Low-grade squamous intraepithelial lesion: Difference between revisions

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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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| Micro      = nuclear membrane irregularies, nuclear hyperchromasia, +/-clear perinuclear halos (koilocytic change), +/-nuclear enlargement, large [[NC ratio]] (usually ~ 1:3), +/-mitoses (lower third)
| Micro      = nuclear membrane irregularies, nuclear hyperchromasia, +/-clear perinuclear halos (koilocytic change), +/-nuclear enlargement, large [[NC ratio]] (usually ~ 1:3), +/-mitoses (lower third)
| Subtypes  =
| Subtypes  =
| LMDDx      = [[high-grade squamous intraepithelial lesion]]
| LMDDx      = [[high-grade squamous intraepithelial lesion]], [[squamous metaplasia of the uterine cervix|squamous metaplasia]], [[reactive squamous epithelium of the uterine cervix|reactive changes]], normal cervix
| Stains    =
| Stains    =
| IHC        = p16 -ve (or lower 1/3 +ve), Ki-67 occasional cells - lower half
| IHC        = p16 -ve (or lower 1/3 +ve), Ki-67 occasional cells - lower half
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| Syndromes  =
| Syndromes  =
| Clinicalhx =
| Clinicalhx =
| Signs      = acetowhite positive lesion
| 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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Overview:
Overview:
*[[LSIL]]: follow-up unless persistent. It usually regresses on its own.   
*[[LSIL]]: follow-up unless persistent. It usually regresses on its own.   
==Gross==
*[[Acetowhite epithelium|Acetowhite lesion]].<ref name=pmid19256708>{{Cite journal  | last1 = Li | first1 = W. | last2 = Venkataraman | first2 = S. | last3 = Gustafsson | first3 = U. | last4 = Oyama | first4 = JC. | last5 = Ferris | first5 = DG. | last6 = Lieberman | first6 = RW. | title = Using acetowhite opacity index for detecting cervical intraepithelial neoplasia. | journal = J Biomed Opt | volume = 14 | issue = 1 | pages = 014020 | month =  | year =  | doi = 10.1117/1.3079810 | PMID = 19256708 }}</ref>


==Microscopic==
==Microscopic==
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>
**Cytoplasmic halos.
**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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DDx:
DDx:
*[[High-grade squamous intraepithelial lesion]].
*[[High-grade squamous intraepithelial lesion]].
*[[Uterine cervix with reactive changes]].
*[[Squamous metaplasia of the uterine cervix]].
*[[Reactive squamous epithelium of the uterine cervix]].
*Normal cervix.


===Koilocytes versus benign squamous===
===Koilocytes versus benign squamous===
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 smack in the middle of the cell.
**Nuclear hyperchromasia.
 
**Central location - nucleus should be in the middle of the cell.
Notes:
***Benign cells have a small nucleus that is peripheral.
# Both perinuclear clearing and nuclear changes are essential.
# 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:
- FRAGEMENTS OF SQUAMOUS EPITHELIUM SHOWING DYSPLASIA, SEE COMMENT.
- 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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==See also==
==See also==
*[[Squamous intraepithelial lesion of the uterine cervix|Squamous intraepithelial lesion]].
*[[Squamous intraepithelial lesion of the uterine cervix|Squamous intraepithelial lesion]].
*[[Uterine cervix]]
*[[Uterine cervix]].
*[[Gynecologic cytopathology]].
*[[Gynecologic cytopathology]].


==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]]
Retrieved from "https://librepathology.org/wiki/Low-grade_squamous_intraepithelial_lesion"