HSIL


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  • Clinical

    • 0.5% of all paps
    • 97% HPV+
    • 60% will have CIN2
    • 2% will have SCC
    • management
      • LEEP
      • or colposcopy with endocervical assessment

  • Criteria

    • cell smaller, less mature than LSIL
    • singly, sheets, or syncytial aggregates
    • NC ratio markedly increased
    • irregular nuclear membrane
    • nucleoli inconspicuous
    • variable other nuclear atypia
      • hyerchromasia
      • irregular chromatin
    • cytoplasm ranges from immature to keratinized

  • Patterns

    • atypical cells with high NC ratio
    • syncytial aggregates
      • hyperchromatic crowded group
      • nuclear atypia
        • high NC ratio
        • size variation
        • hyperchromasia
        • coarse chromatin
        • irregular nuclear membrane
    • HSIL involving endocervical gland
      • central nucleus
      • nuclear atypia
      • endocervical cells on periphery
    • abnormal stripped nuclei
    • HSIL streaming in mucus
    • HSIL in atrophy
    • keratinzing HSIL

  • Ddx

    • reserve cells
    • parabasal cells
    • ASCH
    • SCC
      • HSIL plus
      • prominent nucleoli
      • necrotic debris
    • atrophy
      • postmenopausal
      • fine chromatin
    • ASCUS with atrophy
    • squamous metaplasia
    • transitional metaplasia
      • older women
      • irregular nuclear contours
      • nuclear grooves
      • but minimal hyperchromasia
      • abundance of coffee bean nuclei
    • glandular
    • reactive
      • IUD
        • prominent nucleoli
      • histiocytes
        • fine chromatin
      • follicular cervicitis
    • endocervical polyp atypia
    • pregnancy
      • decidua
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