Cell surface characteristics and the detection of (pre)malignancy of the human uterine cervix

Introduction This review considers the SEM cel 1 surface pattern of the human ectocervical s tra tifi ed squamous epithelium and its differentiation during migration from the Ьаьаі to the exfoliating layer The outer surface of flattened superficial cells has been generally cha гас ten 7ed by microndgeb. Al though this surface pattern is indeed relatively stable -as fo,. lows from in apparently 11 mi ted sensitivity to preparation factorsit also shows dependency on the hormonal state of the patient. In contras', to the superficial cellb very kittle inforrratior ι s ava ι 1 able or the surface structure o** the rnrmal inLerncdiate, parabasal and basal ce' Is The deep surfaces of the superficial cell layers have been examined ubing a stripping techniqie, whereas «-he ьигГасеь of the deeper сеЛ layers have been investigated with a freezc-fracturing technique Juring migration from *-he basal cell layer upwards, the fol lowing s truc turai parame ters change gradual 1 y the shape of the cells, the si7c of the intercellular ьрасе and the length and width of the cellular procesbcs As a result oí •-he differentiation process the flattened eel Is of the superficial 7one acqui re microndges and crests on the luminal side These interdigitate respectively, with globular microvilli and furrows present on the ba&al side of the overlying eel I Crests and furrows del incate regions on *-he cell surface in which vanab ρ n^crondgear d mcrovil^us-patterns appear Be­ cause сгеь'. ь and furrows are not only presene on the cell margins but also more centrally on the surface, the eel 1 surface shows "regional ' dif­ ferences The functional significance of the eel* surface s true ture is discussed. Whereas the surface processes of the basal and parabasal cells presumably are engaged in the enhancement of interre 1 11,lar contact and must permit metabol ic interchange wi_h the intercellular space, the interdigitating processes of superficial celis probably deal with an increase of the surface adhesiveness and in particular the resistance to sideways movements KfcYWORDS cervix uteri, differentiation, epithe­ lium, exfoliated cells, f rcc7C-fract"uring, hor­ monal state, microridges, micróvi111, preparation, stripping. The normal uterine cervix possesses two types of epithelium A one layer thick, cylindrical epithelium lines the endocervical canal, whereas a non-keratimzmg stratified squamous epithelium in continuity with the vaginal epithelium, covers the ectocervix A metaplastic change of cylindrical epithelium into stratified squamous epi '•hel lum preferentially occurs at the squamo-columnar junct-ion between both types of epithel ia. The squamo-columnar junction is а-ьо the site where ргепеор^аьtic and neoplabt-. c transformation gener­ ally occurs. These are indications that the process of ep^^hellai differentiation in ^his reg or o^ ^he cervi χ is sensitive to di sturbi ng influences. Corditions that are of 1ikely mportance in metaplastic ce-il differentiation arc the hormonal s~atc of the patient and/or the pH of the cervica 1 mucus (Kroeks and Kremer, V)//, Singer, 14//) and various pathological processes such as inflammation. Several studies have been performed to find out whe theг or not (pre)neoplastic transformation of the ectocervical cells in biopsies or in cytological smears results in a modified cell surface structure as observable with a scanning electron microscope (SFM) (Jordan and Williams, 1971, WilІіагткэ et al , 1973a,b, Murphy et al. , 1 С )Л, t-rrcnczy and Hichnrt, 1 C )/J, Murphy et al. , 1974, FerenC7y and Hi chart, 1974, Bonilla-Musoles e t_al , 1974, Murphy et al , 1975, Allen et al. , 19/6. 1 udwig and Metzger, 19/b, Rubio and Kran? , 19/b, Rubio and Tinhorn, 19/7, Sherman, 19//, Ferenezy and Gel*and, 1979). This paper considers variation in b'-M surface structure of the ectocervical cell ir relation to ι ts location wi thin "he epithCi.iu"i, its actua contact with neighbouring cells and its dependency on the hormom. state of the patien t The influence of preparation procedures is also discussed. This information *ь of importance in settling the question of whether or not 5E.M structural alterationb can be used as a diagnostic criterium. Moreover, this information is relevant when applying more advanced methods of examination of the ecl1 surface such as the demonstration of cell surface receptors with labeling techniques Firstly, a survey of the SEM surface siructure of exfoliated and exfol lating normal ecto­ cervical cello will be given. The relation of this pattern with the hormonal state of the pat ι ent SCAWWIWG FLFCTOV MICRÖSCOPy/J98J/III [Pagtò 37-4&). SFM Inc., AMF О'Нале [Clu-cago), IL 60666, USA