Difference between revisions of "Squamous intraepithelial lesion of the uterine cervix"

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Squamous intraepithelial lesion of the uterine cervix (view source)

Revision as of 03:05, 24 November 2013

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→‎Microscopic: rework
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==Microscopic==
==Microscopic==
===Cervical intraepithelial neoplasia I===
===Low-grade squamous intraepithelial lesion===
Features - Cervical intraepithelial neoplasia (CIN) I:<ref name=Ref_PBoD1075-6>{{Ref PBoD|1075-6}}</ref>
Features - LSIL:<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.
**Cytoplasmic halos.
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*Atypical cells usually close to basement membrane.
*Atypical cells usually close to basement membrane.
**May be seen, focally, in the upper layers.<ref name=Ref_GP146>{{Ref GP|146}}</ref>
**May be seen, focally, in the upper layers.<ref name=Ref_GP146>{{Ref GP|146}}</ref>
====Koilocytes versus benign squamous====
Koilocytes:
*Perinuclear clearing.
*Nuclear changes.
**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>
**Central location - nucleus should be smack in the middle of the cell.
Notes:
# Both perinuclear clearing and nuclear changes are essential.
# Benign cells have a small nucleus that is peripheral.


====Image====
====Image====
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*[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)].


===Cervical intraepithelial neoplasia II===
===High-grade squamous intraepithelial lesion===
Features - CIN II:<ref name=Ref_PBoD1075-6>{{Ref PBoD|1075-6}}</ref>
Features - CIN II:<ref name=Ref_PBoD1075-6>{{Ref PBoD|1075-6}}</ref>
*Increased nuclear-cytoplasmic ratio, loss of polarity, incr. mitoses, hyperchromasia.
*Increased nuclear-cytoplasmic ratio, loss of polarity, incr. mitoses, hyperchromasia.
**If there are large nuclei... you should seen 'em on low power, i.e. 25x.
**If there are large nuclei... you should seen 'em on low power, i.e. 25x.
Image:
<gallery>
Image:Cervical intraepithelial neoplasia (3) CIN2.jpg| CIN II. (WC/KGH)
</gallery>
===Cervical intraepithelial neoplasia III===
Features - CIN III:<ref name=Ref_PBoD1075-6>{{Ref PBoD|1075-6}}</ref>
*Same changes as in CIN II + outer third (or full thickness).


Notes:
Notes:
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#The most probably place for CIN is the posterior cervix (6 o'clock position) - risk is marginally increased.<ref name=pmid16378031>{{Cite journal  | last1 = Pretorius | first1 = RG. | last2 = Zhang | first2 = X. | last3 = Belinson | first3 = JL. | last4 = Zhang | first4 = WH. | last5 = Ren | first5 = SD. | last6 = Bao | first6 = YP. | last7 = Qiao | first7 = YL. | title = Distribution of cervical intraepithelial neoplasia 2, 3 and cancer on the uterine cervix. | journal = J Low Genit Tract Dis | volume = 10 | issue = 1 | pages = 45-50 | month = Jan | year = 2006 | doi =  | PMID = 16378031 }}
#The most probably place for CIN is the posterior cervix (6 o'clock position) - risk is marginally increased.<ref name=pmid16378031>{{Cite journal  | last1 = Pretorius | first1 = RG. | last2 = Zhang | first2 = X. | last3 = Belinson | first3 = JL. | last4 = Zhang | first4 = WH. | last5 = Ren | first5 = SD. | last6 = Bao | first6 = YP. | last7 = Qiao | first7 = YL. | title = Distribution of cervical intraepithelial neoplasia 2, 3 and cancer on the uterine cervix. | journal = J Low Genit Tract Dis | volume = 10 | issue = 1 | pages = 45-50 | month = Jan | year = 2006 | doi =  | PMID = 16378031 }}
</ref>
</ref>
*The difference between CIN II (moderate dysplasia) and CIN III (severe dysplasia) is: changes as in CIN II + outer third (or full thickness).<ref name=Ref_PBoD1075-6>{{Ref PBoD|1075-6}}</ref>


DDx:
DDx:
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====Images====
====Images====
Image:
<gallery>
Image:Cervical intraepithelial neoplasia (3) CIN2.jpg| CIN II. (WC/KGH)
</gallery>
<gallery>
<gallery>
Image:Cervical_intraepithelial_neoplasia_(4)_CIN3.jpg| CIN III. (WC/KGH)
Image:Cervical_intraepithelial_neoplasia_(4)_CIN3.jpg| CIN III. (WC/KGH)
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*[http://www.flickr.com/photos/euthman/3995927827/in/pool-labmed CIN III (flickr.com/euthman)].
*[http://www.flickr.com/photos/euthman/3995927827/in/pool-labmed CIN III (flickr.com/euthman)].
*[http://www.flickriver.com/photos/euthman/tags/hsil/ CIN III - several images (flickriver.com)].
*[http://www.flickriver.com/photos/euthman/tags/hsil/ CIN III - several images (flickriver.com)].
===Koilocytes versus benign squamous===
Koilocytes:
*Perinuclear clearing.
*Nuclear changes.
**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>
**Central location - nucleus should be smack in the middle of the cell.
Notes:
# Both perinuclear clearing and nuclear changes are essential.
# Benign cells have a small nucleus that is peripheral.


==IHC==
==IHC==
Michael
48,436

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