Squamous metaplasia of the cervix: what is it and how to treat it

The metaplastic layer of the cervical epithelium represents normal cells that are located in the area of transformation. In the absence of abnormalities and pathological processes in the metaplastic epithelium, cells of varying degrees of maturity are detected during diagnosis. Experts note islands of columnar epithelium, which has open and closed types of glands, as well as a normal vascular pattern.

The immature stage of metaplastic epithelium indicates pathological processes in the cervix that require careful diagnosis. Metaplasia means a change in the basic properties of the tissue. Cervical metaplasia is diagnosed mainly in patients over 45 years of age. This disease is a precancerous condition, so untimely treatment can lead to serious complications.

Without treatment, healthy cells gradually begin to turn into malignant cells.

It is for this reason that it is important to begin treatment at the initial stage of development. Gynecologists recommend regularly coming for a preventive scheduled examination and doing a screening examination.

Pathogenesis of metaplasia

The epithelium of the cervix in a healthy state has the following structure. Near the vaginal canal there is a flat stratified epithelium. In the immediate vicinity of the uterus there is the next layer - the intermediate zone. The entire uterine cavity and cervical canal are lined with columnar epithelium. Normally, these layers do not mix with each other; a clear boundary between them is clearly visible.

The development of metaplasia begins with the penetration of pathogenic bacteria or a virus into the cervix. The integrity of the nuclear membranes is disrupted, the process of chaotic cell division begins, and the first epithelial cells with an atypical nucleus appear. In this condition, protein synthesis in the body is disrupted and dysplastic processes are triggered.

The boundary between the layers of the epithelium is erased, as one type of tissue is replaced by another. At the same time, the histotype remains the same. For example, stratified squamous epithelium (MSE) replaces intermediate zone cells. Stem (reserve) cells are activated, adapting to one or another histological type. New tissues are weakened and susceptible to any harmful microenvironment factors.

In such an environment, the processes of growth of malignant tumors intensify, often affecting weakened tissues of reduced differentiation. The disease is asymptomatic. And many women become aware of the problem when they are diagnosed with cancer. That is why it is worth choosing “your” gynecologist, with whom you have established a trusting relationship, and visiting him regularly, taking all the necessary tests. This will prevent complications associated with women's health.

IMPORTANT! Metaplasia is not always dangerous. In fact, the process of replacing some cells with others is normal and is a way of adapting the body to certain microenvironmental conditions. The woman’s condition should be monitored and attention should be paid in time to the development of changes in the uterine epithelium.

Reasons for the development of metaplasia

The most common cause of changes in the epithelium is the human papillomavirus. The virus tropizes in the body, causing the development of papillomas and condylomas of the cervix. In addition to papillomavirus, the cause of the disease is bacterial infections, causing ureaplasmosis and chlamydia, and also often become an impetus for the formation of metaplasia. There are other reasons that provoke disruption of the structure of the epithelium. Women at increased risk are:

who have been diagnosed with hormonal changes;
there are inflammations of various etiologies;
those in contact with harmful chemicals, for example, those working in hazardous industries;
taking contraceptives and other medications without specialist supervision;
having chronic diseases of the reproductive system;
violating the rules of personal hygiene;
patients with injuries (including those with a history of frequent childbirth, miscarriages, abortions).

Hereditary factors play a role. A woman whose mother suffered from cervical pathologies has an increased likelihood of developing the disease. Smoking, alcohol abuse and taking drugs - such habits often lead to pathological changes in the epithelium and other precancerous diseases. Promiscuity should also be considered a cause of serious disruptions in the reproductive system.

Prognosis and prevention

To prevent any gynecological disease, including squamous metaplasia, it is important to eliminate all possible provoking factors and adhere to the following points:

maintain personal hygiene;
exclude frequent changes of sexual partners;
visit a gynecologist in a timely manner for annual preventive examinations;
get rid of drinking alcohol and smoking;
make your diet complete and balanced;
minimize the impact of harmful environmental factors.

Squamous metaplasia is a benign pathological process that occurs in the cervix. However, the lack of diagnostic measures and timely therapy can aggravate the situation and cause the development of malignant neoplasms.

Squamous (squamous) metaplasia is a term used to describe cellular, noncancerous changes in the epithelial lining of certain internal organs, such as the bladder, cervix, and lungs. Metaplasia occurs when persistent stress or irritation causes a reversible process in which differentiated epithelial cells of one type are converted into epithelial cells of another type. In squamous metaplasia, various epithelial cells are replaced as a result of the adaptation mechanism of squamous epithelium.

Changes in cell type can lead to decreased epithelial function. When abnormal stimuli are removed, the metaplastic cells return to their original form and function. The persistence of physiological stressors in areas susceptible to metaplasia can lead to dysplasia or.

Dysplastic cells, in the absence of timely elimination of the stressor or irritant, can transform into cancer cells.

The epithelium is made up of layers of different epithelial cells such as columnar, cuboidal and squamous cells. Columnar epithelial cells are elongated, cylinder-shaped cells that form the lining of the cervical canal (endocervix), intestines and stomach. Columnar cells whose nuclei are at different heights are called pseudostratified epithelial cells. Cuboidal epithelium is formed from cells resembling squares. Such cells are commonly found in exocrine glands and renal tubules. Flat epithelial cells, in turn, form smooth epithelium.

The process of development of squamous metaplasia and the resulting neoplastic cell changes can be clearly seen using the example of cervical metaplasia. The mucosa of the cervical canal, which is a cavity in the cervix, is usually formed by columnar epithelial cells. Estrogen and chronic exposure to acidic pH levels in the vagina provoke the process of squamous metaplasia, affecting the epithelium of the cervical canal. In response to irritating pH levels, fragile columnar epithelial cells begin to be replaced by stronger squamous cells.

Squamous metaplasia of the cervical canal also occurs as a result of fusion with the adjacent ectocervix.

Squamous cells of the ectocervix begin to fill the endocervix area, replacing columnar epithelial cells. When carcinogenic factors such as the presence of human papillomavirus act as irritants or stressors on metaplastic epithelial cells, cervical cancer is formed. A similar metaplastic process occurs when cigarette smoke persistently irritates the pseudostratified epithelial cells of the lung mucosa.

Cigarette smoke is a stressor that converts pseudostratified cells into much tougher squamous cells. However, even squamous cells, such as those in the bladder, can undergo squamous metaplastic changes. The bladder trigone, or inner triangular region, includes the squamous epithelial cells that form the lining of this area. When adult squamous cells of the bladder undergo chronic inflammation, metaplastic change occurs in these cells.

Cervical metaplasia is a pathology of the glandular epithelium, in which the cells change to squamous cells. The phenomenon belongs to the group of precancerous diseases and requires treatment.

Symptoms of metaplasia

A woman’s body, under the influence of negative factors, quickly adapts to the situation, and the disease can be asymptomatic. But there are some changes in the body that may indicate that a benign process has begun. For example:

Painful sensations during sexual intercourse due to the fact that epithelial dysplasia leads to injuries and bleeding. Don’t be embarrassed to tell your doctor about such “intimate” symptoms, as well as other signs of women’s health problems.
Vaginal discharge increases significantly, its color becomes milky, and its consistency becomes cheesy. In fact, this condition can be confused with a banal thrush.
Erosion, infectious diseases, condylomas can indicate progressive metaplasia, and also warn of the possibility of its development in the near future.
A specific smell appears, indicating that inflammation has begun in the body.

These symptoms may indicate an infectious disease, inflammation, or problems with the woman’s reproductive system. You should not self-medicate, but visit an antenatal clinic as soon as possible for a qualified examination by a specialist.

ATTENTION! At the first symptoms of metaplasia, you should consult a doctor. It is possible that a polyp or harmless condyloma that does not bother a woman at all are harbingers of a precancerous change in the cervix. Timely diagnosis allows you to identify the problem at an early stage, and sometimes helps prevent the development of malignant formation.

Rules for obtaining an informative smear for oncocytology

The doctor must first take a swab and only then conduct a manual examination.
Before taking a smear, mucous secretions are removed.
The material on the glass should be distributed neither thick nor thin.

Swabs cannot be given:

during the period of ovulation, when there is very abundant mucous discharge from the cervix (the so-called mucus plug);
after a vaginal ultrasound (gel remains on the cervix);
after sexual intercourse (sperm interfere with the study of cells under a microscope);
if spermicides or any medications were previously introduced into the vagina;
during menstruation, shortly before it or when it has not yet completely ended.

Diagnosis of metaplasia

You should not diagnose yourself, for example, by asking questions on a women's forum. The first and mandatory point in diagnosing metaplasia is examination of the cervix using vaginal speculum to determine the size of the epithelial lesion. Colposcopy is also necessary - an examination using a colposcope, which makes it possible to see any pathological changes in the structure of the epithelium, and also allows you to perform a targeted biopsy to examine the area of the cervix that causes concern. Histology helps determine the stage of the disease and provide the patient with timely medical care.

A high-quality cytological examination is also necessary. A smear is taken from several areas. These are the exocervix (surface of the cervix), endocervix (lower part) and, in fact, the zone of epithelial transformation. This diagnostic method, relevant for most acute and chronic diseases of the female reproductive system, is carried out in the second half of the menstrual cycle. A smear will help identify endocervicitis, which makes pregnancy difficult, dysplasia, which is a precancer of the cervix, and other diseases.

At the slightest suspicion of metaplasia, bacteriological and bacterioscopic studies are performed to determine the cause, as well as the type of disorder, and prescribe the optimal treatment regimen. Comprehensive diagnostics is the best way to protect against metaplasia and its consequences for the female body.

When making a diagnosis, it is necessary to differentiate metaplasia from other diseases related to precancerous conditions and benign background processes with similar symptoms. These are, for example, leukoplakia without atypia, cervicitis, adenomatosis, benign neoplasms of viral etiology. For example, flat polyps. The disease is also differentiated from erosion (ectopia).

Proliferation of the glandular epithelium also exhibits almost identical symptoms. The glandular structures in the epithelium of the cervix increase, which does not always indicate the development of a serious pathology. Among the diseases with a course similar to metaplasia is intraepithelial cancer.

Risk factors

Risk factors can be divided into general and local. Common ones include bad habits, smoking, drinking alcohol, eating disorders and consumption of carcinogenic products, and the influence of environmental factors. All these changes are accompanied, first of all, by a decrease in the reactivity of the whole organism, and against this background, functional and then morphological changes in organs and systems develop.

Among the risk factors for the development of cervical dysplasia are local ones - early onset of sexual activity, frequent change of sexual partners, as well as infectious and inflammatory diseases of the female genital organs, frequent surgical interventions - abortions, hormonal imbalances, traumatic injuries.

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Types of metaplasia of the cervical epithelium

The form of the disease is determined by screening. This study is the basis for a correct and, at the same time, timely diagnosis. Metaplasia is divided into: immature, squamous and squamous combined with dyskaryosis. The type of epithelial change does not affect the course of the disease, but plays a leading role in its treatment.

Immature metaplasia is considered the most difficult option to diagnose. This is due to the fact that the level of cell differentiation is low, and the risk of malignancy is extremely high. A cytological examination reveals small cells in the smear with unclear boundaries and different shapes. The cells themselves in the smear are located quite chaotically.

When studying the internal structure of cells, a change in the cytoplasm, a violation of the structure and location of all its structural elements is determined. Due to low differentiation, it is difficult to determine which type of epithelium the studied cervical epithelial cells belong to.

The next type of metaplasia is squamous cell. With this option, the epithelium is practically no different from a healthy organ. The only thing that indicates the degree and type of violation of its structure is its abnormal location. Multilayered epithelium, which is normally found near the vaginal canal, appears behind the intermediate zone, interspersed with areas of columnar epithelium.

The most differentiated type of metaplasia is squamous metaplasia with dyskaryosis. This form is mature, that is, the cells have a certain shape, the cytoplasm inside is not changed, the structure is correct. The cells are the same size, which is not typical for immature forms of metaplasia. The only factor that allows one to distinguish pathological reserve cells from healthy ones is abnormal division in the nucleus of pathological mitoses (dyskaryosis).

The diagnosis of immature or squamous metaplasia, made at an early stage of the disease, sometimes does not require medical intervention. A woman is strongly recommended to undergo regular examinations with a gynecologist, take all tests prescribed by a specialist, and also eliminate the causes that contribute to the development of this disease. For example, quit smoking and cure papillomatosis.

Features of the clinical course

The clinical picture of squamous metaplasia is rather weak and has practically no obvious symptoms. Pathological changes are usually detected incidentally during routine examinations, and in some cases may remain undiagnosed for several years if the patient does not seek preventive medical care.

With lung metaplasia, patients may notice unpleasant sensations (tingling, itching and tickling inside the lung) during the inhalation phase, some of them suffer from shortness of breath and a prolonged dry cough. Squamous metaplasia of the urinary tract is manifested, first of all, by pathology of urination (urinary retention, discomfort during urine output, etc.). Less often, such patients complain of moderate pain in the abdominal area and changes in the color, smell and consistency of urine, the appearance of uncharacteristic suspensions, blood streaks and threads in it.

If the lungs are affected, you may experience shortness of breath and a dry cough.

Despite the absence of typical symptoms, there are signs whose appearance should prompt examination and consultation with a specialized specialist. Symptoms that may indicate squamous metaplasia of the cervix are:

mild or moderate pain during sexual intercourse (typically increased pain during penetration and increased range of motion of the partner);
heavy and painful menstruation (one of the main clinical symptoms of metaplasia during puberty in teenage girls);
cyclic disruptions (discrepancy between the duration of the menstrual cycle and the reference values, which range from 26 to 32 days);
bleeding after strength training and intimacy;
uncharacteristic discharge and unpleasant odor from the vaginal tract.

Squamous metaplasia of the cervix is often manifested by painful periods

The patient may also be bothered by urinary disorder, mild itching in the groin and perineum, and discomfort in the lower abdomen (characteristic of mature metaplasia). All of the listed signs are usually mild or absent altogether, so metaplastic changes are most often detected by chance during a routine examination or contacting a gynecologist for another reason.

Important!
As practice shows, in almost 70% of patients with squamous metaplasia of the cervix, the pathology was diagnosed accidentally, and the patients themselves did not present any clinically significant complaints at the stage of collecting anamnesis. Among the most common signs of possible metaplastic pathology, gynecologists identify disruptions in the menstrual cycle and disorders in the sexual sphere caused directly by mechanical irritation of differentiated tissue.

Most often, squamous cell metaplasia of the cervix is detected during a routine gynecological examination.

Treatment methods for metaplasia

The decision on how exactly the treatment will proceed is made by the doctor based on diagnostic studies. If the disease is viral in nature, for example, it is caused by HPV, then drugs that suppress the activity of viruses and block their further reproduction are used for treatment. If, during examination of the mucous membrane, bacteria are found in the smear, then antibiotics and antifungal agents are prescribed. Squamous metaplasia involves treatment with immunity-boosting drugs. Vaginal suppositories that stop the inflammatory process are also prescribed.