PART TWO
Diagnostic Cytology
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Fig. 8.64 Moderate dysplasia. Irregularly shaped cells and enlarged nuclei.
Moderate hyperchromasia of finely granular nuclear chromatin. Compare size
of cells and nuclei with superficial squamous cell (Papanicolaou x OI).
becomes negative, the assumption that the lesion regressed
spontaneously may be invalid.86
Koss and colleagues, in a long-term follow-up study of indi-
vidual patients with carcinoma in situ and related lesions, noted
that a single biopsy could eradicate an area of intraepithelial
neoplasia.110 There can be no doubt that punch biopsies can
eradicate areas of CIN completely, either directly by complete
removal or indirectly by altering the balance between the host
and the neoplasm so that areas of residual CIN regress, thus
producing an immediate cure, a delayed cure, or a change in
the distribution of an area of CIN.86 In follow-up studies after
biopsies, no valid figure for the regression rate can be derived,
because the proportion of cures inadvertently produced by the
diagnostic procedures rather than occurring spontaneously
cannot be determined.
Persistence
Dysplasia may also persist during a variable period of time
before regressing or progressing to a more severe lesion, such
as marked dysplasia, carcinoma in situ, or invasive cancer. Doc-
umented cases of marked dysplasia have persisted for as long
as 20 years without showing malignant progression. There is
Fig. 8.65 Moderate dysplasia. Round, oval, and elongated cells with
enlarged, somewhat irregularly shaped nuclei. Increased nucleocytoplasmic
ratio. Finely granular, slightly and moderately hyperchromatic nuclear
chromatin. Compare with intermediate squamous cells (Papanicolaou x OI).
unanimity among investigators that dysplasia in certain circum-
stances can progress to carcinoma in situ and finally to invasive
cancer.
Progression
Slight dysplasias may also antedate the appearance of a severe
intraepithelial lesion or an invasive cancer by many years. Most
prospective studies, when carried out without intercurrent
intervention through biopsies or frequent repeat smears, indicate
that fewer than 15% of dysplasias progress.73
Follow-up Studies: Literature Review
Christopherson monitored more than 200 patients with dyspla-
sia from 1 to 13 years.111
Patients were included on the basis
of a biopsy diagnosis of dysplasia that later was cytologically
confirmed. During the observation period, 30% of the lesions
regressed to normality, 49% of lesions persisted, 20% showed
progression to carcinoma in situ, and 1.3% evolved to invasive
cervical cancer.
In a study of 120 women with cytologic evidence of dysplasia,
during long-term follow-up for up to 9 years, Scott and Ballard
found regression or complete involution in 60% of women;
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