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  • Clinical

    • low grade dysplasia: 1/2 regress, 30% persist, 15% develop carcinoma
    • high grade dysplasia: 85% progress to carcinoma
  • Histology

    • architecture: glandular crowding, branching, budding, stratification
    • cytology: nuclear atypia (hyperchromasia, enlargement, nucleoli, stratification), decreased apical mucin, mitosis
    • low grade: retains nuclear basal polarity, pencilate nuclei, pseudostratification
    • high grade: back-to-back glands, cribriforming, nuclear polarity loss, more rounded nuclei, stratification
    • carcinoma: marked architectural distortion (crowding, branching, budding), infiltrative, desmoplasia, necrosis, mitosis
  • Ddx

    • reactive
      • nuclear atypia, but architecture normal with basal nuclei
    • adenoma
      • polypoid
  • Signout

    • negative, indefinite (if can't differentiate from reactive), low-grade, high-grade dysplasia
    • intramucosal carcinoma, invasive carcinoma