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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 |
| General Gross Description •white patches on the cervix •when viewed with colposcopy (an illuminated magnifying instrument) may see abnormal vascularization, irregular surface |
| General Microscopic 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 |
| Clinical Correlation •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 |
| References • Cotran RS, Kumar V, Robbins SL: Robbins Pathologic Basis of Disease. 5th ed. Philadelphia, W.B. Saunders, 1994, pp. 1048-1052 |
| Intraepithelial Neoplasia (Dysplasia)(Squamous Intraepithelial Lesion) |
| Synopsis by: Melinda Sanders M.D. (T83000M74007)[264] |
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