Cervical dysplasia of 1 degree

The pathological processes occurring in the cervical epithelium associated with the appearance of mutated cells in the tissue structure are called intraepithelial dysplasia. The mild form of such lesions of the flat epithelium in gynecology is defined as dysplasia of the cervix of the 1st degree.

This diagnosis is very common among women of different age groups.

Pathology refers to the XIV class of diseases - diseases of the genitourinary system (Diseases of the genitourinary system) and has a code for the ICD 10 - N87.0 (Dysplasia of cervix uteri grade I).

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Causes of the cervical dysplasia of 1 degree

The key causes of cervical dysplasia of the 1st degree are the types of HPV 16, 18, 31, 33, 35, 52 and 58. In addition, more than 15 types of papillomavirus are carcinogenic or conditionally oncogenic, that is, capable of causing cancer. In particular, 99% of squamous cell carcinoma of the cervix is associated with infection of HPV 16 and HPV 18.

Light dysplasia (cervical intraepithelial neoplasia grade I), like any other, develops due to the penetration into the body of the HPV virion and the introduction of its nucleocapsids into the multilayered flat epithelium lining the mucous membrane of the cervix. The virus does not fit the upper layer with the old cells, it tends to penetrate deeper into the parabasal layer, because it involves intensive proliferation and differentiation of cells, and where enough proteins are accumulated, which is what is needed for the virus to multiply.

Having introduced into the genome of the normal epithelial cell, the virus blocks its gene E7 with its E7 protein, which "answers" for the accumulation of proteins for cell division and, at the same time, regulates the excessive cell division (stopping the supply of proteins). And while E7 remains attached to Rb, the cell cycle will occur under conditions favorable for HPV.

The viral causes of cervical dysplasia of the 1st degree are aggravated by the fact that the HPV genes attack the human p53 cell protein, which controls their biological cycle and protects the cell DNA from damage (causing apoptosis of defective cells). By integrating their proteins into the genome of epithelial cells, the virus inactivates the protective functions of p53, and cells with damaged or altered DNA continue to live. This allows the virus not only to feel comfortable in the host's body, but also to successfully multiply, causing neoplasia - an abnormal growth of mutated cells. This complex process also means a diagnosis of cervical dysplasia of the 1st degree, in which pathology is localized in the upper third of the epithelial layer. Because of the abnormality of cells and their pathological proliferation, this condition of the cervical mucosa doctors are called precancerous.

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Risk factors

Of the factors contributing to the development of dysplasia, which are indicated by gynecologists, one can name unintelligible and unprotected sex, STDs, inflammatory processes in the genital organs and, of course, weakened immunity.

[6], [7], [8]

Pathogenesis

The pathogenesis of this lesion is attributed to the genital papillomavirus infection. Among almost two hundred known to date types of human papillomavirus (HPV), affecting the mucous membranes, skin and internal organs, the sexual way of transmission is more than four dozen types.

Changes in the cervical tissues caused by this virus can be considered as a symptom of HPV infection, that is, in fact - a gynecological infectious disease, and then classify it according to the ICD 10 can be B97.7 (papallomaviruses as the cause of other diseases).

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Symptoms of the cervical dysplasia of 1 degree

The life cycle of papallomavirus pertaining to persistent infections has its own peculiarities: its incubation period can last for years, and you may not even guess about its presence, since it does not manifest itself in any way.

Therefore, most cases of damage to the cervical mucosa HPV are subclinical, that is, do not cause any physical symptoms. So the first signs of cervical intraepithelial dysplasia of the patient can not feel. Although the pathological process in the epidermis of the cervix is, and a cytological analysis reveals a number of morphological changes in the form of an abnormal cell form, an increase in their nuclei and the appearance of large vacuoles in the cytoplasm.

Some symptoms of cervical dysplasia of the 1st degree of a woman can be noticed when the nature and intensity of vaginal discharge changes. As a rule, such a change (an admixture of bloody elements in the cervical mucus), accompanied by itching or burning, can be with additional bacterial infection of the vagina and cervical canal.

Whether there are complications at a dysplasia of a neck of a uterus of 1 degree? There are, and they are in the transition pathology in the next stage - dysplasia of the cervix of a moderate degree, in which neoplastic processes affect already half and more thickness of the flat epithelium.

But the consequences depend on the oncogenic potential of the papillomavirus: even with the subclinical nature of infection in 5-10% of infected with HPV 16 and HPV 18, there is a high risk of developing precancerous lesions of the vulva and cervix, which can progress to oncology.

By the way, at the same time there may be dysplasia of the cervix of the 1st degree and pregnancy, since the papallomavirus, which was before gestation, does not disappear anywhere. And, given the characteristics of the immunity of the female body during pregnancy, it can even become more active. An easy degree of pathology of treatment does not require, as it does not imply delivery by caesarean section.

[10], [11]

Diagnostics of the cervical dysplasia of 1 degree

The earlier the diagnosis of cervical dysplasia of the 1st degree was carried out, the better. Standard diagnostic methods for determining this pathology, in addition to the usual gynecological examination, include:

• PAP-smear test (pap smear) - cytological examination of the mucosa;
• HPV analysis (smear from cervical endoepithelium) - determination of papillomavirus and its serotype by polymerase chain reaction (PCR);
• scraping the tissue of the cervix and checking it for the DNA of the papilloma virus (Digene test).

Instrumental diagnostics for dysplasia is performed by the method of vaginal endoscopy (coloscopy) - examination of the cervix through the colposcope, which provides a 30-fold increase and a sufficiently clear visualization of normal and abnormal tissues. For more accurate detection of the localization of foci of dysplasia, an expanded colposcopy is performed (with samples with a weak solution of acetic acid and potassium iodide).

According to the results of the PAP-test, if there is a suspicion of oncology, a cervical biopsy (under the control of the colposcope) and a histological examination of the biopsy are assigned. This, in fact, is the differential diagnosis of intraepithelial dysplasia.

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Treatment of the cervical dysplasia of 1 degree

It should immediately be noted that there is no remedy for getting rid of the cause of cervical dysplasia.

In addition, according to clinical studies of this pathology, a mild degree of cervical neoplasia occurs in 70% of cases in one year without any therapy, and in two years - in 9 cases out of 10.

Therefore, treatment of dysplasia of the cervix of the 1 st degree consists in monitoring the condition of its epithelium, for which the patients should give a smear once a quarter or six months. Operative treatment of this degree of dysplasia, as a rule, does not apply. Only with unsatisfactory coloscopy parameters can an excision procedure of electric conization (conical removal of abnormal tissue) be assigned.

Gynecologists recommend taking vitamins C, beta-carotene, B2, B6, B9, E, as well as selenium (0.2 mg per day) and zinc (15-25 mg per day).

There are also immunomodulatory and antiviral pharmacological agents:

Vaginal suppositories of Viferon and Genferon;

• Novirin (Inosin pranobeksa, Isoprinosin) - two tablets three times a day for 2-4 weeks;
• Alloferon (Allokin-alpha) for subcutaneous injections against HPV.

Alternative treatment offers the use of turmeric (daily on a teaspoonful), tea with echinacea and infusion of hips (150-200 ml per day for 3-4 weeks), douching the vagina with an aqueous solution of propolis.

It is also used with herbs, for example, syringing with a decoction of a mixture of such medicinal plants as calendula (flowers), licorice (root), yarrow, sweet clover and labaznik (tavolga).

Probably, someone can help homeopathy: a preparation Beta-Mannan on the basis of an extract of an aloe; Thuja occidentalis (thuja western); DIM (Diindolymethane) is based on the metabolite indole-3-carbinol, a compound found in cruciferous vegetables (cabbage, broccoli, etc.). Naturopaths are advised to be treated with an extract of green tea epigallocatechin-3-gallate (EGCG), which inhibits the receptors of epidermal growth factor and inhibits the proliferation of abnormal cells in neoplasias.

Given the high level of spontaneous cessation of the pathological process, the prognosis of dysplasia of the cervix of the 1st degree is positive if HPV does not belong to oncogenic serotypes.

Prevention

Prevention consists of measures taken to minimize the possibility of infection with papillomavirus, that is, safe sexual relations with the use of a condom.

Smoking predisposes to the development of cervical abnormalities, since nicotine reduces the level of ascorbic acid, disrupting the pH balance of the epidermis. So quitting smoking is part of the prevention of dysplasia. An extremely important aspect of preventing cervical dysplasia of the 1st degree is the maintenance of a healthy immune system of the body.

[15], [16]