 |
Lectures
Name and address of case presenter: Eduardo Schejter MD, Women Health Centre director and Michael Schvimer MD Senior pathologist, Maccabi Health Service , Tel Aviv, Israel
Title of case: High grade squamous lesion: LLETZ performed following cytological results and colposcopic findings without colposcopic directed biopsy.
Presentation: a 36 year old woman, married +3, without background diseases was referred t the colposcopic unit because routine conservative smear with HG-SIL ( slides I and II, description attached ), in colposcopic examination( video picture): no vulvar or vaginal abnormal findings. No hyperkeratotic lesion, after application of acetic acid 5% during 30 second: transformation zone completely visualized (satisfactory colposcopy). Note the rapid appearance of extensive area of intensive aceto white epithelium with coarse mosaic pattern, no irregular vessels present.
The colposcopic impression fits the cytological diagnosis of HGSIL i.e. extensive area with intense aceto white epithelium and coarse mosaic pattern, without sings of invasion (regular vessels + satisfactory colposcopy). Directed colposcopic biopsy and the HPV status will no change the case management, therefore a LLETZ procedure under local anaesthesia was performed (video picture). Histology of the LLETZ biopsy (slides III and IV, description attached) shows a large area of CIN III involving endocervical glands without sings of invasion.
| VIDEOS & SLIDES |
| Name/Link |
Description |
| Video I |
HGSIL |
| Video II |
LLETZ |
| Slide I |
PAP smear showing HG SIL , (X 400) , note dysplastic squamous cells with high nuclear:cytoplasmic ratio and hyperchromatic, nuclei with irregular nuclear contours. Background low grade squamous cells are also present. |
| Slide II |
Pap smear showing HGSIL (X1000) High grade squamous dysplasia with prominent nuclear irregularity and hyperchromasia. |
| Slide III |
Cervical cone biopsy showing CIN 3 (H&E x400). Note loss of polarity and full thickness involvement of epithelium by dysplasic squamous cells. Mitotic figures are present in upper layers of epithelium. Underlying basement membrane is intact .
|
| Slide IV |
Cervical cone biopsy showing CIN 3 with endocervical gland involvement (H&E x200). Glandular involvement by CIN 3 represents intraepithelial spread of dysplastic cells and showed not be confused with invasion. Note smooth contour and intact basement membrane around preexisting gland. |
More Lectures
|
|
