Clinical History:

A 39 year-old woman had a sensation of pelvic heaviness and a mucinous vaginal discharge which had persisted for months. A pelvic examination revealed the uterus to be enlarged, and a thick, creamy- yellow discharge to be exuding from the external cervical os. In addition there was a 5 mm diameter translucent mucosal nodule adjacent to the external os. At hysterectomy the uterine enlargement was found to be secondary to an intramural, fundic leiomyoma (benign smooth muscle tumor). The section is taken from the cervix.

Image 3.1:

There are multiple, discrete tumor masses arising in the myometrium but impinging upon both endometrial and serosal surfaces. These masses are firm and white to tan on sectioning.

Images 3.2 to 3.4:

The cervix is shown here. Remember, the endocervical glands are not true glands, but only invaginations of the surface endocervical mucinous epithelium into the fibromuscular stroma.

Answers:

1. What cell types compose the inflammatory infiltrate?

There is an intense chronic inflammatory cell infiltrate, composed of lymphocytes, plasma cells, and histiocytes, in the stroma adjacent to the endocervical epithelium. There is also hemorrhage. The gland-neck narrowing may result from stromal chronic inflammation. Some degree of nonspecific, chronic cervicitis is present in most women; but in this case, the degree of inflammation is greater than what is usually observed.

2. What is the diagnosis for the (a) uterine masses and (b) cervix?

The uterine masses are benign leiomyomata. The cervix demonstrates severe chronic cervicitis.

3. Is further workup indicated?

One might suspect Chlamydia cervicitis on the basis of the vaginal discharge, but culture or immunohistologic studies would be needed to confirm this diagnosis.