3001 GYN Cytology - Squamous Cell Abnormalities: Recognition

173 Pages·2014·21.14 MB·English

3001 GYN Cytology -
Squamous Cell Abnormalities:
Recognition, Differential Interpretation,
Management, Histopathologic Correlation
and HPV Testing
Fadi W. Abdul-Karim, MD, MMed (FASCP)
Christine Noga Booth, MD (FASCP)
Cleveland Clinic
Cleveland, Ohio
No Disclosures

In the past 12 months, we have not had a
significant financial interest or other
relationship with the manufacturer(s) of the
product(s) or provider(s) of the service(s) that
will be discussed in our presentation.
Learning Objectives
• Describe the spectrum of squamous cell
abnormalities and their differential diagnoses.
• Evaluate the significance and impact of the Pap
test management guidelines and the role of HPV
testing.
• Integrate practical diagnostic skills and
management guidelines into the interpretation of
squamous cell abnormalities.

Cervical Carcinogenesis Model
• Incremental progression from normal to
atypical to CIN1, to CIN2 to CIN3:

– A continuum of intraepithelial proliferations
– Grades distinguished by cumulative assessment of
several morphologic parameters : Degree of
maturation/basaloid proliferation, level of mitotic
activity/mitotic configuration, and cellular atypia
Age at Peak Prevalence for Each Stage in Cervical
Carcinogenesis
Schiffman M, Solomon D. N Engl J Med 2013;369:2324-2331.
Transient Infection Persistent HPV Infection
HPV
Mild Cytologic
abnormalities
Mild Cytologic
abnormalities
Progression
Invasion

Precancerous
Normal cervix HPV-infected cervix Cancer
lesion
Regression
Clearance
Wright and Schiffman NEJM 2003, 348(6):489
Maturation of Squamous Epithelium
• Cells become bigger
• Cells change from round to oval
to polygonal
• Cytoplasm volume increases
• Long axis of nucleus changes
from perpendicular to parallel
• Nuclear size decreases, cytoplasm
increases, N/C ratio decreases
• Mitotic activity only in parabasal
cells
• Cyanophilic basal cells mature to
pink/orange staining cells
ICN: 35um2

ECN: 40um2

MCN: 50um2
9
SIL/CIN/Dysplasia
Abnormal partial arrest in differentiation
resulting in:
• Increased thickness of “parabasal”
layer.
• With increasing severity of SIL, the
nuclear-to-cytoplasmic ratios
increase, mitotic activity increases,
and, in most cases, the cells appear
more immature.
• Nuclear changes present throughout
the full thickness of the epithelium,
irrespective of the severity of the
lesion.
• Cytologic sampling of the
superficial layers can detect both
low- and high-grade lesions. In
general, it is the relative maturation or
lack of maturation of the cytoplasm in
the superficial layers, coupled with
persistent mitotic activity, that defines
the severity of the process.