PART TWO
Diagnostic Cytology
Fig. 8.68 Severe dysplasia. Palisade arrangement of cells in the lower
half of the epithelium. The upper half of the epithelium is composed of
abnormal cells with irregular nuclei and hyperchromatic nuclear chromatin
lying parallel to the surface. The sudden change in the polarity of the cells in
this abnormal epithelium may reflect a sudden change in the environment
during the development of the lesion (H&E x HP).
related to an incidence of carcinoma in situ of 4 in 100,000
women per year, the yearly progression risk of moderate dyspla-
sia can be calculated to be 2000 times greater than for a woman
without cervical dysplasia. Regression showed only slight varia-
tion between different age groups.
Tanaka and co-workers monitored 230 cases with an initial
diagnosis of mild dysplasia cytologically and colposcopically
for 2 to 10 years.115 Regression of the epithelial abnormality was
observed in 73.5% of cases, persistence in 20%, and progression
in 6.5% of cases. Of 15 cases that showed progression, 10 cases
of carcinoma in situ or microinvasive carcinoma developed. The
average period after which progression was diagnosed was 54.8
months.
An important factor in explaining the wide variation between
the results obtained in different follow-up series is the highly
subjective character of the histologic diagnosis of intraepithe-
lial neoplasia. Various pathologists studying the same lesion
return a diagnosis varying from mild dysplasia to carcinoma
in situ.116
Fig. 8.69 Severe dysplasia. Only in the most superficial layers are
signs of maturation identifiable by a change in polarity and a somewhat
increased cytoplasmic volume of the cells. Vacuolation of the cytoplasm of
the superficial cells (koilocytosis) may be caused by infection with human
papillomavirus but is more often a sign of degeneration (H&E x HP).
Clinical management of intraepithelial lesions of the cervix
depends greatly on the cytologic and histologic definitions of
dysplasia. The diagnosis of dysplasia is often considered incon-
sequential by uninformed physicians, who fail to take appropri-
ate action.117
Rate o f Progression: Transition Tim e
On the basis of all available evidence, it may be concluded
that the rate of progression of dysplastic lesions is strongly
related to the severity of the lesion as evaluable by cytologic
analysis.
Data from long-term population studies in a population that
has been screened intensively allow true incidence figures to be
measured and can provide evidence from the ratios between
mild and severe intraepithelial lesions that the majority of mild
and moderate intraepithelial changes eventually regress or per-
sist for a prolonged period.
In the Nijmegen screening program, the ratio between mild
and moderate dysplasias on the one hand and severe dysplasias
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