Page 519 - Concise Pathology for Exam Preparation ( PDFDrive )

504 SECTION II Diseases of Organ Systems

CIN I

• Dysplasia is present in lower one-third of stratified squamous epithelium.
• May be raised (as in condyloma acuminatum) or macular (flat condyloma).
• Abundant HPV nucleic acid of low-risk HPV type is present.
• Koilocytic atypia or viral cytopathic effect is seen (koilocytosis is seen as nuclear abnor-
malities with perinuclear halo).

CIN II

• Dysplasia is limited to basal two-thirds of stratified squamous epithelium.
• Increased number of atypical cells in lower layers (increased N/C ratio, anisokaryosis,
loss of polarity, mitotic figures and hyperchromasia)
• Upper layer cells appear differentiated
• Associated with high-risk HPV types

CIN III/Carcinoma In Situ

Dysplasia spreads to the entire thickness of the epithelium.
Note: A low-grade lesion does not always progress to a high-grade lesion. Most low-grade
lesions regress spontaneously; whereas, most high-grade lesions progress.

Q. Write briefly on predisposing factors, aetiology, morphology and
diagnosis of carcinoma cervix.
Ans. Carcinoma cervix is a major cause of morbidity and mortality.

Predisposing Factors for Carcinoma Cervix
• HPV infection: Nearly all cervical carcinoma is HPV related (Types 16, 18, 31, 45, etc.).
• Early age at first intercourse
• Multiple sexual partners or a male partner with multiple sexual partners
• Oral contraceptives
• Cigarette smoking
• High parity
• Family history
• Associated genital infections
• Lack of circumcision in male sexual partner
Pathogenesis
Sequence of events that follow HPV infection are given in Flowchart 18.1.

Clinical Features
• Usually affect women between fourth and sixth decades
• Present with unexpected vaginal bleeding, leucorrhoea, painful coitus (dyspareunia)
and dysuria (due to bladder infiltration).

Gross Morphology
Arises from the transformation zone and has three main gross types:
• Fungating or exophytic (most common)
• Ulcerative or ulceroinfiltrative
• Infiltrative

Microscopy
• Most (90%) are squamous cell carcinomas (SCCs)

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