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Difference between revisions of "Low-grade squamous intraepithelial lesion"
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Low-grade squamous intraepithelial lesion (view source)
Revision as of 14:29, 6 May 2016
, 14:29, 6 May 2016no edit summary
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{{ Infobox diagnosis | {{ Infobox diagnosis | ||
| Name = {{PAGENAME}} | | Name = {{PAGENAME}} | ||
| Image = Low-grade squamous intraepithelial lesion -- high mag.jpg | | Image = Low-grade squamous intraepithelial lesion -- high mag.jpg | ||
| Width = | | Width = | ||
| Caption = LSIL. [[H&E stain]]. | | Caption = LSIL. [[H&E stain]]. | ||
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| Syndromes = | | Syndromes = | ||
| Clinicalhx = | | Clinicalhx = | ||
| Signs = acetowhite | | Signs = [[acetowhite lesion]] | ||
| Symptoms = | | Symptoms = | ||
| Prevalence = common | | Prevalence = common | ||
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'''Low-grade squamous intraepithelial lesion''', abbreviated '''LSIL''', is a pre-cancerous lesions of the [[uterine cervix]]. | '''Low-grade squamous intraepithelial lesion''', abbreviated '''LSIL''', is a pre-cancerous lesions of the [[uterine cervix]]. | ||
Increasingly, the term is being applied to other anatomical sites, e.g. [[vagina]]. | Increasingly, the term is being applied to other anatomical sites, e.g. [[vagina]], [[anal intraepithelial lesions|anus]]. | ||
It is in the larger category of '''[[Squamous intraepithelial lesion of the uterine cervix|squamous intraepithelial lesion]]''', abbreviated '''SIL'''. | It is in the larger category of '''[[Squamous intraepithelial lesion of the uterine cervix|squamous intraepithelial lesion]]''', abbreviated '''SIL'''. | ||
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Features:<ref name=Ref_PBoD1075-6>{{Ref PBoD|1075-6}}</ref> | Features:<ref name=Ref_PBoD1075-6>{{Ref PBoD|1075-6}}</ref> | ||
*"Koilocytic atypia":<ref name=Ref_GP146>{{Ref GP|146}}</ref> | *"Koilocytic atypia":<ref name=Ref_GP146>{{Ref GP|146}}</ref> | ||
** | **Clear cytoplasmic halos (perinuclear clearing). | ||
**Nuclear enlargement >=3:1 enlarged nucleus:normal nucleus. | **Nuclear enlargement. | ||
**Nuclear membrane irregularities. | ***Classically >=3:1 enlarged nucleus:normal nucleus. | ||
**Nuclear hyperchromasia. | ***May be mild (superficial cells = size of basal cells). | ||
**Nuclear membrane irregularities - '''important'''. | |||
**Nuclear hyperchromasia - '''important'''. | |||
**Coarse chromatin. | **Coarse chromatin. | ||
**Binucleation may be seen (cytopathic effect of [[HPV]]).<ref name=pmid11491378>{{cite journal |author=Roteli-Martins CM, Derchain SF, Martinez EZ, Siqueira SA, Alves VA, Syrjänen KJ |title=Morphological diagnosis of HPV lesions and cervical intraepithelial neoplasia (CIN) is highly reproducible |journal=Clin Exp Obstet Gynecol |volume=28 |issue=2 |pages=78–80 |year=2001 |pmid=11491378 |doi= |url=}}</ref> | **+/-Binucleation may be seen (cytopathic effect of [[HPV]]).<ref name=pmid11491378>{{cite journal |author=Roteli-Martins CM, Derchain SF, Martinez EZ, Siqueira SA, Alves VA, Syrjänen KJ |title=Morphological diagnosis of HPV lesions and cervical intraepithelial neoplasia (CIN) is highly reproducible |journal=Clin Exp Obstet Gynecol |volume=28 |issue=2 |pages=78–80 |year=2001 |pmid=11491378 |doi= |url=}}</ref> | ||
***Useful when present. | |||
Note: | Note: | ||
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Koilocytes: | Koilocytes: | ||
*Perinuclear clearing. | *Perinuclear clearing. | ||
*Nuclear changes. | **Halo should be crystal clear. | ||
*Nuclear changes - '''key feature'''. | |||
**Size similar (or larger) to those in the basal layer of the epithelium. | **Size similar (or larger) to those in the basal layer of the epithelium. | ||
**Nuclear enlargement should be evident on low power, i.e. 25x. <ref>V. Dube 2008.</ref> | ***Nuclear enlargement should be evident on low power, i.e. 25x.<ref>V. Dube 2008.</ref> | ||
**Central location - nucleus should be | **Nuclear hyperchromasia. | ||
**Central location - nucleus should be in the middle of the cell. | |||
***Benign cells have a small nucleus that is peripheral. | |||
===Images=== | ===Images=== | ||
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www: | www: | ||
*[http://www.flickr.com/photos/jian-hua_qiao_md/3987000055/ CIN 1 (flickr.com/Qiao)]. | *[http://www.flickr.com/photos/jian-hua_qiao_md/3987000055/ CIN 1 (flickr.com/Qiao)]. | ||
*[https://www.flickr.com/photos/jian-hua_qiao_md/3986999903/ CIN 1 (flickr.com/Qiao)]. | |||
*[http://www.eurocytology.eu/static/eurocytology/eng/cervical/mod6img1a.html CIN 1 (eurocytology.eu)]. | *[http://www.eurocytology.eu/static/eurocytology/eng/cervical/mod6img1a.html CIN 1 (eurocytology.eu)]. | ||
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<pre> | <pre> | ||
UTERINE CERVIX, BIOPSY: | UTERINE CERVIX, BIOPSY: | ||
- | - FRAGMENTS OF SQUAMOUS EPITHELIUM SHOWING DYSPLASIA, SEE COMMENT. | ||
COMMENT: | COMMENT: | ||
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to distinguish low-grade from high-grade in this specimen. That said, | to distinguish low-grade from high-grade in this specimen. That said, | ||
there is at least low grade-dysplasia. Follow-up is recommended with | there is at least low grade-dysplasia. Follow-up is recommended with | ||
re-biopsy if clinically indicated. | |||
</pre> | |||
===Biopsy - cannot grade=== | |||
<pre> | |||
UTERINE CERVIX, BIOPSY: | |||
- AT LEAST LOW-GRADE SQUAMOUS INTRAEPITHELIAL LESION (LSIL), SEE COMMENT. | |||
- BENIGN ENDOCERVICAL EPITHELIUM. | |||
COMMENT: | |||
A concerning area of dysplastic squamous epithelium is missing its surface cells. This | |||
precludes assessment for a high-grade lesion. Follow-up is recommended with | |||
re-biopsy if clinically indicated. | re-biopsy if clinically indicated. | ||
</pre> | </pre> | ||
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The Ki-67 positive cells are confined to the lower aspect of the squamous epithelium. | The Ki-67 positive cells are confined to the lower aspect of the squamous epithelium. | ||
A p16 stain is negative. | A p16 stain is negative. | ||
</pre> | |||
<pre> | |||
COMMENT: | |||
A p16 immunostain is strong and diffuse in the lower aspect of squamous epithelium, | |||
and weak and patchy in the superficial portions; this is compatible with LSIL. | |||
</pre> | </pre> | ||
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==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
==External links== | |||
*[http://www.medecine.ups-tlse.fr/dcem1/histologie/courtade/CINtec.pdf Interpretation altas for p16 staining (ups-tlse.fr)]. | |||
[[Category:Uterine cervix]] | [[Category:Uterine cervix]] | ||
[[Category:Diagnosis]] | [[Category:Diagnosis]] | ||