Histopathology:
-Some loose aggregates and a few dispersed, fine to densely granular melanin-pigmented polygonal to wavy spindle melanocytes and dendritic cells, seen in the superficial cervical stroma, just below and around endocervical epithelium.
– The endocervical epithelium does not show melanocytes or melanin pigment accumulation.
– Atypical features and necrosis are not seen.
Note: The above presented cervical blue nevus is incidentally found in the hysterectomy specimen received for lipoleiomyoma.
Practical Points of Pathoclinics:
- Blue nevi are an uncommon, incidental microscopic finding in the endocervix in cases of hysterectomy specimens received for dysfunctional uterine bleeding, leiomyoma, adenomyosis, prolapse and many other indications. Very rarely it produces visible mass lesions.
- Most such lesions are asymptomatic, usually <5 mm in size, and appear as solitary or multiple brown color macules. The careful gross examination is necessary as these lesions are tiny and easily missed.
- In cervical melanosis, benign pigmented melanocytes are restricted in the cervical basal epithelium only. Melanin-laden cells are not seen in the stroma. Hyperkeratosis and acanthosis of epithelium are seen.
- Malignant melanoma is the important differential here. Symptoms like itching, discomfort, bleeding, ulceration, and clinical evidence of pigmentary irregularity indicate a need for biopsy evaluation. Atypical melanocytes, junctional activity, and stromal infiltration favor neoplastic lesion.
Reference:
– Bhat ST, Shivamurthy A, Kini Rao AC. Incidentally Detected Blue Nevus of Endocervix: a Case Report. Iran J Pathol. 2015 Summer;10(3):248-52. PMID: 26351493; PMCID: PMC4539768.