Low-grade cells with marked HPV effect.
CIN-I, or low-grade cells, with marked HPV effect.
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The next case was in her 30s. The patient went to her gynecologist and had a cone excisional biopsy for the workup of previously diagnosed CIN. On cone excisional biopsy just on lower power, one could see some of these endocervical glands had a fair degree of architectural atypia or complexity in that they had some budding or protuberances. On higher power, one could see an abrupt change in the endocervical glands from normal endocervical glandular epithelium to neoplastic epithelium. The normal endocervical glandular epithelium has a very small basally-locally nucleus and abundant cytoplasm with mucin. In addition, normal endocervical glands should very rarely have mitotic figures. Neoplastic epithelium is very different; it has very crowded, pseudostratified cells, the nuclei are very cigar-shaped, elongated and hyperchromatic and often you may be mitotic activity. The endocervical stroma surrounding this appears fairly normal, which is very important, because this lesion represents adenocarcinoma in situ. In situ is retained within the basement membrane and there is no invasion. By no invasion, I mean that there is no endocervical reaction and the abrupt change is very characteristic of adenocarcinoma in situ thirdly, the depth of glands are not beyond the level of normal endocervical glands. Adenocarcinoma in situ is very characteristic for this. In other places in this patient there was CIN-III, severe dysplasia. Here, the full thickness of the epithelium is occupied by small, basaloid, undifferentiated cells with a lot of nuclear crowding, pleomorphism and disorganization and the presence of mitotic figures. So this is an example of severe dysplasia, or carcinoma in situ. Severe dysplasia involving the superficial endocervical glands may be mistaken for invasive carcinoma, because it appears to go into the underlying stroma. I do not call this invasive carcinoma is because the borders of the gland are very smooth and regular and the stroma is very normal looking and is not reactive. In invasive carcinoma, the stroma tends to be more reactive and the borders tend to be very irregular and shaggy. I would call this severe dysplasia involving an endocervical gland. The hint is the endocervical glandular epithelium.
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