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| Intraepithelial Neoplasia (Dysplasia)(Squamous Intraepithelial Lesion) |
| Etiology |
•human papillomavirus infection (HPV) •types 6 and 11 associated with low grade lesions •types 16, 18, 31, 33, 35 etc associated with high grade
lesions •cigarette smoking may also play a role |
| Pathogenesis |
•low grade lesions probably
represent self limited viral
infections with the cellular features representing
viral cytopathic effects •high grade lesions probably represent transformation of
the host genome by viral integration |
| Epidemiology |
•young women with multiple sexual partners or •young women with a high risk partner |
| Clinical |
•asymptomatic lesions not visible on usual speculum exam •detected on pap smear •without therapy up to 70% of the high grade lesions may
progress to invasive squamous carcinoma; <%5 of the mild
lesions ultimately progress to invasive carcinoma •treatment is generally ablative using a variety of
techniques to destroy the surface epithelium |
| General Gross Description |
•white patches on the cervix •when viewed with colposcopy (an illuminated magnifying
instrument) may see abnormal vascularization, irregular
surface |
| General Micro Description |
•loss of a single basal layer with crowding of the
squamous cells, hyperchromasia of the nuclei, and failure
to mature •mitotic figures seen above the basal cell layer •thickened epithelium which may contain koilocytes •mild (CIN1) when abnormal cells involve <1/3 of epithelial
thickness; moderate (CIN2) when between 1/3 and 2/3 and
severe (CIN3) when >2/3 of thickness |
| Reference |
• Cotran RS, Kumar V, Robbins SL: Robbins Pathologic Basis of Disease. 5th ed. Philadelphia, W.B. Saunders, 1994, pp. 1048-1052
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