bubble_chart Overview

Leucoplasia of the cervix refers to a grayish-white, opaque patch-like lesion that appears in the vaginal portion of the cervix. Most scholars believe that the clinically visible white patches merely indicate varying degrees of epithelial hyperplasia. With in-depth research on precancerous lesions and early-stage cervical carcinoma, as well as the widespread use of colposcopy, this condition has gradually gained attention.

bubble_chart Etiology

The disease cause of cervical leukoplakia is not yet clear, but it may be related to the following factors:

(1) Endocrine disorders: Increased estrogen levels in the body, leading to abnormal keratinization of the cervical surface epithelium.

(2) Local irritation: Such as chronic cervicitis or the influence of vaginal trichomoniasis. In a clinical analysis of 700 cervical erosion biopsy cases by Zhongshan Medical University, 37 cases of cervical leukoplakia were identified, accounting for 5.2%. This indicates a significant increase in incidence among cases of chronic cervicitis.

(3) Other factors: According to literature reports, cervical leukoplakia occasionally coexists with atypical hyperplasia, carcinoma in situ, or early invasive carcinoma. It is suggested that the occurrence of cervical leukoplakia may be related to the carcinogenic factors of cervical carcinoma.

bubble_chart Pathological Changes

Upon gross observation, whitish opaque patchy areas of varying sizes and shapes can be seen on the surface of the cervix, typically small in size with diameters not exceeding 1 cm. They may appear singly or multiply, and in some cases, the leukoplakia may extend beyond the cervix to the vaginal fornix. The surface appears grayish-white or slightly shinier than the surrounding pink mucous membrane, with some lesions having neat, clearly defined edges while others are irregular. The surface of the leukoplakia can be easily wiped off with a cotton swab, revealing punctate bleeding at the base.

Microscopic examination reveals the following characteristics: ① The superficial layer of the leukoplakia shows hyperkeratosis or parakeratosis; ② Epithelial cells exhibit hyperplasia and hypertrophy, accompanied by thickening of the prickle cell layer; ③ The granular cell layer thickens, with elongation and widening of the epithelial ridges; ④ The subepithelial stroma shows infiltration of round cells and lymphocytes. Based on histological features, cervical leukoplakia is classified into two grades: Grade I leukoplakia shows only 2–3 layers of keratinization or parakeratosis on the cervical epithelial surface, with the prickle cell and basal cell layers remaining normal or exhibiting benign hyperplasia; Grade II leukoplakia is characterized by atypical hyperplasia of the epithelial cells beneath the keratinized layer.

bubble_chart Clinical Manifestations

Simple cervical leukoplakia is often asymptomatic and may resolve spontaneously; if combined with cervical erosion or cervical ectropion, there may be an increase in leucorrhea, or occasional bloody vaginal discharge and contact bleeding. Local examination findings are as described above.

bubble_chart Diagnosis

(1) Local visual inspection: Through careful observation of the cervical area, white patch regions can be detected, but incomplete keratinization lesions cannot be identified with the naked eye.

(2) Iodine solution test: Due to the lack of glycogen storage capacity in epithelial keratinization or incomplete keratinization, the iodine-stained area does not take on color, which helps identify the extent of the lesion. However, the iodine test is non-specific, as conditions such as cervical erosion, ectropion, or precancerous lesions can also yield positive results.

(3) Colposcopy: Using colposcopy to magnify and observe cervical lesions makes it significantly easier to detect cervical leukoplakia compared to naked-eye observation. Shanghai Second Medical University conducted colposcopy on 1,000 cases, identifying cervical leukoplakia in 79 cases, accounting for 7.9%.

Based on local visual inspection, the iodine test, and colposcopy, diagnosis is generally not difficult. However, it is more important to conduct further examinations after detecting leukoplakia to avoid missing early cervical cancerous changes coexisting with fistula disease and leukoplakia. According to literature reports, various types of leukoplakia observed under colposcopy are significant manifestations of early cervical cancer. For example, among 60 cases of abnormal changes observed via colposcopy in 105 cases of carcinoma in situ, various types of leukoplakia accounted for the majority (36 cases). For cervical leukoplakia, a biopsy should be performed to rule out the presence of early cancer.

bubble_chart Treatment Measures

Since cervical leukoplakia is a benign sexually transmitted disease, cervical electrocoagulation or cryotherapy can generally be performed after excluding malignant sexually transmitted disease changes. For those with concurrent grade III cervical erosion, cervical conization may be considered, followed by continuous pathological section examination to determine the presence of early cervical carcinoma, allowing timely further treatment. For asymptomatic patients, close observation and regular follow-ups are recommended.