Patient diagnosed as squamous cell intraepithelial lesion which of the following has the highest risk for progression to carcinoma
High grade squamous intraepithelial neoplasia [Ref C.G.O.T. 9th/e p 895, 8961 Cervical lesions are characterized Histologically --> using the CIN nomenclature and Cytologically -4 using the Bethesda system Now the Pap smears are repoed using the Bethesda system which has advocated a standardized repoing system for cytological repos. EPITHELIAL CELL ABNORMALITIES Squamous cell Atypical squamous cell - Of undetermined significance (ASC-US) - Cannot exclude HSIL (ASC-H) Low grade squamous intraepithelial lesion (LSIL) - encompassing HPV/mild dysplasia/CIN High grade squamous intraepithelial lesion (HSIL) - encompassing moderate and severe dysplasia - CIN 2 and CIN 3/CIS Squamous cell carcinoma Glandular cell Atypical (AGC) - endocervical cells - endometrial cells - glandular cells not otherwise specified (NOS) Atypical, our neoplastic - endocervical cells - glandular cell NOS Endocervical adenocarcinoma in situ (AIS) Adenocarcinoma - endocervical - endometrial - extrauterine - not otherwise specified (NOS) Cervical Cytology Screening (American College of Obstetricians and Gynecologists Guideline) Initial screening Age 21 or 3 y after vaginal sex Interval Every year Every 2-3 y after age 30 with 3 consecutive normals Discontinue No upper limit of age Comparison of Cytology Classification Systems (in simplified form) Bathesda CIN Dysplasia Limit of histologic changes *LSIL CIN 1. Mild Basal 1/3rd of sq. epithelium CIN 2 Moderate Basal 1/2 to 2/3rd HS1L CIN3 Severe Whole thickness except one or two superficial layers CIS Whole thickness
Low grade squamous intraepithelial neoplasia
High grade squamous intraepithelial neoplasia
Squamous intraepithelial neoplasia associated with HPV 16
Squamous intraepithelial neoplasia associated with HIV