ULTRASTRUCTURAL CHARACTERISTICS OF TRUE CERVICAL EROSION (EROSIO VERA) BY SCANNING ELECTRON MICROSCOPY: A QUALITATIVE AND QUANTITATIVE ANALYSIS

Abstract

True cervical erosion (erosio vera) is characterized by denudation of the cervical epithelium with stromal exposure, but detailed SEM characterization remains limited. This study provides qualitative and quantitative SEM analysis of microrelief, cellular morphology, intercellular interactions, and vascular changes across clinical stages. Cervical tissue from 7 patients (mean age 43.6±7.2 years) was processed for SEM and evaluated for seven ultrastructural parameters with quantitative morphometry via ImageJ. True cervical erosion showed a well-demarcated epithelial defect (mean depth 25±5 μm) with sharp margins. The defect base consistently (100%) revealed exposed stroma with fibrin threads and erythrocytes in various hemolysis stages, with active thrombus formation in all cases. Cellular polymorphism was absent (0%), plasmolemma remained intact outside the defect zone (14.3% minimal peri-lesional changes), intercellular connections were completely preserved (0% disruption), and epithelial stratification was undisturbed. Erythrocyte poikilocytosis with pre-hemolytic forms was marked, and diapedetic hemorrhages beyond the defect margin occurred in 60% of cases. Healing erosions showed fibrin sheets with early re-epithelialization. Comparison with CIN I lesions (n=10) revealed significant differences in cellular polymorphism (0% vs 80%, p<0.001), plasmolemma disruption (14.3% vs 50%, p=0.04), and intercellular connection integrity (0% vs 40% disruption, p=0.006). SEM provides definitive ultrastructural criteria for distinguishing true cervical erosion from CIN I: a sharply demarcated epithelial defect with thrombus formation, absent cellular atypia, preserved intercellular architecture, and intact stratification.