Cervical dysplasia

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Author: Mikael Häggström [note 1]

Presentations

Cervical dysplasia specimens may present as:

Microscopic evaluation

Dysplasia is mainly seen as nuclei with hyperchromasia, coarse chromatin and irregular contours.[1]

Dysplasia grading

Cervical intraepithelial neoplasia
Histology Grade Corresponding Cytology Description Image
CIN 1 (Grade I) Low-grade squamous intraepithelial lesion (LSIL)
  • Mild epithelial dysplasia
  • Confined to the basal 1/3 of the epithelium
LSIL (CIN 1), Cervical Biopsy (3776284166).jpg
CIN 2/3 High-grade squamous intraepithelial lesion (HSIL)[notes 1]
  • Represents a mix of low and high-grade lesions not easily differentiated by histology
CIN 2 (Grade II)[notes 2]
  • Moderate dysplasia confined to the basal 2/3 of the epithelium
High-Grade Squamous Intraepithelial Lesion of the Cervix (311128961).jpg
CIN 3 (Grade III)[notes 3]
  • Severe dysplasia with undifferentiated neoplastic cells that span more than 2/3 of the epithelium
  • May involve the full thickness
  • May also be referred to as cervical carcinoma in situ
Histopathology of CIN 3.jpg

Radicality

Locations of non-radicality should be reported in relation to tissue markings (such as needles), or in terms of quadrants or corresponding to a clock face, based on the patient being in supine position.

Look whether there is normal epithelium on each side of all slices where neoplasia is seen, and when the epithelium is missing in any direction, consider ordering additional serial sections or step sections.

HPV changes

Also look koilocytic changes of human papillomavirus (HPV), with such cells typically displaying:

  • Nuclear enlargement (two to three times normal size).
  • Irregularity of the nuclear membrane contour, creating a wrinkled or raisinoid appearance.
  • A darker than normal staining pattern in the nucleus, known as hyperchromasia.
  • Perinuclear cytoplasmic vacuolization ("nuclear halo").

p16 immunostaining

p16 staining. To support a diagnosis of high-grade SIL, the reaction needs to be strong and diffuse, as seen here.

Indications for p16 immunostaining are:[5]

  • To differentiate between HSIL and mimics such as atrophy, immature squamous metaplasia, or tangential cuts.
  • If a diagnosis of cervical intraepithelial neoplasia grade 2 (CIN2) is considered
  • In case of professional disagreement.
  • Cases of high-risk colposcopic referral situations where the H&E biopsy specimen is interpreted as LSIL or lower.

Microscopy report

If a neoplasia is found, the report should include:[6]

  • The histolopathological type and degree of differentiation
  • Location and extent, if possible (generally not on biopsies)
  • Radicality, if possible (generally not in biopsies)
Histopathology of CIN 3.jpg

High-grade squamous intraepithelial lesion (CIN-2), present at 3:00 to 12:00.
All margins of excision are negative for CIN-2.

Example microscopic description

The transition zone has thickened endocervical epithelium with poorly differentiated neoplastic cells, which span more than half of the epithelial thickness, and with invasion of endocervical glands. Otherwise, glands are clad by a simple columnar epithelium without atypia. The neoplastic cells are radically removed.

Notes

  1. HSIL+ encompasses HSIL, AGC, and cancer
  2. CIN 2+ encompasses CIN 2, CIN 3, adenocarcinoma in situ (AIS), and cancer
  3. CIN 3+ encompasses CIN 3, AIS, and cancer
  1. For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.

Main page

References

  1. Khaled J. Alkhateeb, M.B.B.S., Ziyan T. Salih, M.D.. HSIL / CIN II / CIN III. PathologyOutlines. Topic Completed: 29 March 2021. Minor changes: 9 February 2022
  2. Nagi, Chandandeep S.; Schlosshauer, Peter W. (2006). "Endocervical glandular involvement is associated with high-grade SIL ". Gynecologic Oncology 102 (2): 240–243. doi:10.1016/j.ygyno.2005.12.029. ISSN 00908258. 
  3. . What Is Cervical Cancer?. American Cancer Society.
  4. . Cervical cancer – Types and grades. Cancer Research UK.
  5. Clinton LK, Miyazaki K, Ayabe A, Davis J, Tauchi-Nishi P, Shimizu D (2015). "The LAST guidelines in clinical practice: implementing recommendations for p16 use. ". Am J Clin Pathol 144 (6): 844-9. doi:10.1309/AJCPUXLP7XD8OQYY. PMID 26572990. Archived from the original. . 
  6. Monica Dahlgren, Janne Malina, Anna Måsbäck, Otto Ljungberg. Stora utskärningen. KVAST (Swedish Society of Pathology). Retrieved on 2019-09-26.

Image sources