Mild cervical dysplasia

Light dysplasia of the cervix is the most common cause of development of oncopathology, which can be diagnosed at early stages due to screening of this pathology. To date, the pathology of the cervix is the first among the most common diseases of the reproductive system of women. Cervical dysplasia is a precancerous disease that requires early diagnosis and adequate, correct and timely treatment. Therefore, it is necessary to know the main clinical manifestations and complications of this pathology, because the first degree of cervical metaplasia has a good prognosis in case of timely diagnosis.

[1], [2]

Causes of the mild cervical dysplasia

Light dysplasia of the cervix develops gradually under the influence of certain factors, but it is very important to identify the main risk factors and the etiological causes of the development of this process. Risk factors can be divided into general and local. Common include bad habits, smoking, drinking alcohol, eating disorders and the use of carcinogenic products, the influence of environmental factors. All these changes are accompanied primarily by a decrease in the reactivity of the whole organism, and against this background, functional and then morphological changes in organs and systems develop. At the same time, all conditions are created for the development of mild dysplasia first, and then the second and third degree of metaplasia. Among the local risk factors for the formation of mild cervical dysplasia, cervical cancer is characterized by untimely onset of sexual activity, violation of the rules of sexual hygiene with frequent changes in partners, as well as infectious and inflammatory diseases of the internal sexual organs of the woman, frequent surgical interventions such as abortions, hormonal disorders, traumatic injuries.

Among the etiological factors, infection control agents are in the first place. Among the possible pathogens can be both viruses and bacteria. Among the viral agents - it is most often the infection of a woman with human papillomavirus. This virus has a tropism for the female genital organs and causes the development of another disease - condyloma or cervical papilloma. But the infection can not be felt for a long time, and its course can be asymptomatic, and in some cases dysplasia of the cervix can develop. Other possible agents are herpes viruses of all types. These viruses also have a tropism for the epithelium of the cervix and a sufficiently high oncogeneity, so they can be a trigger mechanism for the development of dysplastic processes in the cell. There are different strains of these viruses, and each strain has its degree of ocogenicity, which determines the possibility of malignancy of mild dysplasia in the future.

Bacteria less often play a role in the development of this disease, because they do not penetrate into the nuclear apparatus of the cell and do not induce changes in genetic material. But among the possible bacterial infections, only intracellular ones are of more importance - they are ureaplasma, toxoplasma, chlamydia, gonococcus. These microorganisms penetrate the cell and remain there for a very long time, while protecting themselves from immune cells and supporting a chronic inflammation focus. This is not the true cause of dysplasia, but similar changes can develop on its background, which will lead to dysplasia in the future. It also reduces local immune defense mechanisms and further contributes to the disruption of metabolism in the cell.

Causes of metaplasia of the cervix are definitely difficult to establish, but to date, one of the proven etiological factors is infection with the human papillomavirus, which plays a key role in the further progression of changes within the cell. Therefore, this condition must be treated and the diagnosis of mild dysplasia is associated with papillomavirus, which is often confirmed by additional methods, that is, this viral agent can be considered a priority cause of the development of mild cervical dysplasia.

With regard to the pathogenesis of mild dysplasia, it is necessary to know some normal anatomical features of the structure of the cervix to know when to talk about dysplasia. The histological structure of the cervix in a healthy woman is an alternation of epithelial cells:

• flat multilayer non-coring epithelium - located in the endocervix closer to the vaginal canal and is a continuation of it;
• the intermediate zone is located farther and is the border on the way to the cervix, both types of epithelium are absent here;
• Cylindrical epithelium - lining the cavity of the cervix and the cervical canal.

Normally, these balls do not mix and there is a clear boundary between them. With mild dysplasia, there is a disruption of the normal anatomical structure and alternation of these zones, in which the epithelium of one zone can move to another, for example, the cylindrical epithelium is located among cells of the flat epithelium. This occurs when a certain etiological factor disrupts the normal life cycle of the cell, the process of its normal division is disrupted, and abnormal cells appear in numerical numbers in the area where they should not normally exist. The genetic apparatus of the cell is disrupted in such a way that atypy of cells is formed, that is, the process of cell division can stop at a certain phase of mitosis, and then the development of numerical cells with an incorrect set of chromosomes can be initiated. Such cells can not provide a normal metabolism in the cytoplasm, which is the cause of dysplasia. Such changes pose a particular danger in terms of the fact that these cells already carry a potential threat due to a violation of their normal division and at any time may be their uncontrolled reproduction. In this case, the process of dysplasia, which does not reach the basal cell of the cell, is observed, but is only one third of the epithelial cover of the cervix.

Since the epithelium of the cervix has several types of cells, the dysplasia may be different. This concerns the degree of maturity of cells and their morphological features. There are several types of dysplasia:

1. immature metaplasia of the cervix;
2. squamous metaplasia of the cervix with dyskaryosis;
3. squamous cell metaplasia of the cervix.

The higher the degree of differentiation of cells, the lower the likelihood of malignancy.

Such pathogenetic features of the course of the process allow to determine the tactics of treatment, since it is necessary to eliminate this process even before the onset of progression of atypical changes.

[3], [4]

Symptoms of the mild cervical dysplasia

Cervical dysplasia is one of the diseases of the female reproductive system, which is characterized by the fact that often the morphological changes that develop are much faster than the development of at least minimal clinical symptoms. In this case, it is mild dysplasia of the cervix, as an initial process, has an asymptomatic course. This requires as much attention as possible for timely diagnosis.

Symptoms of mild metaplasia of the cervix can be manifested most often with some provoking factor. It can be with accompanying condylomata, erosions, infectious lesions, as well as during pregnancy or its planning. Rarely, the clinical picture occurs without such conditions and is characterized by soreness in sexual intercourse, a violation of the normal menstrual cycle, if there are hormonal failures, secretions from the vagina. Excretions can be in the form of whites - curdled, plentiful, white or milky discharge with an unpleasant odor, and also in the form of bloody discharge before menstruation, after or after sexual intercourse. Local pain with metaplasia is not characteristic if it is purely a dysplastic process. Violations of menstruation with mild cervical dysplasia may occur with concomitant hormonal pathologies, cysts, which is often the case with dysplasia. Therefore, in this case, dysplasia can be diagnosed accidentally.

The first signs that appear most often and are not specific, but should alert - this is a painful sexual act. Unpleasant sensations arise due to trauma to the dysplastic epithelium, which can also be accompanied by bloody discharge. These discharges are contact and appear only after a provoking factor. This does not happen so often, but it can be one of the first manifestations. As for older women, their first symptoms of mild dysplasia may often not be expressed due to involuntary processes in the uterus and cervix, suggesting premenopausal changes. So the symptoms that appear in a woman, she explains by the beginning of menopause and does not address the doctor. Sometimes mild dysplasia of the cervix in women of reproductive age can be asymptomatic and when planning pregnancy can be an accidental finding, then there is the opportunity to successfully treat this condition. If mild dysplasia before pregnancy is not diagnosed, then in the future such a condition does not have clinical symptoms until the moment of delivery, then the first signs can appear. This can be traumatic damage at the site of dysplasia, ruptures of the cervix, bleeding, the development of concomitant pathologies in the form of infection and the formation of genital warts and papillomas.

Sometimes the only clinical sign of mild cervical dysplasia may be the impossibility of a normal gestation with a tendency to "habitual" miscarriages.

Given the fact that mild dysplasia of the cervix in 90% of cases has an asymptomatic course, this condition should be diagnosed on time by screening the women. This reduces the percentage of possible malignancy of dysplasia.

Diagnostics of the mild cervical dysplasia

Light dysplasia of the cervix is the initial stage of further changes and aggravation of the process, so it should be diagnosed as early as possible. Since the course of this pathology is often asymptomatic, an important element in the timely diagnosis and prevention of complications are preventive examinations at the gynecologist, which the woman must undergo annually. When examined, the doctor examines the cervix of the woman in the mirrors, which makes it possible to see changes that can be seen without additional methods. Several cells of metaplastic epithelium among the normal cover, as a rule, can not be seen, therefore the obligatory stage of the examination is taking a smear with a special brush for histological examination and detection of dysplasia. This screening method of examination, which is conducted for all women precisely for timely diagnosis. Moreover, in addition to the smear for cytology, one more smear is taken for the pathological flora, which helps to identify additional accompanying infectious lesions of the cervix or to identify a possible causative agent. A smear on the flora is taken from the posterior vaginal fornix, and the smear on the cytology is directly from the cervix. Be sure to observe the right technology - a swab is taken from three zones of the cervix - endocervix, intermediate zone and cervical canal, that is, all three types of epithelium should be present. This ends the objective examination. Then all the smears are sent to the laboratory for cytology and histology.

Analyzes, which the doctor receives from the laboratory, allow one to suspect dysplastic changes. There are six basic types of smears:

1. histological picture of a healthy woman;
2. inflammatory and benign changes in the smear;
3. cervical intraepithelial neoplasia

• mild metaplasia (CIN-I) - altered dysplastic cells extend deep into not more than one-third of the epithelial cover;
• Moderate metaplasia (CIN-ІІ) - altered dysplastic cells extend deeper into not more than two-thirds;
• severe metaplasia (CIN-III), altered dysplastic cells extend inward by two-thirds or more, but without invasion of the basal membrane;

1. suspected cancer;
2. cancer;
3. a non-informative smear (not all types of epithelium are represented).

The result of mild dysplasia or CIN-I is an occasion in which a woman is necessarily called for a second examination and carries out additional instrumental methods to confirm the diagnosis and determine the tactics of treatment.

Colposcopy is the diagnosis of various pathological conditions of the cervix by a special device that has a magnifying power of 2 to 32 times, depending on the power. This increase allows you to see those areas of metaplasia, which are not determined by routine examination in the mirrors. In addition to simple colposcopy, an expanded colposcopy is also performed. In this case, the site of the examined epithelium of the cervix is colored with trichloroacetic acid, iodine or Lugol solution, and look at the degree of coloration. The sites of metaplastic epithelium will be pale against a normally colored epithelium. Such a diagnosis can confirm the presence of metaplasia, even if visually nothing can be found. Often to confirm the degree of change, colposcopy with a repeated biopsy is performed. In this case, repeated histological examination allows to determine the morphological features of the punctate and to determine the prognosis and treatment tactics.

Immature mild dysplasia is characterized by the appearance in the smear of cells that are small in size, fuzzy unequal boundaries, and also placed chaotically in the smear itself. As for the internal structure of the cells, the cytoplasm has been altered in violation of the arrangement and structure of the structural elements of the cell. There are various changes in mitosis in the nucleus. Sometimes it is difficult to attribute such cells to any kind of epithelium, since they do not have characteristic distinctive features. This kind of metaplasia requires immediate surgical treatment.

Squamous cell metaplasia of the cervix with dyskaryosis is a more differentiated species, compared with immature forms. Such cells already have a certain shape, the same size and sufficient size. Within the cell, the cytoplasm is not altered, and the structural elements are located correctly, in sufficient quantity, which characterizes the cytoplasm of the normal epithelial cell.

Squamous cell metaplasia of the cervix is the most differentiated option, since the epithelium has all the characteristics of normal cells, except for the location. Thus, in squamous cell metaplasia of the cervix, the flat multilayered epithelium is determined beyond the intermediate zone in the region of the cervical canal among the cylindrical epithelium. These types of mild dysplasia are necessarily determined in the cytological examination of the smear.

[5], [6], [7], [8]

Differential diagnosis

Light dysplasia of the cervix should be differentiated with other precancerous conditions and benign cervical structures: polyps or condylomata, with adenomatosis, with leukoplakia without atypia, with erosions.

Cervical polyps are benign neoplasms of viral etiology. The cause of the development of cervical polyps, as in some cases and metaplasia, is the human papillomavirus. This neoplasm is characterized, as well as metaplasia, by the multiplication and proliferation of cells. But with polyps these formations are visible to the naked eye and rise above the surface of the epithelial cover. With mild dysplasia, such changes are not determined visually, but histologically have a different type of structure.

Leukoplakia is the appearance of the horny epithelium in those areas where it should not be. This is a form of dysplasia, but in this case, it is not intraepithelial neoplasia. These areas look like whitish islets among the epithelial cover. Establish the presence of atypia cells and accurately distinguish leukoplakia from neoplasia allows a histological examination.

Cervical erosions in colposcopy have a characteristic appearance - a defect in the mucous membrane. Also distinguish pseudo-erosions, which are in girls under 25 years, as a consequence of a violation of the hormonal background. In any case, they have a bright red color, a small swelling due to an inflammatory component. Such a defect is seen on the mucous membrane of the cervix, and in case of mild dysplasia, the result of histological examination is decisive.

Thus, the main and more informative method of diagnosis and differential diagnosis of mild dysplasia of the cervix is a histological examination, which for the purpose of early diagnosis of pathology is performed by all women.

Treatment of the mild cervical dysplasia

Treatment of mild cervical dysplasia is mandatory, because of possible serious complications. At the same time, conservative and operative treatment is distinguished, which depends on the degree of dysplasia and on the nature of the histological smear.

In the second type of smear, a woman is given an etiological therapy, symptomatic anti-inflammatory therapy. In the third type of stroke (CIN-I), when dysplastic cells occupy up to one-third of the epithelial cover, treatment can be conservative with the use of medications and local medications. Sometimes mild dysplasia can be treated promptly, for which there are special indications.

Conservative treatment of mild cervical dysplasia includes:

1. The regime with this disease is common, dietary recommendations are without special characteristics, healthy food is recommended.
2. For the period of treatment it is necessary to keep from sexual activity.
3. Use of medication.

As for medicines, for carrying out etiological treatment it is necessary to determine the human papillomavirus, which is most often metaplasia, and to use antiviral drugs. To date, there are two main drugs that are used to influence the virus - "Genferon" and "Panovir". These drugs inhibit the activity of the virus by affecting the nucleic acid and disrupt the process of reproduction of viral particles.

In the case of the definition of a concomitant bacterial flora in the smear - antibiotic therapy is mandatory. Preference is given to complex preparations that have in their composition not only an antibiotic, but a corticosteroid, and an antifungal drug. It is necessary to carry out parallel systemic therapy with an antibiotic. From antibiotics preference is given to preparations of a wide spectrum of cephalosporin series.

Cefepime is a beta-lactam antibiotic from the 4 th generation group of cephalosporins, which has a pronounced bactericidal effect on gram-positive and gram-negative microorganisms. The drug is used in a dose of 1 gram per day, is administered intramuscularly or intravenously at intervals of 12 hours. The course of treatment is 7-10 days.

Contraindications to prescription are allergic reactions to penicillins or other beta-lactam antibiotics. There was no adverse effect on the fetus during pregnancy. Side effects are possible on the part of the gastrointestinal tract, allergic manifestations, reactions of the nervous system in the form of headache, drowsiness, dizziness.

It is also necessary to use local therapy, especially before planning an operation or in detecting a pathology that is concomitant with dysplasia. In this case, the chances of complete recovery of dysplasia are increased. I use anti-inflammatory suppositories that have anti-inflammatory, anti-edematous, antimicrobial effect against the microflora of the vagina.

Such a complex treatment allows curing mild dysplasia and modifying risk factors to avoid this in the future.

Operative treatment of metaplasia of the epithelium of the cervix is carried out with CIN-II and CIN-III. In the case of mild dysplasia, operative treatment is not used as starting therapy, but there are special cases when this is not adhered to. In this case, there are special indications: if mild dysplasia is characterized by the presence of immature cells, then it is necessary to conduct surgical treatment, as this ensures the complete disappearance of dysplastic sites. This tactic is due to the fact that conservative treatment with a low level of differentiation is ineffective, and during this time, malignancy is possible.

There are several methods of surgical treatment: laser vaporization, cone excision, scraping of the cervical canal, electrocoagulation. With a mild degree of dysplasia, more minimally invasive methods are used, which are less traumatic.

Cone excision is the excision of the cervical epithelium in the form of a cone, depending on the depth of the lesion. This method has its advantages, since the risk that any cells will remain deeper is minimal, since the site is cut to the basement membrane or even deeper if necessary. But this method is more invasive and traumatic than the rest. After excision the material is sent for histological examination and it is possible to exclude atypical cells again.

Electrocoagulation is the use of an electric charge to create a high temperature that is able to coagulate a protein and thus destroy dysplastic cells.

Laser vaporization works on the same principle as electrocoagulation, but laser energy is used here. This is an electrosurgical method of treatment, which consists in the directed action of the laser beam on the pathological focus of cells, and under the influence of this beam, the mechanical energy is converted into thermal energy and heats the cells strongly. As a result of this process, evaporation of pathological cells occurs - vaporization.

Scraping of the cervical canal is the most "crude" method and can be used if there are no technological possibilities of other methods of treatment or there are concomitant conditions requiring such a method. With mild dysplasia, this method is not justified.

In the treatment of mild cervical dysplasia, conservative treatment is first performed, and only then, if it is ineffective, is prompt. But there are indications in which surgical intervention is carried out in the first place.

Alternative treatment of mild cervical dysplasia

Alternative treatment for mild dysplasia is carried out in parallel with drug treatment. Herbal medicine and alternative methods, as well as homeopathic methods, are used.

1. Treatment with celandine helps to heal the defect because of the pronounced anti-inflammatory and healing properties of this plant. Use infusion celandine: half a glass of dry leaves celandine pour a liter of boiling water and take inside two teaspoons twice a day. You can also make an alcoholic tincture and take 10 drops for ten days.
2. The juice from the leaves of the nettle should be squeezed into a glass, then soak a tampon in this juice and enter into the vagina for a few minutes, this procedure should be repeated throughout the month once a day.
3. Widely used infusions of herbs. Prepare a herb collection of leaves of mint, raspberries and currants - take them in equal quantities, pour hot water and boil for another 5 minutes, after which they cool and drink half the glass in a warm day every other day for a month.
4. Treatment of pine - need half a glass of pine buds pour hot water, insist, and then boil for five minutes, after which a warm solution can be syringed twice a day. Such treatment can be done for a long time until complete recovery.
5. Juice of a burdock perfectly removes irritation, edema and has an antiproliferative effect, which reduces the growth and reproduction rates of abnormal dysplastic cells. To do this, from the burdock leaves pre-washed, it is necessary to squeeze out the juice and take five days for one teaspoon three times a day, and then one teaspoon twice a day for five more days.
6. Cones of hops, valerian, lime, coriander, motherwort and oregano must be filled with a liter of hot water and after being infused, drink in the morning and in the evening 2 teaspoons. This treatment with herbs has a pronounced anti-inflammatory effect and promotes wound healing after surgical treatment, so you can recommend this herbal tincture after treatment for more efficient and quick recovery.

Also, homeopathic remedies are widely used, the main effect of which is directed to the immunostimulating effect. These drugs include "Immunovita". Also used drugs that have an etiological focus, that is, they act on the human papilloma virus, which is the main causative agent. These drugs are Allokin-alpha and the vaginal suppository "Papillocan".

[9], [10]

Prevention

Prevention of dysplasia may be specific and nonspecific. Nonspecific prevention is a modification of the way of life with the exception of risk factors. Such risk factors that are subject to modification are the exclusion of bad habits, proper nutrition, exclusion of the work of women in industry with hazardous substances. It is also necessary to monitor the hygiene of sexual life, because its early onset and frequent change of partners is a risk factor not only for metaplasia of the cervix, but for cervical cancer and breast cancer. Sexual life should be safe in terms of possible infections - avoid infection of the human papillomavirus as much as possible.

As for specific prevention, this is the use of vaccines. Since the only proven etiologic factor in the development of cervical metaplasia in women can be considered HPV, the timely vaccination against this virus reduces the risk of developing both metaplasia and malignant oncological pathologies of the cervix. There is a vaccine against the papilloma virus, which is used for girls 9-14 years of age. One of the vaccines "Gardasil" is used against 6, 11, 16, 18 types. It consists of three doses, which must be administered before the onset of sexual activity. Another vaccine "Cervarix" is also aimed at 16, 18 type. These vaccines create immunity for about 5 years. Therefore, the method of vaccination is not absolute in the prevention of the etiologic factor of mild dysplasia, because infection can happen by another type of virus, however, this is already at least some preventive remedy. With mild dysplasia, there is a high probability of a favorable outcome, since these are the initial manifestations that must be treated immediately after the discovery of this problem.

Light dysplasia of the cervix is very common, which is explained by the high percentage of detection of this pathology. This correct diagnosis contributes to the early initiation of treatment of the pathology and the reduction of cervical cancer cases. Considering the asymptomatic course of this pathology, it is necessary only to be examined in a timely manner and to observe preventive measures.

[11], [12], [13]

Forecast

Light dysplasia of the cervix is a precancerous condition that has the ability for rapid malignancy, since there is a predisposition in the form of cell dysplasia. Therefore, the prognosis in the absence of treatment is unfavorable. In the case of timely diagnosis - a complete reduction is possible, both conservative and surgical, and then the prognosis is positive. It is mild dysplasia, as the initial stage of such changes is well treatable.

[14],