Cervix Cytology - HSIL / CIN III / severe dysplasia

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Cervix-Cytology

Atypia / premalignant / preinvasive lesions

HSIL / CIN III / severe dysplasia

Reviewer: Marilin Rosa, M.D., University of Florida (see Reviewers page)
Revised: 8 June 2011, last major update June 2011
Copyright: (c) 2002-2011, PathologyOutlines.com, Inc.

Terminology
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● Also called carcinoma in situ

Epidemiology
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● The median reporting rate of HSIL in US laboratories was 0.7% (Arch Pathol Lab Med 2004;128:1224)
● 2% of women with HSIL at cytology have invasive cancer upon further workup

Etiology
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● Due to high risk HPV infection

Clinical features
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● Cases with only a few abnormal cells are more likely to be missed (Arch Pathol Lab Med 2004;128:746)
● Underdiagnosis may be due to air drying artifact and metaplasia (Indian J Cancer 2004;41:104)
● Cases diagnosed antepartum usually persist postpartum, and 11% develop invasive carcinoma postpartum (Cancer 2004;102:228)

Cytology description
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● Usually single, small, round/oval cells with scant cytoplasm and increased N/C ratio (greater than 1/2)
● Nuclear membrane does not have sharp angles
● Nuclei vary markedly in contour and have irregular coarsely clumped chromatin
● No macronucleoli, no tumor diathesis

Cytology images
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Various images

Haphazard nuclei with clumped chromatin and hyperchromasia

HSIL in pregnant patient

HSIL and LSIL

HSIL, suspicious for invasion

Virtual slides
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High grade SIL

Other #1; #2

Differential Diagnosis
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● Atrophy

End of Cervix-cytology > Atypia / premalignant / preinvasive lesions > HSIL / CIN III / severe dysplasia

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