EROSION of the NECK OF UTERUS (Latin erosio corrosion) — defect of an epithelium of a mucous membrane of a vulval part of a neck of uterus.
The erosion of a neck of uterus meets often and usually accompanies others ginekol. to diseases (inflammatory processes of generative organs, effects of injuries of a neck of uterus at the time of delivery, etc.). The term «erosion» combines heterogeneous patol. processes and not always corresponds to their essence, however it is widely used in a wedge, practice. Distinguish inborn and true E. highway of m.
The inborn erosion represents an ectopia (shift) of a cylindrical epithelium of the channel of a neck of uterus towards a multilayer flat epithelium of a mucous membrane of a vulval part of a neck of uterus. The etiology is not found out. Inborn E. highway of m is observed in children's and pubertal, is rare at mature age; she usually small size, pink coloring, does not tend to an atipizm of cells, as a rule, is exposed to involution, does not demand treatment.
The true erosion results from inflammatory processes, especially necks of uterus and vaginas (see the Colpitis, the Cervicitis) caused by stafilokokka, streptococci, gonokokka, chlamydias, trichomonads, asporous anaerobe bacterias, barmy fungi, etc., and also associations of microbes. Long influence patol. the secret which is allocated from the channel of a neck of uterus leads to maceration, dystrophy and desquamation of a multilayer flat epithelium of a vulval part of a neck of uterus. Penetration of microbes into erosive glands, a basal layer of an epithelium and the subject tissues of a neck of uterus promotes the long course of process. According to nek-ry researchers, developing of a true erosion is connected with the injury of a neck of uterus (e.g., in labor) leading to formation of ectropion (an ectropion of a mucous membrane of the channel of a neck of uterus) with the subsequent its infection. Assume that in an origin E. highway of m plays a part also an imbalance of sex hormones.
True E. highway of m represents disturbance of an integrity of a multilayer flat epithelium of a vulval part of a neck of uterus. It usually is located around an outside pharynx of the channel of a neck of uterus (an ostium of the uterus, T.), has bright red color, the wrong, slightly roundish outlines are more often, bleeds at a touch. Often at E. highway of m is observed a hypertrophy of a neck of uterus. At microscopic examination of a true erosion signs of inflammatory reaction under - epithelial connecting fabric come to light (a trichangiectasia, leukocytic and kruglokletochny infiltrates, swelled). In 1 — 2 week process of healing begins.
The pseudo-erosion (a false erosion) is formed as a result of the shift of the cylindrical epithelium covering the channel of a neck of uterus on an eroziro-bathing mucosal surface of a cover of a vulval part of a neck of uterus. Consider that reserve cells can be a source of a cylindrical epithelium. The cylindrical epithelium expands in depth and forms the branching ferruterous courses (erosive glands) reminding glands of a mucous membrane of the channel of a neck of uterus. Formation of erosive glands due to their growth from a mucous membrane of a neck of uterus towards a vulval part of a neck of uterus where the pseudo-erosion is located is possible. The beginning of formation of a pseudo-erosion many researchers call the first stage of healing true E. highway of m
of Psevdoeroziya can be various form and size, is located around an outside pharynx or is preferential on a back or front lip of a neck of uterus, has bright red coloring, is surrounded with a light pink rim. The surface its fine-grained, velvety, is covered mucopurulent separated, quite often at a careless touch it bleeds.
The pseudo-erosion can exist a long time (months and years) while there is an inflammatory process which served as an origin E. highway of m. On the other hand, the pseudo-erosion itself supports inflammatory process in a neck of uterus owing to infection of erosive glands. At the long course of process there is an increase in the sizes of erosive glands, their immersion in deeper layers of a neck of uterus, expansion of a gleam that leads to education so-called follicular, or ferruterous, erosion. In some cases on a surface of a pseudo-erosion there are papillary growths of a stroma covered with a cylindrical epithelium (papillary and ferruterous and papillary, or mixed, erosion). In the field of a pseudo-erosion, especially at its long current against the background of inflammatory process, there can be centers of a dysplasia (see) which are characterized by increase in proliferative activity of an epithelium of basal and parabasal type (a basal and cellular hyperactivity) and signs of an atipizm of cells (see the Uterus, pathological anatomy). Pseudo-erosion with the centers of a dysplasia carry to pretumor diseases of a neck of uterus.
After elimination of inflammatory process and other reasons E. highway of m occurs gradual substitution of a cylindrical epithelium multilayer flat, inherent in a normal mucous membrane of a vulval part of a neck of uterus (the second stage of healing of a true erosion). The multilayer flat epithelium from adjacent healthy sites grows under the cylindrical epithelium covering a pseudo-erosion, to-ry, in turn, is exposed to dystrophic changes and desquamation. At the same time nek-ry erosive glands can sometimes remain under a multilayer flat epithelium, turning into the cystic educations (a nabotova of a cyst) filled with a secret. There is an opinion that healing of a pseudo-erosion happens at the expense of the reserve cells possessing a plyuri-potentnost (ability to turn into a cylindrical or flat epithelium).
True E. highways of m are usually observed at women in the reproductive period, quite often proceed asymptomatically and come to light accidentally, napr, at routine maintenance. Sometimes at pseudo-erosion allocations from a vagina and the so-called contact bleedings arising, e.g., at sexual intercourse are observed.
The diagnosis is made at vaginal examonation using mirrors. In case of detection of an erosion necks of uterus by means of a kolposkop examine; at the same time the neck of uterus is processed surely water solution of Lugol (Schiller's test) for the purpose of identification of sites of a dysplasia and a malignancy (see Kol-poskopiya). Conduct also cytologic research (see) the tearing-away cells. The aim biopsy with the subsequent gistol is important for detection of a possible dysplasia and differential diagnosis of a pseudo-erosion with pre-invasive cancer of a neck of uterus.
a research of the received material.
Treatment first of all is directed to elimination of inflammatory process, the accompanying endocrine disturbances and to elimination of deformation of a neck of uterus. Apply antibacterial agents taking into account the activator to treatment of inflammatory diseases of a neck of uterus and a vagina (see Gonorrhoea, the Colpitis, the Trichomoniasis, the Cervicitis). At the expressed inflammatory reaction of surrounding fabrics the neck of uterus is oiled sea-buckthorn and liquid, the emulsions containing antibacterial substances. Use of caustics (lyapis, etc.) is not recommended, and according to many researchers, contraindicated.
Apply physical therapy to treatment of pseudo-erosion — an electrophoresis of zinc (see the Electrophoresis), short-wave UF-radiation (see. Ultraviolet radiation), microwave therapy (see). At the pseudo-erosion which are not giving in to conservative treatment resort to diathermocoagulation (see the Uterus, malignant tumors), to-ruyu carry out after a kolposkopiya, an aim biopsy and gistol. researches of the received material. Most of specialists recommend to carry out diathermocoagulation at the end of the second phase of a menstrual cycle (for the purpose of prevention of endometriosis of a neck of uterus). In the presence on-botovykh cysts, and also the ectropion complicated by an erosion, diathermocoagulation is combined with diatermopunk-Tura (perforation of cysts by means of diathermocoagulation); at ectropion with considerable deformation of a neck of uterus apply diatermo-conization (see the Uterus, malignant tumors) or plastic surgery. In recent years with success use a cryolysis (see the Cryosurgery), and also treatment by the laser (see). At a pseudo-erosion with the centers of a dysplasia method of the choice is the diatermokonization, to-ruyu make only after a diagnostic scraping of the channel of a neck of uterus and gistol. researches of the received material.
The forecast at timely treatment, as a rule, favorable.
Prevention consists in early diagnosis and treatment of inflammatory diseases of a vagina and neck of uterus, in the prevention of injuries of a neck of uterus at the time of delivery and timely surgical correction of ruptures of a neck of uterus (see Childbirth).
Bibliogrgrishchenko V. I. A hypothermia and a cryosurgery in obstetrics and gynecology, M., 1974; Glands
B. I is new. Precancerous changes of a neck of uterus and endometria, Arkh. patol., t. 34, No. 5, page, 3, 1972; 3 and p about r about and N In, N *
Justification of a technique of medical cryogenic impact on a neck of uterus, Akush. and ginek., No. 7, page 48, 1977; Petrova E. H. Histologic diagnosis of diseases of a uterus, M., 1964; P au-krovsky V. A., etc. Dysplasia and intra epithelial carcinoma of a neck of uterus, M., 1970; Serebrov A. I. Cancer of a uterus, M., 1968; Yakovleva I. A. Morphology and histogenesis of a precancer of a neck of uterus, Akush. and ginek., No. 12, page 12, 1978; Klinik der Frauenheilkunde und Geburts-hilfe, hrsg. v. G. Doderlein u. K. - H. Wulf, Bd 5, S. 209, Munchen u. a., 1977.
V. I. Bodyazhina.