PART TWO
Diagnostic Cytology
Fig. 7.57 Human papillomavirus (HPV)
infection cervix.
Left transformation zone,
ecto and endocervix. (a) Hyperkeratotic
papillae, (b) squamous plaques, (c) koilocytes
transformation zone changes, (d) endocervical
cells changes, (e, f) endocervix. (H&E x LP, [(a) x LP,
(b-d) x HP, (e, f) x MP] Papanicolaou.
In cases with infection involving the ecto- and endocervical
regions, a mixture of mature, parakeratotic squamous cells and
metaplastic-type cells with evidence of HPV infection may all
appear together (Fig. 7.57). A number of these morphologic
changes observed either singly or in various combinations may
be grouped as ASC-US.
Using the diagnostic criteria mentioned previously and as
summarized in Table 7.8 and Fig. 7.57, we have excellent correla-
tion between the cytodiagnosis of HPV, its histology, and detec-
tion of HPV by in situ hybridization (ISH) molecular techniques.
The sampling procedures and the interval between the cytosmear
and appropriate tissue studies are important. Changes observed
in the endocervical cells in HPV infection, in our experience, have
not been sufficiently specific to be useful diagnostically.
Nuclear changes,
although not specific,
are commonly
observed among HPV-infected cells. The nuclei may not show
any changes; they may degenerate and appear hyperchromatic
and pyknotic or reveal chromatin margination and abnormal
clearing. Bi- and multinucleated forms in the squamous cells
occur often. The nuclei may be enlarged, but changes most often
are proplastic with pale, finely divided chromatin granules dis-
tributed uniformly within the enlarged nucleus. The nucleoli
are absent or inconspicuous in these cells. The nuclear mem-
brane may be loose and wavy. It may be degenerated and appear
folded and somewhat wrinkled, giving the typical raisin like
appearance so often observed in HPV infections (Fig. 7.51).
HPV and Cervical Dysplasia
The established Bethesda System of
gynecologic cytology reporting recognizes changes of HPV infec-
tion or condyloma and varying degrees of dysplasia. The same
terminology is being used to describe the HPV-related lesions.
Morphologically, it can be difficult to distinguish condyloma
from mild dysplasia or a CIN I lesion, both cytologically and
histologically. An awareness of this difficulty and no differ-
ence in clinical management has led to the two lesions being
grouped together as low-grade squamous intraepithelial lesion.
When distinguished or subclassified, CIN grade I lesions have
enlarged nuclei and hyperchromasia in contrast to condyloma.
Chromatin granules are uniformly distributed and they tend to
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