Uterus neck leukoplakia
Uterus neck leukoplakia – the limited pathological change of an ekzotserviks which is characterized by processes of proliferation and an orogoveniye of a multilayered epithelium. The uterus neck leukoplakia in general proceeds asymptomatically; can be followed considerable belyam and contact allocations. It is diagnosed by means of survey of a neck of a uterus in mirrors, an expanded kolposkopiya, a research of scrapes of a neck of a uterus, a biopsy with histologic studying of material. In treatment of a leukoplakia of a neck of a uterus methods of a kriodestruktsa, radio wave coagulation, CO2-lazernoy vaporizations, argonoplazmenny coagulation are used; the konization or amputation of a neck of a uterus are in certain cases shown.
Uterus neck leukoplakia
Leukoplakia (Greek - leucos; plax – a white plaque) represents zones of an orogoveniye and a thickening of an integumentary epithelium of a neck of a uterus of various expressiveness (as a giperkeratoz, a parakeratoz, an akantoz). Macroscopically the picture of a leukoplakia looks as the whitish plaques towering over mucous vaginal department of a neck of a uterus, sometimes these educations are localized in the tservikalny channel.
Prevalence of a leukoplakia makes 5,2% among all pathology of a neck of a uterus. A thicket women of reproductive age are subject to a disease. Craftiness of a leukoplakia consists highly risk of malignant transformation of an epithelium of a neck of a uterus which develops at 31,6% of patients. Therefore questions of timeliness of diagnostics and treatment of a leukoplakia of a neck of a uterus are in close connection with a problem of prevention of cancer of neck of a uterus.
Reasons of development of a leukoplakia of a neck of a uterus
In an etiology of a leukoplakia of a neck of a uterus allocate influence of endogenous factors (violation of hormonal and immune regulation), and also the exogenous reasons (infectious, chemical, traumatic). In change of a hormonal homeostasis violation of functional interrelation in a chain a hypothalamus – a hypophysis – ovaries – a uterus, leading to an anovulyation, a relative or absolute giperestrogeniya, deficiency of progesterone and, as a result, - to hyper plastic processes in target organs matters.
Developing of a leukoplakia of a neck of a uterus is quite often preceded by infectious and inflammatory processes (endometritises, adneksita), violations of a menstrual cycle (, ). The human papillomavirus infection, ureaplasmosis, clamidiosis, mycoplasmosis, herpes, a Cytomegaloviral infection, the nonspecific colpitises and tservitsita recuring ektopiya are among background factors; the reduced general and local reactivity; chaotic sex life. Development of a leukoplakia is promoted by traumatic and chemical injuries of a neck of a uterus at surgical termination of pregnancy, diagnostic vyskablivaniye, medicamentous cauterization or a diatermokoagulyation of an erosion of a neck of a uterus, other aggressive interventions.
Against the background of etiologichesky factors the mechanisms causing a keratinization of cages of a multilayered epithelium of an ekzotserviks are started (is normal not of orogovevayushchy). Owing to gradual reorganization of cages of an epithelium (disintegration of kernels and intracellular organelles) the horn scales which are not containing a glycogen are formed. The centers of a leukoplakia of a neck of a uterus can be single or multiple.
Uterus neck leukoplakia forms
By morphological criteria the gynecology allocates a simple and proliferative leukoplakia of a neck of a uterus. The simple leukoplakia of a neck of a uterus is carried to background changes (hyper - or to a parakeratoz). It is characterized by a thickening and an orogoveniye of blankets of an epithelium; at the same time cages of basal and parabasal layers of changes do not undergo.
At proliferative transformation the differentiation, proliferation of cages of all layers is broken, atypical structural elements appear. This form of a leukoplakia of a neck of a uterus is regarded as precancer process - a tservikalny intraepitelialny neoplasia (CIN, a uterus neck dysplasia).
Uterus neck leukoplakia symptoms
The disease is not followed by a specific clinical picture and subjective complaints. More often the leukoplakia of a neck of a uterus comes to light at the next survey of the gynecologist. In certain cases there can be indirect symptoms of a leukoplakia of a neck of a uterus – considerable bleach with an unpleasant smell, contact allocations of small volume of blood after sexual intercourse.
Diagnosis of a leukoplakia of a neck of a uterus
At gynecologic survey by means of mirrors on a neck of a uterus whitish sites in the form of spots or plaques are defined, is more often than an oval form, with a clear boundary, the variable sizes. The leukoplakia centers, as a rule, slightly tower over a surface of not changed epitelialny cover of a neck of a uterus. The surface of plaques can be covered with the horny epithelium scales.
The cytologic research of scrape of a neck of a uterus reveals congestions of superficial epitelialny cages with signs of a giperkeratoz or a parakeratoz. In case of a giperkeratoz in a large number the nuclear-free horny scales come to light. At a parakeratoza density and coloring of cytoplasm of small cages with piknotichesky kernels amplifies.
Processes hyper - and a parakeratoza interfere with hit in scrape of cages of deep layers of an epithelium in which proliferation, violations of a differentiation and an atipiya are possible. Therefore in diagnosis of a leukoplakia as the leading method serves the aim knife biopsy of a neck of a uterus and a histologic research of fabrics of an ekzotserviks allowing to exclude or confirm tumoral processes and also a tservikalny intraepitelialny neoplasia (CIN). For the purpose of an exception of cancer of neck of a uterus the scraping of the tservikalny channel is carried out.
By means of an expanded kolposkopiya (videokolposkopiya) character and the amount of defeat are specified. At kolposkopichesky visualization white plaques with the fine-grained surface, accurate and smooth edges, lack of blood vessels are visible. The size and prevalence of a leukoplakia of a neck of a uterus can vary from a single dot plaque to the multiple and extensive zones covering all and passing to the vaginal arches. Conducting test of Schiller reveals yodonegativny sites.
Clinical laboratory tests include a microscopic, bacteriological research of dabs, PTsR-identification and typing of VPCh, hormonal and immunological researches (according to indications). In the course of diagnostics the leukoplakia of a neck of a uterus is differentiated with tservikalny cancer, a uterus neck erosion. Consultation of an onkoginekolog, the gynecologist-endocrinologist can be required by patients with a leukoplakia of a neck of a uterus.
Treatment of a leukoplakia of a neck of a uterus
The strategy of treatment is defined by a form of the revealed uterus neck leukoplakia (simple or proliferative). As the purposes of treatment serve elimination of background diseases and full removal of the pathological centers.
According to indications antibacterial, antiviral, anti-inflammatory therapy is carried out. For removal of the centers of a leukoplakia of a neck of a uterus in gynecology methods of cryogenic influence, radio wave destruction, argonoplazmenny coagulation, CO2-lazernoy vaporizations, diatermokoagulyation, chemical coagulation are used. Low-invasive destruction of the centers of a leukoplakia of a neck of a uterus is carried out on an outpatient basis; healing of fabrics can demand term from 2 weeks to 2 months taking into account extensiveness of defeat, associated diseases, a destruction method.
For treatment of a leukoplakia of a neck of a uterus sex life and use of any contraception is excluded. In case of existence of a tservikalny intraepitelialny neoplasia, a leukoplakia combination to a hypertrophy, kraurozy, cicatricial deformations of a neck the volume of intervention can include a konization of a neck of a uterus or amputation of a neck of a uterus.
Prevention of a leukoplakia of a neck of a uterus
For the prevention of development of a leukoplakia of a neck of a uterus early treatment of erosion, inflammatory and infectious processes in reproductive organs is necessary; exception of abortions, uterus neck injuries at the time of delivery and gynecologic manipulations; prevention of STD, use of barrier contraception.
The women suffering from violation of a menstrual cycle have to be observed at the gynecologist-endocrinologist for the purpose of correction of hormonal violations. In a question of prevention of a leukoplakia of a neck of a uterus screening and explanatory work, regular gynecologic surveys are important. The essential preventive moment is vaccination against VPCh.
After destruction of the centers of a leukoplakia without atipiya to the patient each half a year carry out a kolposkopiya, dab research on an onkotsitologiya, analyses on VPCh. After 2 years and in the absence of a recurrence the woman is transferred to the usual mode of observation.
The forecast at a uterus neck leukoplakia
In the absence of an atipiya, a human papillomavirus infection, elimination of adverse background factors the forecast after treatment of a leukoplakia of a neck of a uterus is favorable. At preservation of the prime cause of a disease perhaps manifest current and transition of a leukoplakia to tservikalny cancer.
At a simple leukoplakia at the women planning a child-bearing in order to avoid cicatricial deformation of a neck of a uterus use of the sparing destruction methods - cryodestructions, laser vaporization, radio surgical treatment, chemical coagulation is preferable. Conducting pregnancy demands the increased control of a condition of a neck of a uterus from this group of patients.