Cervical dysplasia specimens may present as:
Dysplasia is mainly seen as nuclei with hyperchromasia, coarse chromatin and irregular contours.
|Histology Grade||Corresponding Cytology||Description||Image|
|CIN 1 (Grade I)||Low-grade squamous intraepithelial lesion (LSIL)||
|CIN 2/3||High-grade squamous intraepithelial lesion (HSIL)[notes 1]||
|CIN 2 (Grade II)[notes 2]||
|CIN 3 (Grade III)[notes 3]||
Spectrum from normal to high grade SIL.[images 1]
Endocervical gland invasion is associated with high-grade lesions.
Invasive cervical cancer is most commonly squamous cell carcinoma (about 80–85% of cervical cancers). In contrast to tangentially cut projections of glands involved by HSIL, the invasive nests of tumor cells are irregular and accompanied by a distinct stromal reaction of edema and chronic inflammatory cells.[images 2]
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.
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").
Indications for p16 immunostaining are:
- 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.
If a neoplasia is found, the report should include:
- The histolopathological type and degree of differentiation
- Location and extent, if possible (generally not on biopsies)
- Radicality, if possible (generally not in biopsies)
High-grade squamous intraepithelial lesion (CIN-2), present at 3:00 to 12:00.
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.
- HSIL+ encompasses HSIL, AGC, and cancer
- CIN 2+ encompasses CIN 2, CIN 3, adenocarcinoma in situ (AIS), and cancer
- CIN 3+ encompasses CIN 3, AIS, and cancer
- 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
- 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.
- . What Is Cervical Cancer?. American Cancer Society.
- . Cervical cancer – Types and grades. Cancer Research UK.
- 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. .
- Monica Dahlgren, Janne Malina, Anna Måsbäck, Otto Ljungberg. Stora utskärningen. KVAST (Swedish Society of Pathology). Retrieved on 2019-09-26.
- Ed Uthman from Houston, TX, USA. Creative Commons Attribution 2.0 Generic (CC BY 2.0) license
- Invasive Squamous Carcinoma of the Cervix. Cold Knife Cone (6076190079).jpg by Ed Uthman, MD. Creative Commons Attribution 2.0 Generic (CC BY 2.0) license