Cervix Cytology - HSIL / CIN II / moderate dysplasia

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Cervix-Cytology

Atypia / premalignant / preinvasive lesions

HSIL / CIN II / moderate dysplasia

Reviewer: Marilin Rosa, M.D., University of Florida (see Reviewers page)
Revised: 8 June 2011, last major update June 2011
Copyright: (c) 2006-2011, PathologyOutlines.com, Inc.

Terminology
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● CIN II / moderate dysplasia is classified as HSIL

Epidemiology
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● Mean reporting rate of HSIL in US laboratories was 0.5% (Arch Pathol Lab Med 2004;128:1224); 2% of women with HSIL at cytology have invasive cancer after further evaluation

Etiology
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● Due to infecton by high risk HPV

Clnical features
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● Cases with a few moderately dysplastic cells may have either LSIL or HSIL at followup, which cannot be predicted (Diagn Cytopathol 2000;23:245)

Treatment
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● Colposcopy, then as appropriate

Cytology description
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● Cell size is same as squamous metaplastic or parabasal cells; polygonal shape (like intermediate or superficial cell), denser cytoplasm
● N/C ratio is 1/3 to 1/2
● Enlarged and hyperchromatic nucleus
● Nuclear membranes may be irregular (crinkled paper)
● No nucleoli
● Check for variation in nuclear size at basal layer

Cytology images
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CIN II

Possible CIN II

Differential diagnosis
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● Atrophy, immature squamous metaplasia (College of American Pathologists Practical Guide to Gynecologic Cytopathology. Morphology, Management, and Molecular Methods)

End of Cervix-cytology > Atypia / premalignant / preinvasive lesions > HSIL / CIN II / moderate dysplasia

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