Diagnosis of cervical intraepithelial lesions by integrated cell and tissue changes
Department of Pathology, University of Massachusetts Medical School, Worcester, MA, United States
AIMS: Evaluation of cytologic and histologic alterations in intraepithelial lesions of the uterine cervix in relation to their neoplastic development. METHOD: Thirty-three cases of intraepithelial lesions with benign and atypical changes were followed, for periods up to 8 years 3 months. All patients were observed by yearly cytologic tests and biopsies. RESULTS: Retrospective examination of the cytologic and histologic alterations with followup information on outcome of the 33 cases revealed in all initial lesions a lack of differentiation from the basal layer to the surface. Benign lesions and those with carcinoma in situ (CIS) and infiltrating carcinoma had disorderly cell polarity whereas those that were designated as atypical dysplasia were distinguised by their uniform cell polarity. In benign intraepithelial lesions, the cell nuclei were often pale with discreet nucleoli, whereas the atypical dysplasias with uniform cell polarity were associated had spindle-shaped cells with a distinct malignant nuclear cribriform pattern. CIS and invasive carcinomas had cell nuclei with either hyperchromatic chomocenters and chromatin bands alone, or together with prominently enlarged nucleoli. Carcinogenic progression occurred only in cases of the initial lesions with intraepithelial alterations of atypical dysplasia and CIS. CONCLUSION: Integrated examination of histologic and cytologic changes in tissue sections of squamous intraepithelial lesions may permit prognostic evaluation.
Paper presented at the International Symposium on Predictive Oncology and Intervention Strategies; Nice, France; February 7 - 10, 2004; in poster session 896 (Tumor suppressor genes).