الفهرس 
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Abstract
This work was performed to study the problem of the clinically
unhealthy cervix through comparison of cytologic, colposcopic and
histopathologic findings, and evaluation of immunohistochemical examination
of various cervical lesions, 8iS an additional technique for’increasing sensitivity
of conventional Haematoxytin and Eosin histopathological examination in
detection of premalignant cervical lesions.
This study included a group of 80 non-pregnant women with the mean
age 30.26 years, the mean age of marriage 19.88 years, the mean duration of marriage 10.38 years, the mean parity 3.5 - having clinically unhealthy cervix
as identified to have one or more of the following criteria: whilte or ted
patches, polyps, hypertrophied cervix, ulcer, endocervical purulent discharge,
nodular cervix with retention cyst.
For every patient; a full history was taken, general and abdominal
examination were done, cytological examination followed by colposcopic
examination and directed punch biopsy (for histopathology and
immunohistochemical staining using monocolonal anticytokeratin 18
antibodies); and finally bimaaaal examination.to exclude any pelvic lesions.
In this study.cytological examintion revealed; normal smear in 6 cases,
one case atrophic smear, 2:S cases showed non specific inflammation, 6 cases trichomonas vaginalis,. S cases candidiasis, one case chlamydia, 34 cases low grade squamous intraepitbelial lesions and 2 cases high grade squamous
intraepitheliallesions.
In colposcopic examination we found no colposcpic findings inS cases,
then colposcopicappearance of: atrophic cervix in one case, non specific
inflammation in 21 cases, trichomonas vaginalis in 5 cases, candidiasis in 4
cases, chlamydia in one case, polyp in 2 cases, By use of Reid’s colposcopic
index we found 36 cases giving the colposcopic impression of low’ grade
squamous intraepitheliallesions and 5 cases with the colposcopic impression of
high grade squamous intraepitheliallesions.
As regard to the histopathology, 4 cases showed no pathological lesion,
one case showed atrophic lesion, 18 cases showed non specific inflammation,
one case showed chlamydia, one case showed bilharziasis, 4 cases showed
immature metaplasia, 4 cases showed microglandular hyperplasia, 2 cases
showed infected polyp, 39 cases showed low grade squamous intraepithelial
lesions and 6 showed high grade squamous intraepitheliallesions.
Immunohistochemical staining of tissue specimens of 53 cases revealed;
23 ?ases showed negative staining, 14 cases showed faint positive staining (12
cases low grade SIL - one case immature metaplasia - one case microglandular
hyperplasia), 10 cases showed positive staining (8 cases low grade SIL - 2
cases high grade SIL), and 6 cases showed strong positive staining (2 cases low
grade SIL - 4 cases high grade SIL).
Sensitivity of cytology in diagnosis of squamous intraepitheliallesions
was 80.00%, specificity was 100.00%, positive predictive value was 100.00%,
negative predictive value was 79.50%, accuracy was 88.70% and false negative
cytology rate was 20.00%.
Sensitivity of colposcopy in diagnosis of squamous intraepithelial
lesions was 91.10%, specifiicity was 100.00%, positive predictive value was
100.00%, negative predictive value was 89.71% and accuracy was 95.00%.
• Squamous intraepithelial lesions (SlLs) are more common in clinically
unhealthy cervices, So, cytologic, colposcopic, histopathologic and
immlmohistochemical examinations are recommended in clinically
unhealthy cervices.
• The accuracy of colposcopy in prediction of SIL~ is higher than the
accuracy of cytology. The use of the Reid’s colposcopic index could greatly
improve the accuracy of colposcopy and might provide a uniform and
objective basis for comparison,
• The accuracy of immunohistochemical staining usmg monocolonal
anticytokeratin 18 antibodies in prediction of high gradeSILs is 100”10. So, immunohistochemistry could _be_used. as an additi~onalJ~chniqne for
increasing the sensitivity ofhist~at.1l0logic~ c::x:amin~~~I!iJ!.ctetect.iCo?n,f
high grade SILs.