Epidermalization of cervix and vagina: an unsolved dilemma

Epidermoid metaplasia of the uterine cervix and vagina has previously been described, yet few well-documented cases exist. The tendency of the cervical and vaginal epithelium to undergo reactive changes as, for example, adenosis, squamous hyperplasia, hyperkeratosis, and parakeratosis is well known. Such changes can be secondary to uterine prolapse or to other causes that produce continuous irritation. The presence of ectodermal appendages (e.g., sebaceous glands and/or hair follicles), on the other hand, is less common. This is an interesting phenomenon, specially taken into consideration that the embryologic origin of the cervix and upper third of the vagina is from the mullerian duct.

We present and discuss the case of a 70-year-old patient that, on routine gynecologic examination, showed whitish areas on the upper vagina and cervix. Biopsies from such areas demonstrated melanin pigment in the basal squamous epithelium, hyperkeratosis, and hair follicles with associated sebaceous glands.

The presence of ectodermal structures in the cervix and upper vagina can be seen and is still an unresolved issue. To the authors, this phenomenon probably represents metaplastic changes instead of a developmental abnormality.