Abstract
Preinvasive intraepithelial lesions contain a group of proliferative lesions characterized by abnormal cytological and histological differentiation, maturation, and stratification of squamous or columnar epithelium. Microscopically they are characterized by nuclear atypia, increased mitotic activity, and the presence of atypical mitoses and cellular pleomorphism on all epithelium levels, regardless of the degree of cytoplasm maturation [1]. The intensity of these lesions varies in accordance with the extent of epithelial involvement. Since these lesions have a potential to develop into invasive carcinoma, pathological diagnosis plays a very important role in the management of these conditions. The fear of missing an invasive carcinoma leads to a tendency of overdiagnosis by the pathologist and overtreatment by the clinician. Hence, understanding the basic pathology and the use of correct terminology and standard management guidelines are the need of the hour. A good knowledge of the etiology, pathophysiology, and natural history of cervical intraepithelial neoplasia (CIN) provides a strong basis both for visual testing and for colposcopic diagnosis and understanding the principles of treatment of these lesions. This chapter describes the evolution of the classification systems of cervical squamous cell cancer precursors and the cytological and histological basis of their diagnosis.
Keywords
- Cervical Cancer
- Cervical Intraepithelial Neoplasia
- Bacterial Vaginosis
- Squamous Metaplasia
- Nuclear Abnormality
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsBibliography
Muntean M, Simionescu C, Taslica R, et al. Cytological and histopathological aspects concerning pre-invasive squamous cervical lesions. Curr Health Sci J. 2010;36(1):26–32.
Castellsagué X, Muñoz N. Cofactors in human papillomavirus carcinogenesis–role of parity, oral contraceptives, and tobacco smoking. J Natl Cancer Inst Monogr. 2003;31:20–8.
Ferenczy A, Franco E. Persistent human papillomavirus infection in cervical neoplasia. Lancet Oncol. 2002;3:11–6.
Sonnex C. Human papillomavirus infection with particular reference to genital disease. J Clin Pathol. 1998;51:643–8.
Doorbar J. Molecular biology of human papillomavirus infection and cervical cancer. Clin Sci (Lond). 2006;110:525–41.
Reagan JW. Dysplasia of the uterine cervix. In: Gray LA, editor. Dysplasia, Carcinoma in Situ and Microinvasive Carcinoma. Springfield: Thomas;1965.
Richart RM. Natural history of cervical intraepithelial neoplasia. Clin. Obstet. Gynecol. 1967;10:748.
National Cancer Institute workshop. The 1988 Bethesda System for reporting cervical/vaginal cytologic diagnosis. JAMA 1989;262:931–4.
National cancer Institute Workshop. The 1991 Bethesda System for reporting cervical/vaginal cytologic diagnosis. Acta Cytologica 1993;37:115–24.
Soloman D. The 1988 Bethesda System for reporting cervical/ vaginal cytologic diagnosis.Acta Cytologica 1989;33:567–74.
Kurman RJ, Malkisian GD Jr, Sedlis A, et al. From Papanicolaou to Bethesda:the rationale for a new cervical cytologic classification. Obstet Gynecol 1991;77:779–82.
Waxman GA, Chelmow D, Darragh TM, et al. Revised terminology for cervical histopathology and its implications for management of high-grade squamous intraepithelial lesions of the cervix. Obstet Gynecol. 2012;120(6):1465–71.
Tavassoli FA, Devilee P, editors. World Health Organization classification of tumors: pathology and genetics. Tumors of the breast and female genital organs. Lyon: IARC Press; 2003.
Fox H, Buckley CH, Al-Nafussi AI, et al. Histopathology reporting in cervical screening. NHS Cervical Screening Programme (NHSCSP), Sheffield, England. Publication no. 10; Apr 1999.
Jaworski RC, Pacey NF, Greenberg ML, et al. The histologic diagnosis of adenocarcinoma in situ and related lesions of the cervix uteri. Cancer. 1988;61:1171–81.
Mc Cluggage WG, Shah R, Connolly LE, McBride HA. Intestinal- type cervical adenocarcinoma in situ and adenocarcinoma exhibit a partial immunophenotype with consistent expression of CDX2. Int J Gynecol Pathol. 2008;27:92–100.
Nicolae A, Goyenaga P, McCluggage WG, Preda O, Nogales FF. Endometrial intestinal metaplasia: a report of two cases, including one associated with cervical intestinal and pyloric metaplasia. Int J Gynecol Pathol. 2011;30:492–6.
Schlesinger C, Silverberg SG. Endocervical adenocarcinoma in situ of tubal type and its relation to atypical tubal metaplasia. Int J Gynecol Pathol. 1999;73:305–11.
Park JJ, Sun D, Quade BJ, et al. Stratified mucin producing intraepithelial lesions of the cervix: adenosquamous or columnar cell neoplasia? Am J Surg Pathol. 2000;24:1414–9.
Hu L, Guo M, He Z, Thornton J, McDaniel LS, Hughson MD. Human papillomavirus genotyping and p16INK4a expression in cervical intraepithelial neoplasia of adolescents. Mod Pathol. 2005;18:267–73.
Kelly D, Kincaid E, Fansler Z, Rosenthal DL, Clark DP. Detection of cervical high-grade squamous intraepithelial lesions from cytologic samples using a novel immunocytochemical assay (ProEx C). Cancer. 2006;108:494–500.
Klaes R, Benner A, Friedrich T, et al. p16INK4a immunohistochemistry improves inter-observer agreement in the diagnosis of cervical intraepithelial neoplasia. Am J Surg Pathol. 2002;26:1389–99.
Ortega S, Malumbres M, Barbacid M. Cyclin D–dependent kinases INK4 inhibitors and cancer. Biochim Biophys Acta. 2002;1602:73–87.
Sano T, Oyama T, Kashiwabara K, Fukuda T, Nakajima T. Expression status of p16 protein is associated with human papillomavirus oncogenic potential in cervical and genital lesions. Am J Pathol. 1998;153:1741–8.
von Knebel Doeberitz M. New molecular tools for efficient screening of cervical cancer. Dis Markers. 2001;17:123–99.
Horn LC, Reichert A, Oster A, Arndal SF, Trunk MJ, Ridder R, et al. Immunostaining for p16INK4a used as a conjunctive tool improves inter-observer agreement of the histologic diagnosis of cervical intraepithelial neoplasia. Am J Surg Pathol. 2008;32:502–12.
Indinnemo M, Cicchini C, Stazi A, et al. Immunohistochemical assessment of Ki-67 as prognostic cellular proliferation marker in anal canal carcinoma. J Exp Clin Cancer Res. 2000;19:471–5.
al-Saleh W, Delvenne P, Greimers R, et al. Assessment of Ki-67 antigen immunostaining in squamous intraepithelial lesions of the uterine cervix. Correlation with the histologic grade and human papillomavirus type. Am J Clin Pathol. 1995;104(2):154–60.
Santin AD, Zhan F, Bignotti E, et al. Gene expression profiles of primary HPV16- and HPV18-infected early stage cervical cancers and normal cervical epithelium: identification of novel candidate molecular markers for cervical cancer diagnosis and therapy. Virology. 2005;20(331):269–91.
Chen Y, Miller C, Mosher R, et al. Identification of cervical cancer markers by cDNA and tissue micro arrays. Cancer Res. 2003;15:1927–35.
Davidson B, Goldberg I, Lerner-Geva L, et al. Expression of topoisomerase II and Ki-67 in cervical carcinoma–clinicopathological study using immunohistochemistry. APMIS. 2000;108:209–15.
Shi J, Liu H, Wilkerson M, et al. Evaluation of p16, MCM2, DNA Topoisomerase IIA and ProExC in cervical squamous intraepithelial lesions. Lab Investig. 2007;87 Suppl 1:214A.
Bell SP, Dutta A. DNA replication in eukaryotic cells. Annu Rev Biochem. 2002;71:333–74.
Walts AE, Bose S. p16, Ki67, and BD ProEx C immunostaining: a practical approach for diagnosis of cervical intraepithelial neoplasia. Hum Pathol. 2009;40:957–64.
Guo M, Baruch AC, Silva EG. Efficacy of p16 and ProExC immunostaining in the detection of high-grade cervical intra- epithelial neoplasia and cervical carcinoma. Am J Clin Pathol. 2011;135:212–20.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2017 Springer Science+Business Media Singapore
About this chapter
Cite this chapter
Kaur, S. (2017). Pathology of Preinvasive Lesions of the Cervix. In: Mehta, S., Sachdeva, P. (eds) Colposcopy of Female Genital Tract. Springer, Singapore. https://doi.org/10.1007/978-981-10-1705-6_2
Download citation
DOI: https://doi.org/10.1007/978-981-10-1705-6_2
Published:
Publisher Name: Springer, Singapore
Print ISBN: 978-981-10-1704-9
Online ISBN: 978-981-10-1705-6
eBook Packages: MedicineMedicine (R0)