8
Benign Proliferative Reactions, Intraepithelial Neoplasia, and Invasive cancer of the Uterine cervix
Fig. 8.66 Moderate-to-severe dysplasia. Cells vary in size and shape.
Nuclei are round to oval and irregular in shape. Nuclear chromatin is in part
finely, in part coarsely, granular and moderately hyperchromatic. Increased
nucleocytoplasmic ratio (Papanicolaou x OI).
progression to carcinoma in situ in this series was 4.1%.112 In
223 women monitored for an average of 3.8 years, progression
to carcinoma in situ was 5.8%.113 In a retrospective study of
364 women with dysplastic lesions of varying severity that were
initially detected and closely monitored by cytology alone for
a minimum of 9 months and a maximum of 24 months, Patten
found the reaction to regress or disappear in 71.9% with slight
dysplasia, 44.2% with moderate dysplasia, and 16.3% with
marked dysplasia.9 Furthermore, during this period of obser-
vation, only those cases initially classified as marked dysplasia
progressed to carcinoma in situ. Of cases initially diagnosed as
marked dysplasia, 6.8% (3) developed carcinoma in situ from
10 to 17 months later. None of these cases were seen to evolve
to invasive cancer. In a retrospective study of 102 women with
moderate dysplasia, Patten noted regression in 44.2%, persist-
ence in 42.2%, and progression in 13.6% during follow-up
from 9 to 23 months.13
Progression occurred on the average 3 years after initial diag-
nosis of dysplasia. Patten stated that on the basis of data avail-
able, 5-10% of dysplastic lesions could be expected to antedate
the subsequent appearance of cancer in situ.12 From reported
Fig. 8.67 Severe dysplasia. Irregular arrangement and disturbed
maturation of cells involving almost the entire thickness of the epithelium.
Only in the most superficial layers do cells show an increased cytoplasmic
volume resulting in a lower nucleocytoplasmic ratio (H&E x HP).
series, it seems likely that in fewer than 1.5% of patients with
evidence of dysplasia will an invasive cancer subsequently
develop.98,111,112
Nasiell and associates monitored 894 women with cytologi-
cally diagnosed moderate dysplasia by cytology with minimal
treatment.114 During a follow-up period of 78 months, they
observed regression of the moderate dysplasia in 54%. Average
follow-up time for patients with continuous normal cytology
after disappearance of dysplasia was 53 months. During follow-
up for 51 months, progression was observed in 30% and per-
sistence in 16%. In 54% of patients, biopsies were performed.
In patients without biopsies, regression was 50%, progression
35%, and persistence 15%, which implies a statistically signifi-
cant difference between patients with and without biopsy. In
patients over 51 years of age, fewer lesions progressed than in
younger patients, and the progression time was also significantly
longer.
In 3.8% of patients with persistent moderate dysplasia
observed for an average of 50 months, cytology periodically gave
no evidence of an abnormality. The risk of progression of mod-
erate dysplasia was 5 to 9 cases per 100 women per year. When
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