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Difference between revisions of "Uterine cervix"
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→Cervical intraepithelial neoplasia (CIN): ref location of lesion most likely
(→Cervical intraepithelial neoplasia (CIN): ref location of lesion most likely) |
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=Non-invasive= | =Non-invasive= | ||
==Cervical intraepithelial neoplasia | ==Cervical intraepithelial neoplasia== | ||
Refers to changes in squamous epithelium. | *Abbreviated ''CIN''. | ||
===General=== | |||
*Refers to changes in squamous epithelium. | |||
Grades (squamous intraepithelial neoplasia): | Grades (squamous intraepithelial neoplasia): | ||
| Line 85: | Line 88: | ||
*HSIL (high-grade squamous intraepithelial lesion) = CIN II, CIN III. | *HSIL (high-grade squamous intraepithelial lesion) = CIN II, CIN III. | ||
===Treatment=== | ====Treatment==== | ||
*LSIL: nothing, as usually regress. | *LSIL: nothing, as usually regress. | ||
*HSIL: excision (e.g. cone, LEEP, laser) + followup. | *HSIL: excision (e.g. cone, LEEP, laser) + followup. | ||
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*Pathologist gets a ring or donut-shaped piece of tissue. | *Pathologist gets a ring or donut-shaped piece of tissue. | ||
=== | ===Microscopic=== | ||
Features: | |||
*CIN I = cytoplasmic halos (koilocytic atypia), atypical cells close to basement membrane only. | *CIN I = cytoplasmic halos (koilocytic atypia), atypical cells close to basement membrane only. | ||
**Nuclear enlargement -- >=3:1 enlarged nucleus:normal nucleus. | **Nuclear enlargement -- >=3:1 enlarged nucleus:normal nucleus. | ||
| Line 106: | Line 110: | ||
Notes: | Notes: | ||
#Hyperchromasia is a very useful feature for identifying CIN (particularly at low power, i.e. 25x). | |||
#Koilocytes are the key feature of CIN I. | |||
#Koilocytes are ''not'' considered to be part of a CIN II lesion or CIN III lesion. | |||
#Large irregular nuclei are not required for CIN II... but you should think about it. | |||
#Some mild changes at the squamo-columnar junction are expected. | |||
#Look for the location of mitoses... | |||
#* If there is a mitosis in the inner third (of the epithelial layer) = at least CIN I. | |||
#* If there is a mitosis in the middle third (of the epithelial layer) = at least CIN II. | |||
#* If there is a mitosis in the outer third = CIN III. | |||
#Nucleoli are usually NOT present in CIN.<ref>STC. January 2009.</ref> | |||
#*Nucleoli are common in reactive changes.<ref>STC. January 2009.</ref> | |||
#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> | |||
====Koilocytes versus benign squamous==== | ====Koilocytes versus benign squamous==== | ||