8
Benign Proliferative Reactions, Intraepithelial Neoplasia, and Invasive cancer of the Uterine cervix
4
Fig. 8.62 Moderate dysplasia. Cells of squamous and squamous
metaplastic type. Nuclear enlargement, moderate hyperchromasia
of the finely granular chromatin. Increased nucleocytoplasmic ratio
(Papanicolaou x OI).
more prone to regress spontaneously, and conversely, severe
dysplasia and carcinoma in situ are more likely to persist or
progress.
Dysplasia may follow a variable course.
Regression
Dysplastic lesions may undergo spontaneous regression. A lesion
may disappear in a matter of weeks and become undetectable at
a short-term follow-up screening, or it may take a much longer
in shape. Nuclear chromatin is evenly distributed and finely granular
(Papanicolaou x OI).
time, becoming gradually less abnormal in a matter or months
or even years. In some cases, the disappearance may be caused
by desquamation of the abnormal epithelium due to minimal
trauma.
A dysplastic epithelium tends to separate more easily from the
supporting stroma than the normal epithelium does. This may
account in part for the disappearance of dysplastic lesions after
initial cytologic diagnosis in women during cytologic follow-up.
In these instances, the diagnostic test essentially becomes a cure
for the lesion.
In studies reporting on regression or progression after con-
firmation of the cytologic diagnosis by histology, part of the
observed regression during follow-up must be ascribed to the
surgical procedure, as may be the case in studies reporting on
follow-up of dysplasias diagnosed during pregnancy, due to the
traumatic effects on the cervix during childbirth.109 Spontaneous
regression may therefore be lower than cited in these studies,
whereas progression may be higher in cases that have not had
bioptic intervention or that are diagnosed during pregnancy.
Even if regression does not follow the biopsy, however, it
is entirely possible that the biology of the lesion is altered in
various ways. If the smear is positive after a biopsy and later
163
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