ASCUS


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  • Clinical

    • 4.3% of paps
    • prognosis
      • premenopausal
        • 46% SIL
        • 50% HPV+
      • postmenopausal
        • 17% SIL
        • 10% HPV+
    • management
      • reflex HPV
        • colposcopy if positive
        • repeat cotesting in 3 years if negative
      • repeat pap after vaginal cream for atrophy

  • Criteria

    • mild nuclear enlargement
      • 2.5-3x normal
      • or 2x squamous metplastic
    • mild NC ratio increase
    • minimal other nuclear atypia
      • mild hyperchromasia
      • mild nuclear irregularity
      • mild chromatin irregularity
        • smudgy, rather than clumpy

  • In practice

    • nuclear enlargement, other atypia is minimal
      • not quite a koilocyte
      • atypical repair
      • atypical parakeratosis
      • atypical atrophy
    • orangeophilic cytoplasm, nuclear atypia is mild
      • atypical parakeratosis
    • koilocytes, but not enough to call LSIL
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