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30 Cards in this Set
- Front
- Back
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What are the main cytologic features of HSIL? (3)
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1. Immature cytoplasm (dense, round, similar to parabasal or basal squamous cells)
2. Abnormal nuclear features (could be irregular nuclear membrane, hyperchromatic, salt and pepper chromatin, coarsely granular, etc.) 3. Increased N:C Ratio. (Anywhere from 50% to over 75% of the cell is composed of nucleus) |
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What is the general size of an HSIL nucleus compared to normal intermediate cell nucleus?
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HSIL nucleus is 2 to 5 times the size of normal intermediate nucleus.
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Can an HSIL have a nucleolus?
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Yes, it is possible to see a nucleolus in some LBPs, but for the most part, chromatin will be hyperchromatic and (coarsely) granular, evenly distrubuted.
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What do the nuclear membranes look like in HSIL?
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usually irregular or wrinkled, typically with a significant degree of anisonucleosis
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What are the two most important differences between LSIL and HSIL?
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immaturity of cytoplasm and high N:C ratio
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General cellular morphology in moderate dysplasia?
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either large (intermediate sized) or small (parabasal or metaplastic sized)
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Nuclei in Moderate Dysplasia?
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enlarged
hyperchromatic abnormal chromatin 50%-75% N:C ratio Nuclear membrane slightly irregular |
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Chromatin in Moderate Dysplasia?
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finely or coarsely granular with an even or irregular distribution
nucleoli generally ABSENT, but chromocenters usually present |
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Cytoplasm in Moderate Dysplasia?
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Cyanophilic, thin and homogeneous
OR dense and vacuolated |
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What percentage of HSIL will progress to cancer if left untreated?
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50%
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General Cellular Morphology in Severe Dysplasia?
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single, or in clusters with each nucleus surrounded by distinct cytoplasm
usually immature, small, round to oval shape N:C ratio very high! |
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Nuclei in Severe Dysplasia?
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enlarged, considering small cell size
75% or greater N:C ratio Nuclear outline IRREGULAR with notches and grooves depth of focus or convoluted nuclei may be present |
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Chromatin in Severe Dysplasia?
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hyperchromatic
coarsely granular OR evenly dark chromatin (Nucleoli generally absent) |
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Cytoplasm in Severe Dysplasia?
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SCANT!
lacy and delicate OR dense usually cyanophilic occasionally keratinized (in keratinizing dysplasia) |
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What should you watch out for in determining N:C ratios for cells?
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folded cytoplasm
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How many dysplastic cells are required to call it a high grade?
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5
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How can you distinguish moderate dysplasia from metaplasia?
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dysplasia has higher N:C ratio (50% or greater), hyperchromasia, and more depth of focus. Mod dys will also be slightly larger, but that is a minor criteria.
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What do you report out when you have varying degrees of abnormality?
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the most severe that you have enough examples of
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What is the main difference between severe and moderate?
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moderate looks more parabasal and severe looks more basal
(amt of cytoplasm) |
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What is something to note about HSIL when looking on LBPs?
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nuclei my appear normo to hypochromatic because of the way the preparation is made so don't take it too much into account on LBPs if it's not hyperchromatic
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How did Patten break down HSIL types?
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Nonkeratinizing Dysplasia, Metaplastic Dysplasia, and Keratinizing Dysplasia
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How did DeMay break down HSIL types?
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Metaplastic Dysplasia and Keratinizing Dysplasia
(He included Patten's nonkeratinizing dysplasia in his metaplastic category) |
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Where does keratinizing dysplasia arise?
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ectocervix
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Ectocervix is an area where you are likely to see ____________ dysplasia arise.
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keratinizing
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Where does nonkeratinizing dysplasia arise?
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DISTAL transformation zone
(closer to ectocervix) |
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Distal TZ would be an area for _________ dysplasia to arise.
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NONkeratinizing
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Where does metaplastic dysplasia arise?
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PROXIMAL transformation zone
(higher up in the endocervical canal) |
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Can HSIL occur with LSIL?
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YES, 15% to 20% of LSIL paps actually have HSIL on biopsy
(more prevalent in women under 40 years old) CALL IT HSIL WHEN 5 OR MORE CELLS SHOW HIGH GRADE CRITERIA IN A BACKGROUND OF LSIL |
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What is the progression of the different HSILs?
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Basal --> Reserve Cell Hyperplasia --> Atypical Reserve Cell Hyperplasia --> Small Cell CIS --> Small Cell Carcinoma
Parabasal --> Immature Sq. Metaplasia --> Immature Metaplastic Dysplasia (HSIL) --> Intermediate CIS --> Nonkeratinizing SCC Intermediate --> Mature Sq. Metaplasia --> Mature Metaplastic Dysplasia --> Large cell CIS --> Nonkeratinizing SCC Superficial --> Keratosis --> Keratinized dysplasia --> Keratinizing SCC |
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What are the two types of Metaplastic Dysplasia?
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mature and immature (intermediate and parabasal)
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