8
Benign Proliferative Reactions, Intraepithelial Neoplasia, and Invasive cancer of the Uterine cervix
Fig. 8.59 Moderate dysplasia. Irregular arrangement of cells in basal and
intermediate cell layers. Reduced maturation, nuclear enlargement, and
irregularities in nuclear size and shape still appear in the more superficial
layers (H&E x HP).
Fig. 8.60 Moderate dysplasia. Disturbed maturation in all cell layers. In
the uppermost layers, stratification is still recognizable. Moderate increase of
nuclear size. Irregular nuclear shapes and some hyperchromasia (H&E x HP).
Moderate Dysplasia (CIN Grade 2, High-Grade SIL)
Histology
In moderate dysplasia, there is a moderate disturbance of
stratification. Usually only the upper third of the epithelium
still shows evidence of stratification of cells of superficial and
intermediate cell size. The uppermost layers are still composed
of flat squamous cells, although nuclei may be enlarged and
slightly hyperchromatic (Fig. 8.59). The surface layers occasion-
ally are keratinized, with loss of nuclei and the formation of
a granular layer. Nuclear abnormalities may be seen through-
out the epithelium, particularly in the more basal layers. Cell
arrangement is disturbed in as much as two-thirds of the thick-
ness of the epithelium (Figs. 8.60 and 8.61). In these disturbed
layers, mitoses, sometimes abnormal, are present in increased
numbers.
Cytology
The size of abnormal cells is more variable. Next to some abnor-
mal cells of the superficial squamous cell type, smaller cells
of the intermediate and parabasal cell type are usually found
(Fig. 8.62). Most cells are round to oval, but spindle cells and
elongated and bizarre shapes may occasionally be found. Cyto-
plasmic staining is cyanophilic, but a relatively high number
of cells may show eosinophilia of the cytoplasm. Nuclei are
enlarged and round to oval, sometimes elongated or irregularly
shaped (Fig. 8.63). Nuclear chromatin is evenly distributed and
slightly to moderately hyperchromatic (Fig. 8.64). Nucleoli are
usually absent. The nucleocytoplasmic ratio is increased, both
by nuclear enlargement and by reduction of the cytoplasmic vol-
ume (Figs 8.65 and 8.66). The nucleus generally occupies less
than half of the total area of the cell.
Key features of moderate dysplasia (CIN 2, HSIL)
• Singly lying cells and cells in sheet-like
arrangement of superficial, intermediate, and
parabasal type;
• Moderately reduced cell size;
• Cells predominantly round to oval, but
occasional spindled, elongate, or bizarre cells
may be seen;
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