Cervical leukoplakia: treatment and diagnosis,symptoms and prognosis

ABOUTбновление: Декабрь 2018

Cervical leukoplakia refers to the “interesting”
gynecological pathologies and is in a special position. Until now
the mechanism of development of this pathology is not clear, therefore doctors are not in
able to definitely answer the question how will flow
the disease is benign or malignant. Frequency
the incidence of this pathology is different (according to the statistics of different
authors) and is in the range from 1.1% to 12.5%. It is from
difficulties in establishing the causes and pathogenesis of the disease are
the complexity of the treatment of leukoplakia.

ABOUTпределение лейкоплакии

A condition in which the epithelium covering the vaginal or
visible part of the cervix, compacted and orgovevaetsya, and the neck itself
thickens, called leukoplakia. Literal translation of the word
�”Leukoplakia” in Greek means “white plaque”. Indeed,
pathological areas on the neck when viewed with the naked eye
look like whitish patches or plaques. Overseas concept
leukoplakia replaced by intraepithelial neoplasia or
dyskeratosis.

Classification

AT зависимости от макроскопической картины различают следующие
forms of leukoplakia:

  • simple, which is considered the initial stage of the process, while
    white plaques are flush with the mucous and do not protrude above it
    surface, they can easily be overlooked during the inspection of the neck
    uterus;
  • verrucous or warty (second stage of the disease) –
    whitish growths are layered on each other, because of which the neck
    looks bumpy, and leukoplakia lesions themselves are significantly
    rise above the mucous and not notice them practically
    impossible;
  • erosive – there are cracks on the whitish plaques and / or
    эрозивные plots.

After conducting a histological examination of a piece of plaque
emit simple leukoplakia and leukoplakia with atypia
(proliferative). Simple leukoplakia (not identified atypical, then
there is a tendency to rebirth, cells) is considered to be the background
процессам necks. Leukoplakia with atypia (there are atypical cells)
considered a precancer.

Withчины лейкоплакии

Experts still have not figured out what “starts” the process
leukoplakia. But it is assumed that the provoking factors
are certain states of the body or effects on the neck
uterus. AT связи с этим все причинные факторы подразделяются на
exogenous (internal) and endogenous (that is, those that act
�”outside”).

ATнутренние причины

hormonal disorders

in the hypothalamus-pituitary-ovarian-uterine system that
leads to anovulation and excess estrogen (as a relative, so
and absolute) and progesterone deficiency:

  • лечение лейкоплакии шейки маткиendometrial hyperplasia;
  • uterine fibroids and other tumors;
  • ovarian dysfunction;

inflammation of the genital organs:

  • adnexitis;
  • endometritis;
  • vaginitis;
  • cervicitis.

metabolic disorders:

  • obesity;
  • diabetes;
  • pathology of the thyroid gland.

weakening of immunity

  • acquired and congenital immunodeficiency;
  • lack of vitamins;
  • прием неwhich лекарств (цитостатики).

ATнешние причины

Factors that act from the outside:

  • cervical injury:
    • neck ruptures in labor;
    • cervical damage during abortions;
    • other intrauterine procedures (diagnostic curettage,
      hysteroscopy).
  • aggressive effects on the neck
  • cauterization (electrocoagulation of the neck);
  • exposure to chemicals (solkovagin).
  • genital infections:
  • chlamydia;
  • human papillomavirus;
  • ureaplasmas and mycoplasmas;
  • herpes infection;
  • cytomegalovirus;
  • promiscuous and early sex life.

Development mechanism

Under the influence of certain factors in the mucous neck first
an inflammatory process occurs. Then the mechanisms are connected
which lead to keratisation (keratinization) of multilayer flat
эпителия видимой части necks. This epithelium is known to be normal.
is non-threshold. AT результате эпителиальные клетки
gradually rebuilt, which ends with the formation of horny
scales and plaques. It is characteristic that in these scales is absent
glycogen.

Clinical picture

Leukoplakia cervix, which is perhaps the most unpleasant,
proceeds without symptoms. As a rule, the disease is detected
случайно во время очередного посещения gynecologist. But it is possible and
complaints from the patient, which are more likely to be associated with concomitant
pathology than with leukoplakia itself. AT случае воспаления влагалища
and / or cervical women may experience pain during sexual intercourse.
contact and contact bleeding. Also пациентка
complains about the selection of an unusual color, and, as a rule, with
unpleasant smell. If a процесс продолжает распространяться и
captures the adjacent vaginal wall, it is possible the appearance
burning and itching.

With осмотре в зеркалах врач наблюдает на шейке матки тонкую
whitish film, which is not removed by a tampon, but when you try to
exfoliate bloody discharge. it первая стадия
diseases – simple leukoplakia. With бородавчатой лейкоплакии,
a film that rises a couple of millimeters above the mucosa,
raids are easily removed with a tampon, after removal which
pink glossy areas of the neck are found. The plaques themselves have
clear contours, rounded or oval.

Leukoplakia during pregnancy

If a woman planning a pregnancy has this
the disease, the doctor strongly recommends first treat
leukoplakia, and then become pregnant. Leukoplakia does not have
negative impact on the course of pregnancy or on growth and
fetal development. But in the period of gestation, when it changes dramatically and rapidly
hormones, perhaps the progression of the process. If a
the disease occurred during gestation, its treatment
lay off for the period after childbirth. Delivery is recommended through
natural birth canal. The exception is the growth of plaques and
spreading them to the vaginal walls, then
cesarean section.

Warning signs

In the case of malignancy leucoplakia lesions, that is, the appearance
atypical cells, the following symptoms may occur:

  • leukoplakia focus sharply and significantly increased in
    sizes;
  • unexpected formation of seals or erosion at the site
    flat leukoplakia;
  • there is uneven density of the lesion of flat leukoplakia,
    especially from one pole of the plaque;
  • with erosive leukoplakia forms in the center of the seal
    ulcer;
  • the appearance of ulcers on the surface of erosive leukoplakia:
  • on the plaque of simple leukoplakia papillary are formed or
    warty growths.

The listed symptoms should alert the doctor, although the process
malignant transformation can proceed without visible
changes in leukoplakia foci.

Diagnostics

The diagnosis is established on a set of clinical data,
laboratory, cytological and colposcopic examination.
During the initial treatment of the patient, the doctor carefully collects anamnesis.
(identification of provoking factors), complaints and inspect the cervix
uterus and vaginal walls in mirrors. Further assigned
additional survey methods:

Smear test

Bacterioscopic examination is carried out first.
vaginal and cervical smears for the purpose of determining vaginal
microflora. If necessary, assigned to the tank. seeding smears on
flora and research on genital infections by PCR.

Cytological examination of smears

Cytological examination allows to determine the quality
composition of epithelial cells. To this end, taken smears prints with
the visible part of the neck, from the lower third of the cervical canal and from the transitional
zones (border of leukoplakia plaque and healthy cervix area). Fence
material produced with a special brush or Eyre’s spatula.

When examining the material in a microscope, “flocks” of cells are detected
stratified squamous epithelium (normally it covers the vaginal
часть шейки), в which имеются явления гипер- и паракератоза. AT
in case of hyperkeratosis, a large number of non-nuclear
scales. And with parakeratosis, the density and color of the cytoplasm is enhanced in
small cells with possible violations of their differentiation,
proliferation and atypia.

Colposcopic examination

Examination of the cervix with colposcope has an important diagnostic
value and allows not only to determine the areas of leukoplakia,
which are not visible to the naked eye, but also determine their size and
suggest the presence of an atypical transformation (precancer).

If a очаги лейкоплакии видны при банальном осмотре в зеркалах,
speak of a clinically expressed form. AT случае определения
pathological foci only during colposcopy
called colposcopic form.

Signs of colposcopic form is the identification of so
called dumb iodine-negative zones that are only detected
when conducting a sample of Schiller. Schiller’s test is to color
cervix iodine solution (called Lugol solution). ABOUT
a positive test is indicated by a uniform coloration of the neck in
brown color, with negative sample revealed undyed
plots. ABOUTчаги лейкоплакии йодом не окрашиваются, так как
modified epithelial cells do not contain glycogen, which
reacts to iodine in brown.

Clinically expressed forms are leukoplakia lesions.
(thin and thick), visible both at usual survey, and
colposcopic, punctuation (multiple red dots) coarse
or tender as well as mosaic. Mosaic and punctuation are determined
only when viewed with a colposcope and indirectly indicate
precancerous transformation.

Histological examination

For histological examination, cervical biopsy is performed.
with the subsequent obligatory curettage of the cervical canal. Fence
material is produced from the most suspicious part of the neck under
control of colposcopy. Histological examination позволяет
estimate the depth of involvement in the pathological process of epithelial
cervical layers, and, most importantly, identify atypical cells.
The histological picture of this disease is as follows:

  • proliferation of multilayer epithelial cells;
  • uneven thickening of multilayer epithelium due to pronounced
    increasing the number of intermediate cells;
  • acanthosis;
  • horny layer (normally absent);
  • granular layer located under horny;
  • hyper and parakeratosis;
  • lymphocytic stromal infiltration.

Study of ovarian function

It is carried out according to indications and includes tests of the functional
diagnosis (basal temperature), the content of genital
hormones.

Immunogram

It is carried out according to indications.

Treatment

To eliminate cervical leukoplakia, various
treatment methods. But first you need to eliminate
inflammatory process (if available) and others
provoking factors. If you find inflammation of the genitals
or detection of genital infections prescribed drugs with
antiviral, antibacterial, anti-trichomonas or
antifungal effects (depending on the identified
pathogen). AT случае диагностики гормональных нарушений
Corrective hormone therapy is prescribed. How to treat
cervical leukoplakia caused by many factors, and
The specific treatment method is selected based on its shortcomings and
merits

Diathermocoagulation

The method is to influence the electric current
the affected area, after which a burn is created. Electrowaves
served on the electrode (loop or “button”), which is in contact with
damaged part of the cervix. Since the burn is formed
surface after processing, the method is also called cauterization.
Cauterization of cervical leukoplakia, although quite effective
way (reaches 70%), but very painful. To the benefits
method DTK can be attributed only:

  • cheapness;
  • the presence of the device DTK in almost every office
    gynecologist.

DTC has a lot of flaws, so now
rarely used. Cauterization is carried out in the first phase of the cycle, after
how monthly ended. The disadvantages include:

  • significant painfulness of the procedure;
  • exacerbation of inflammatory diseases of the uterus, ovaries and
    pipes;
  • high risk of bleeding as during
    cauterization, and after (premature rejection of the scab);
  • prolonged healing (up to 2 months);
  • cicatricial deformity of the neck up to atresia (fusion)
    cervical canal, therefore, is used only in giving birth
    women.

Cryodestruction

Treatment лейкоплакии холодом – криотерапия или криодеструкция,
is a highly efficient way. Cryodestruction efficiency
reaches 94%. The pathological area is affected by liquid nitrogen.
very low temperature. AT результате в клетках формируются
crystals, which lead to their destruction and subsequent necrosis.
The way to contact, the duration of the procedure depends on the nature and
the area of ​​the pathological focus (2 – 5 minutes). To pluses
�”Freezing” include:

  • painlessness;
  • good effect;
  • bloodlessness;
  • the possibility of use in birthless;
  • lack of scars.

Among the drawbacks of cryodestruction it is worth noting:

  • relapse of leukoplakia;
  • the probability of cervical shortening, which reduces the chances of
    conception.

Laser therapy

The most effective treatment for leukoplakia today
day is considered laser therapy. Focal Laser Coagulation
leukoplakia is performed in the first phase of the cycle and does not require
pain relief. Contactless method and is processing
СABOUT2-лазерным лучом патологического очага. AT результате из
the treated (pathological) cells the liquid evaporates, which
contributes to their destruction. Then on the wound surface
a thin coagulation film is formed that prevents
penetration of infection into the wound. AT случае распространения процесса на
Vagina treatment is carried out in 2 stages. At the first stage
the cervix is ​​processed, on the second – the vaults and walls of the vagina.
The advantages of the method are:

  • painlessness;
  • high efficiency;
  • the absence of scar deformity of the cervix (it can be given birth);
  • bloodlessness;
  • fast healing (16-40 days).

Of the shortcomings should be noted the high cost of the method and the presence of
special equipment (available only in specialized
clinics).

Read more about indications and contraindications.
laser therapy.

Radio wave method

For the treatment of this method using the apparatus “Surgitron”.
The method is modern, effective and contactless. Essence of the treatment
consists in inserting an electrode into the cervical canal, at the tip
which electric waves are converted to radio waves.
Abnormal cells heat up, liquid evaporates from them, and
there is a destruction of the center of leukoplakia. The advantages of the method
should include:

  • painlessness;
  • bloodlessness;
  • no scar deformation of the neck;
  • fast healing.

The disadvantage is perhaps one. Not all women’s clinics
have the device “Surgitron”

Chemical coagulation

This method of treatment of leukoplakia consists in processing
pathological site of the cervix Solkovagin. AT состав
This product includes organic and inorganic acids,
which coagulate (cauterize) the abnormal cells. Method
painless, suitable for those who did not give birth, reaches an efficiency of 75%.
Of the drawbacks it should be noted that the depth of penetration
drug no more than 2.5 mm, which makes its use ineffective
with atypical rough leukoplakia. And also the impossibility of processing
large areas of cervical lesions.

Postoperative period

AT postoperative doctors strongly recommend
observe sexual peace for 1.5 months. Also
It is forbidden to lift weights, hot baths, trips to the baths and
saunas. In addition, douching and
use of hygienic tampons. It is necessary to observe and
rules of intimate hygiene. AT первые 10 дней после любого способа
treatment of the cervix may cause the appearance of abundant liquid secretions,
that should not scare a woman. This is a reaction to treatment and
evidence of healing of the wound surface.

Traditional methods of treatment

In order to eliminate leukoplakia of the cervix is ​​not allowed
use of no popular methods of treatment. Diverse
douching, the introduction of tampons with herbs and other
not only will not benefit, but also contribute to the spread
process and the appearance of atypical cells.

Previously beloved doctors such methods of treatment of any pathology
cervix, like the introduction of sea buckthorn or rosehip tampons,
Aloe ointment and others are not currently used. Proven
что  перечисленные препараты влияют на тканевой обмен, что
causes the proliferation of abnormal cells and provoke the development
dysplasia.

ATопрос – ответ

ATопрос: Каков прогноз при лейкоплакии шейки и
Is it possible to fully recover?

ABOUTтвет: Да, полное излечение гарантировано
almost 99%. The prognosis for this disease is favorable, in
case of timely treatment and elimination of provoking factors.
AT противном случае возможно рецидивирование процесса, а в 15%
rebirth of leukoplakia in dysplasia and malignant degeneration
cervix.

ATопрос: Проводится ли диспансерный учет пациенток
after cervical leukoplakia therapy?

ABOUTтвет: Да, все больные после перенесенного
treatments are taken at the dispensary account. Every six months they are taken
мазки на цитологию, проводится кольпоскопия и ATПЧ-тестирование. With
negative outcomes and supportive colposcopic and
cytological picture after 2 years, the patient is removed from the register.

ATопрос: Можно ли забеременеть с лейкоплакией шейки
uterus?

ABOUTтвет: AT принципе, данная патология не
prevents conception, problems with pregnancy can be
due to other factors provoking leukoplakia. it
there may be hormonal disorders or hidden flowing genital
infections. AT любом случае, при выявлении лейкоплакии необходимо
first undergo treatment, and then plan a pregnancy.

ATопрос: Существует ли прививка от данного
diseases?

ABOUTтвет: Да, в настоящее время разработаны
Gardasil and Cervarix vaccines. ATведение данных вакцин предупреждает
human papillomavirus infection which provokes not
only the occurrence of cervical leukoplakia, but also dysplasia and cancer
necks.

ATопрос: Можно ли вести половую жизнь при наличии
лейкоплакии шейки uterus?

ABOUTтвет: Да, можно. But it is recommended to do
treatment of the disease, especially if there are complaints (discomfort during
sexual intercourse, blood discharge, etc.).

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