Differential Diagnosis for Cervical Prolapse
When a specimen of uterus with cervix is received for histopathological examination with a clinical diagnosis of cervical prolapse, several histopathological findings and diagnoses should be considered. The differential diagnoses can be categorized as follows:
Single Most Likely Diagnosis
- Cervical fibrosis or atrophy: This is the most likely diagnosis, as cervical prolapse often results from weakened cervical and uterine support, which can be due to fibrosis or atrophy of the cervical tissue. Histopathological examination may show features of chronic inflammation, fibrosis, and atrophy of the cervical stroma.
Other Likely Diagnoses
- Uterine leiomyomas (fibroids): These can contribute to cervical prolapse by increasing the size and weight of the uterus, putting additional strain on the cervical and uterine supports. Histopathological examination would reveal characteristic whorled patterns of smooth muscle cells.
- Cervical ectropion or eversion: This condition, where the glandular epithelium of the endocervix is everted to the exterior, can sometimes be associated with prolapse. Histologically, it shows glandular epithelium on the ectocervix.
- Chronic cervicitis: Inflammation of the cervix can lead to scarring and weakening of the cervical tissue, contributing to prolapse. Histopathological findings include chronic inflammatory infiltrates.
Do Not Miss Diagnoses
- Malignant neoplasms (e.g., cervical carcinoma): Although less common, it is crucial not to miss a diagnosis of cancer, as it would significantly alter the management and prognosis. Histopathological examination would reveal features of malignancy such as abnormal cell morphology, increased mitotic activity, and invasion.
- Invasive infections (e.g., necrotizing fasciitis): Rarely, severe infections can cause rapid deterioration and necessitate urgent intervention. Histopathological findings would include necrosis, acute inflammation, and evidence of microbial invasion.
Rare Diagnoses
- Congenital anomalies of the uterus and cervix: Certain congenital anomalies can predispose to cervical prolapse. Histopathological examination may reveal abnormal development or structure of the cervical and uterine tissues.
- Inflammatory conditions like pelvic inflammatory disease (PID) or endometriosis: These conditions can lead to adhesions and fibrosis, potentially contributing to prolapse. Histopathological findings would depend on the specific condition but might include chronic inflammation, adhesions, or endometrial implants.
- Connective tissue disorders (e.g., Ehlers-Danlos syndrome): These can affect the integrity of the supportive tissues of the uterus and cervix, leading to prolapse. Histopathological examination might show abnormalities in collagen or elastic fibers.