Skip to main content
NCBI home page
Journal of Clinical Pathology logoLink to Journal of Clinical Pathology
. 1994 Sep;47(9):799–804. doi: 10.1136/jcp.47.9.799

Histological features of CIN3 and their value in predicting invasive microinvasive squamous carcinoma.

A I al-Nafussi 1, D E Hughes 1
PMCID: PMC494935  PMID: 7962647

Abstract

AIMS--To determine the histological features in CIN3 associated with or predictive of subsequent microinvasion. METHODS--The histological appearances of CIN3 accompanying 120 cases of microinvasive carcinoma of the uterine cervix were retrospectively studied. Major features were defined as those present in greater than 80% of cases of microinvasive carcinoma (MICA) and less than 10% of control cases of CIN3. One hundred cases of CIN3, 36 showing all, and 64 lacking all, of the major features associated with microinvasion, as defined in the retrospective study, were prospectively studied. Deeper levels were cut to exclude the presence of microinvasion in the original biopsy specimen and negative cases were followed up for a period of up to 18 months in order to assess rates of recurrence or progression. RESULTS--The major features identified in CIN3 associated with microinvasive carcinoma were extensive involvement of surface epithelium and deep endocervical crypts by expansile CIN3, luminal necrosis, and intraepithelial squamous maturation. Other features more commonly present in MICA associated CIN3 than in controls included frequent mitosis and apoptosis, pericryptal concentric fibroplasia, pericryptal inflammatory infiltrate, pronounced cellular pleomorphism, nuclear changes (distinct nucleoli and chromatin clearing), and the emergence of streams of darkly stained spindle cells oriented at right angles to the basement membrane. In the prospective study 83% of cases illustrating the major MICA associated features revealed evidence of MICA or frank invasion either on serial sections of the original biopsy or on subsequent biopsy. None of the 64 cases of CIN3 that lacked these features showed evidence of invasion on serial sections or on further follow up over 18 months. CONCLUSIONS--The data strongly suggest that cases of CIN3 which have a higher probability of association with or rapid progression to invasive disease can be identified. When these features are present in a biopsy specimen of CIN3, serial sections should be performed to exclude the presence of microinvasion. Closer clinical follow up of these patients may be needed.

Full text

PDF
799

Images in this article

800Image
on p.800
801Image
on p.801
802Image
on p.802
802Image
on p.802
802Image
on p.802
803Image
on p.803
803Image
on p.803

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Abdul-Karim F. W., Fu Y. S., Reagan J. W., Wentz W. B. Morphometric study of intraepithelial neoplasia of the uterine cervix. Obstet Gynecol. 1982 Aug;60(2):210–214. [PubMed] [Google Scholar]
  2. Ambros R. A., Kurman R. J. Current concepts in the relationship of human papillomavirus infection to the pathogenesis and classification of precancerous squamous lesions of the uterine cervix. Semin Diagn Pathol. 1990 Aug;7(3):158–172. [PubMed] [Google Scholar]
  3. Anderson M. C., Hartley R. B. Cervical crypt involvement by intraepithelial neoplasia. Obstet Gynecol. 1980 May;55(5):546–550. [PubMed] [Google Scholar]
  4. Arends M. J., Donaldson Y. K., Duvall E., Wyllie A. H., Bird C. C. Human papillomavirus type 18 associates with more advanced cervical neoplasia than human papillomavirus type 16. Hum Pathol. 1993 Apr;24(4):432–437. doi: 10.1016/0046-8177(93)90093-v. [DOI] [PubMed] [Google Scholar]
  5. Benedet J. L., Anderson G. H., Matisic J. P. A comprehensive program for cervical cancer detection and management. Am J Obstet Gynecol. 1992 Apr;166(4):1254–1259. doi: 10.1016/s0002-9378(11)90618-8. [DOI] [PubMed] [Google Scholar]
  6. Buckley C. H., Butler E. B., Fox H. Cervical intraepithelial neoplasia. J Clin Pathol. 1982 Jan;35(1):1–13. doi: 10.1136/jcp.35.1.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Demopoulos R. I., Horowitz L. F., Vamvakas E. C. Endocervical gland involvement by cervical intraepithelial neoplasia grade III. Predictive value for residual and/or recurrent disease. Cancer. 1991 Nov 1;68(9):1932–1936. doi: 10.1002/1097-0142(19911101)68:9<1932::aid-cncr2820680915>3.0.co;2-v. [DOI] [PubMed] [Google Scholar]
  8. Javaheri G. Microinvasive carcinoma of the uterine cervix. Int J Gynaecol Obstet. 1978;16(2):106–114. doi: 10.1002/j.1879-3479.1978.tb00408.x. [DOI] [PubMed] [Google Scholar]
  9. Kirkland J. A., Stanley M. A., Cellier K. M. Comparative study of histologic and chromosomal abnormalities in cervical neoplasia. Cancer. 1967 Nov;20(11):1934–1952. doi: 10.1002/1097-0142(196711)20:11<1934::aid-cncr2820201122>3.0.co;2-4. [DOI] [PubMed] [Google Scholar]
  10. Kirkland J. A. The study of chromosomes in cervical neoplasia. Obstet Gynecol Surv. 1969 Jul;24(7 Pt 2):784–794. doi: 10.1097/00006254-196907001-00010. [DOI] [PubMed] [Google Scholar]
  11. Ng A. B., Reagan J. W. Microinvasive carcinoma of the uterine cervix. Am J Clin Pathol. 1969 Nov;52(5):511–529. doi: 10.1093/ajcp/52.5.511. [DOI] [PubMed] [Google Scholar]
  12. Robert M. E., Fu Y. S. Squamous cell carcinoma of the uterine cervix--a review with emphasis on prognostic factors and unusual variants. Semin Diagn Pathol. 1990 Aug;7(3):173–189. [PubMed] [Google Scholar]
  13. Sedlis A., Sall S., Tsukada Y., Park R., Mangan C., Shingleton H., Blessing J. A. Microinvasive carcinoma of the uterine cervix: a clinical-pathologic study. Am J Obstet Gynecol. 1979 Jan 1;133(1):64–74. doi: 10.1016/0002-9378(79)90414-9. [DOI] [PubMed] [Google Scholar]
  14. Tsukamoto N., Kaku T., Matsukuma K., Matsuyama T., Kamura T., Saito T., Suenaga T. The problem of stage Ia (FIGO, 1985) carcinoma of the uterine cervix. Gynecol Oncol. 1989 Jul;34(1):1–6. doi: 10.1016/0090-8258(89)90094-2. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Clinical Pathology are provided here courtesy of BMJ Publishing Group

RESOURCES