Squamous intraepithelial lesion of the uterine cervix - Revision history

Michael: /* Sign-out */

2014-09-23T06:52:14Z

Sign-out

← Older revision		Revision as of 06:52, 23 September 2014
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	==Sign-out==		==Sign-out==
			{{Main\|Low-grade squamous intraepithelial lesion}}
			{{Main\|High-grade squamous intraepithelial lesion}}
	===ECC - cannot grade===		===ECC - cannot grade===
	<pre>		<pre>

Michael: trim down

2014-09-23T06:51:04Z

trim down

Show changes

Michael: /* Treatment */

2014-09-23T01:26:12Z

Treatment

← Older revision		Revision as of 01:26, 23 September 2014
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	Overview:		Overview:
	*[[LSIL]]: follow-up, as it usually regress.		*[[LSIL]]: follow-up, as it usually regress.
	*[[HSIL]]: excision (e.g. [[cervical cone]], [[LEEP]], laser) + follow-up.		*[[HSIL]]: excision (e.g. [[cervical cone\|cone]], [[LEEP]], laser) + follow-up.

	====Procedures====		====Procedures====

Michael: /* Treatment */

2014-09-23T01:25:52Z

Treatment

← Older revision		Revision as of 01:25, 23 September 2014
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	Overview:		Overview:
	*[[LSIL]]: follow-up, as it usually regress.		*[[LSIL]]: follow-up, as it usually regress.
	*[[HSIL]]: excision (e.g. cone, [[LEEP]], laser) + follow-up.		*[[HSIL]]: excision (e.g. [[cervical cone]], [[LEEP]], laser) + follow-up.

	====Procedures====		====Procedures====

Michael: /* ECC - cannot grade */

2014-02-20T14:47:19Z

ECC - cannot grade

← Older revision		Revision as of 14:47, 20 February 2014
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	there is at least low grade-dysplasia. Follow-up is recommended with		there is at least low grade-dysplasia. Follow-up is recommended with
	re-biopsy if clinically indicated.		re-biopsy if clinically indicated.
			</pre>

			<pre>
			UTERINE ENDOCERVIX, CURETTAGE:
			- FRAGMENTS OF SQUAMOUS EPITHELIUM SHOWING DYSPLASIA, CANNOT GRADE, SEE COMMENT.
			- BENIGN STRIPPED ENDOCERVICAL EPITHELIUM AND BENIGN SCANT ENDOCERVICAL MUCOSA.

			COMMENT:
			The fragments of squamous epithelium do not show the full epithelial thickness; this limits
			the interpretation.

			A p16 immunostain strongly marks very scant squamous epithelium, and a Ki-67 immunostain
			marks increased numbers of squamous cells.

			A cervical biopsy is suggested.
	</pre>		</pre>

Michael: /* ECC - cannot grade */

2014-02-17T19:00:58Z

ECC - cannot grade

← Older revision		Revision as of 19:00, 17 February 2014
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	<pre>		<pre>
	UTERINE CERVIX, BIOPSY:		UTERINE CERVIX, BIOPSY:
	- ~~FRAGEMENTS~~ OF SQUAMOUS EPITHELIUM SHOWING DYSPLASIA, SEE COMMENT.		- FRAGMENTS OF SQUAMOUS EPITHELIUM SHOWING DYSPLASIA, SEE COMMENT.

	COMMENT:		COMMENT:

Michael: /* Sign-out */ remove LSIL

2014-01-30T20:01:42Z

Sign-out: remove LSIL

← Older revision		Revision as of 20:01, 30 January 2014
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	===Cervical biopsy===		===Cervical biopsy===
	~~====LSIL====~~
	~~<pre>~~
	~~UTERINE CERVIX, BIOPSY:~~
	~~- LOW-GRADE SQUAMOUS INTRAEPITHELIAL LESION (LSIL).~~
	~~- NO ENDOCERVICAL EPITHELIUM IDENTIFIED.~~
	~~</pre>~~

	~~<pre>~~
	~~UTERINE CERVIX, BIOPSY:~~
	~~- LOW-GRADE SQUAMOUS INTRAEPITHELIAL LESION (LSIL).~~
	~~- TRANSFORMATION ZONE PRESENT.~~
	~~</pre>~~

	~~<pre>~~
	~~UTERINE CERVIX, BIOPSY:~~
	~~- LOW-GRADE SQUAMOUS INTRAEPITHELIAL LESION (LSIL).~~
	~~- CERVICITIS, CHRONIC.~~
	~~- NO ENDOCERVICAL EPITHELIUM IDENTIFIED.~~
	~~</pre>~~

	~~<pre>~~
	~~UTERINE CERVIX, BIOPSY:~~
	~~- LOW-GRADE SQUAMOUS INTRAEPITHELIAL LESION (LSIL).~~
	~~- TRANSFORMATION ZONE PRESENT.~~

	~~COMMENT:~~
	~~A p16 stain is patchy and confined mostly to the lower aspect of the squamous epithelium.~~
	~~</pre>~~
	~~====CIN 1====~~
	~~<pre>~~
	~~UTERINE CERVIX, BIOPSY:~~
	~~- CERVICAL INTRAEPITHELIAL NEOPLASIA 1 (MILD DYSPLASIA).~~
	~~- TRANSFORMATION ZONE PRESENT.~~
	~~</pre>~~

	~~<pre>~~
	~~COMMENT:~~
	~~The Ki-67 positive cells are confined to the lower aspect of the squamous epithelium.~~
	~~A p16 stain is negative.~~
	~~</pre>~~

	====At least CIN 2====		====At least CIN 2====
	<pre>		<pre>
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	===Micro===		===Micro===
	~~====CIN 1====~~
	The sections show the transformation zone. The squamous epithelium has cells with an increased nuclear size, nuclear hyperchromasia, perinuclear clearing and irregularities in the nuclear membrane. The nucleus-to-cytoplasm ratio is mildly increased. Occasional binucleation is identified. Mitoses are seen in the low third of the epithelium. Nucleoli are not apparent. No columnar dysplasia is identified.

	====CIN 2====		====CIN 2====
	The sections show the transformation zone.		The sections show the transformation zone.

Michael: /* Microscopic */ cut rest

2014-01-30T19:49:19Z

Microscopic: cut rest

← Older revision		Revision as of 19:49, 30 January 2014
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	===Low-grade squamous intraepithelial lesion===		===Low-grade squamous intraepithelial lesion===
	{{Main\|Low-grade squamous intraepithelial lesion}}		{{Main\|Low-grade squamous intraepithelial lesion}}

	~~====Koilocytes versus benign squamous====~~
	~~Koilocytes:~~
	*Perinuclear clearing.
	*Nuclear changes.
	**Size similar (or larger) to those in the basal layer of the epithelium.
	**Nuclear enlargement should be evident on low power, i.e. 25x. <ref>V. Dube 2008.</ref>
	**Central location - nucleus should be smack in the middle of the cell.

	~~Notes:~~
	~~# Both perinuclear clearing and nuclear changes are essential.~~
	~~# Benign cells have a small nucleus that is peripheral.~~

	~~====Images====~~
	~~<gallery>~~
	~~Image: Low-grade squamous intraepithelial lesion -- intermed mag.jpg \| LSIL - intermed. mag. (WC)~~
	~~Image: Low-grade squamous intraepithelial lesion -- p16 - intermed mag.jpg \| LSIL - intermed. mag. (WC)~~
	~~Image: Low-grade squamous intraepithelial lesion -- high mag.jpg \| LSIL - high mag. (WC)~~
	~~Image: Low-grade squamous intraepithelial lesion -- very high mag.jpg \| LSIL - very high mag. (WC)~~
	~~</gallery>~~
	~~<gallery>~~
	~~Image:Cervical intraepithelial neoplasia (2) koilocytosis.jpg\| CIN I. (WC/KGH)~~
	~~</gallery>~~
	~~www:~~
	*[http://www.flickr.com/photos/jian-hua_qiao_md/3987000055/ CIN 1 (flickr.com/Qiao)].
	*[http://www.eurocytology.eu/static/eurocytology/eng/cervical/mod6img1a.html CIN 1 (eurocytology.eu)].

	===High-grade squamous intraepithelial lesion===		===High-grade squamous intraepithelial lesion===

Michael: split out

2014-01-30T19:45:40Z

split out

← Older revision		Revision as of 19:45, 30 January 2014
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	===Treatment===		===Treatment===
	Overview:		Overview:
	*[[LSIL]]: ~~nothing~~, as usually regress.		*[[LSIL]]: follow-up, as it usually regress.
	*[[HSIL]]: excision (e.g. cone, [[LEEP]], laser) + follow-up.		*[[HSIL]]: excision (e.g. cone, [[LEEP]], laser) + follow-up.

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	==Microscopic==		==Microscopic==
	===Low-grade squamous intraepithelial lesion===		===Low-grade squamous intraepithelial lesion===
	~~Features - LSIL:<ref name=Ref_PBoD1075-6>{{Ref PBoD\|1075-6}}</ref>~~		{{Main\|Low-grade squamous intraepithelial lesion}}
	*"Koilocytic atypia":<ref name=Ref_GP146>{{~~Ref GP~~\|~~146}}</ref>~~
	**Cytoplasmic halos.
	**Nuclear enlargement >=3:1 enlarged nucleus:normal nucleus.
	**Nuclear membrane irregularities.
	**Nuclear hyperchromasia.
	**Coarse chromatin.
	**Binucleation may be seen (cytopathic effect of [[HPV]]).<ref name=pmid11491378>{{cite journal \|author=Roteli-~~Martins CM, Derchain SF, Martinez EZ, Siqueira SA, Alves VA, Syrjänen KJ \|title=Morphological diagnosis of HPV lesions and cervical~~ intraepithelial ~~neoplasia (CIN) is highly reproducible \|journal=Clin Exp Obstet Gynecol \|volume=28 \|issue=2 \|pages=78–80 \|year=2001 \|pmid=11491378 \|doi= \|url=}}</ref>~~

	~~Note:~~
	*Atypical cells usually close to basement membrane.
	**May be seen, focally, in the upper layers.<ref name=Ref_GP146>{{Ref GP\|146}}~~</ref>~~

	====Koilocytes versus benign squamous====		====Koilocytes versus benign squamous====

Michael: /* Cervical biopsy */

2014-01-29T13:16:51Z

Cervical biopsy

← Older revision		Revision as of 13:16, 29 January 2014
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	The HSIL is in keeping with at least CIN 2.		The HSIL is in keeping with at least CIN 2.
			</pre>

			====CIN 2 surrounded by endocervical epithelium====
			<pre>
			UTERINE CERVIX, BIOPSY:
			- HIGH-GRADE SQUAMOUS INTRAEPITHELIAL LESION (HSIL).
			- ENDOCERVICAL EPITHELIUM WITHIN NORMAL LIMITS.

			COMMENT:
			A p16 stain marks the full thickness of the squamous epithelium and is strong.
			A Ki-67 stain marks increased numbers of superficial epithelial cells.

			The epithelium surrounding the lesion is endocervical. No normal exocervical epithelium is
			apparent in the sampled tissue.

			The HSIL is in keeping with CIN 2.
	</pre>		</pre>