopsy cases
Squamous cell carcinoma (SCC) was the most common malignancy noted in 12 cases and Adenocarcinoma in 2 cases. Among SCC, moderately differentiated SCC in 11 cases, poorly differentiated SCC in 1 case.
Benign neoplasm included a case of Chronic cervicitis with Leiomyomatous polyp. Adenocarcinoma was seen in 2 cases, and the most affected age group in this malignancy was 41-50 years (8 cases).

Discussion
This study was conducted to study the histopathological spectrum of lesions in cervical biopsies and to assess its frequency in our hospital. A total of 534 cases were included in this study. Among them, non-neoplastic lesions were found to be more common. Chronic cervicitis was the most common lesion observed in this study. The most common age group involved was 41-50 years and the least number of cases were involved in the 81-90 year age group.
In our study, the age-wise distribution of cases was concordant with the study done by Saravanan et al. [10] and Pandit GA et al. [12].
This study consisted of 534 cervical biopsies. The maximum numbers of cases were of nonneoplastic lesions-96.07%, this was concordant to the results of Jain et al and Kumari K et al in which non-neoplastic being the most 73% and 49.39% respectively. 14 cases were of invasive carcinoma comprising of Squamous cell carcinoma(13cases) and 2 cases of adenocarcinoma. Only 0.75% cases were LSIL, in which the normal epithelium could be brought back with treatment, 0.56% cases were diagnosed as HSIL.

CONCLUSION
The main objective of our study was to know the histopathological spectrum of cervical diseases and their frequency in our hospital. In our study, non-neoplastic lesions were more common as compared to neoplastic lesions, adding to that chronic cervicitis being the most common Histopathological examination, tissue biopsy helps in the early detection, diagnosis of malignant and premalignant conditions. These prognostic measures could help the patients to have better treatment options and can at times reduce the fatality rate.

DISCLAIMER
The products used for this research are commonly and predominantly use products in our area of research and country. There is absolutely no conflict of interest between the authors and producers of the products because we do not intend to use these products as an avenue for any litigation but for the advancement of knowledge. Also, the research was not funded by the producing company rather it was funded by the personal efforts of the authors.

CONSENT
It is not applicable.

ETHICAL APPROVAL
As per international standard or university standard written ethical approval has been collected and preserved by the author(s).