PART TWO
Diagnostic Cytology
Fig. 8.57 Mild dysplasia of metaplastic type. Enlarged nuclei and
increased nucleocytoplasmic ratio. Compare cell size with the superficial
squamous cell and the leukocytes (Papanicolaou x OI).
Nuclei of dysplastic cells are relatively large when compared
with their normal counterparts. The greater size of the nuclei
is a reflection of the reduced maturation of the cell, indicated
by a relatively large nucleus and a relatively small amount of
cytoplasm.
Actual nuclear area is of less practical importance in routine
diagnostic cytology because of the lack of a possibility for an
accurate comparison with an object of known size.
Mild Dysplasia (CIN Grade 1, Low-Grade SIL)
Histology
In mild dysplasia, a slight disturbance of the regular arrangement
of cells is seen. The upper two-thirds of the epithelium usually
shows a relatively regular arrangement of cells with preserved
stratification. These layers are composed of cells, recognizable
as intermediate-type and superficial squamous-type cells, with
slightly reduced cytoplasmic volume and slightly increased
nuclear size. Nuclei are usually of normal round-to-oval shape
and have a minimally hyperchromatic nuclear chromatin. Aber-
rations of the nuclear morphology are predominantly limited to
the most basal layers of the epithelium.
Fig. 8.58 Mild dysplasia. Irregular arrangement of cells in the basal and
parabasal layers. Reduced maturation and slightly enlarged, somewhat
hyperchromatic nuclei in the most superficial layers (H&E x HP).
Cytology
Cells from mildly atypical lesions such as mild dysplasia (CIN
grade 1) usually have plentiful clear, translucent cytoplasm with
well-defined angular borders. Cells resemble intermediate- and
superficial-type squamous cells with a somewhat reduced cyto-
plasmic body and a slightly enlarged nucleus, occupying less
than one-third of the total area of the cell (Fig. 8.57; see also
Figs 8.55 and 8.56). Nuclear chromatin is finely granular, evenly
distributed, and only slightly hyperchromatic (Fig. 8.58).
Key features of mild dysplasia (CIN 1, LSIL)
• Singly lying cells of superficial and intermediate
type—slightly reduced cell size;
• Abundant cyanophilic and eosinophilic translucent
cytoplasm with well-defined angulated borders;
• Cells resemble intermediate or superficial squamous
cells;
• Enlarged nucleus (3-5x intermediate cell nucleus)
occupies one-third of cytoplasmic area;
• Chromatin finely granular, evenly distributed, with
slight hyperchromasia; and
• Nucleoli not present.
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