Cervical squamous intraepithelial neoplasia
Cervical intraepithelial neoplasia (CIN)
Updated: 02/29/2020
© Jun Wang, MD, PhD
General features
- AKA Squamous Intraepithelial Lesion (SIL)
- Precancerous changes
- Human papilloma virus associated
- Usually start from cervical transformation zone
- Bethesda system (High and low grade)
- Low grade: CIN I
- High grade: CIN II and III
- Low grade dysplasia tend to regress
- Much higher risk for development of invasive cancer if high grade
Clinical presentations
- Most time identified due to screening with Pap test
Key risk factors
- Human papilloma virus infection, especially high risk group, such as HPV 16 and 18
- Most HPV infections will regress, even without treatment
Key pathogenesis
- P16 overexpression in high grade dysplasia and cancers
Key Laboratory findings
- Pap smears
- HPV test
Key morphological features
- Dysplastic changes: Enlarged hyperchromic nuclei with wrinkled nuclear member, increased nuclear/cytoplasmic ratio
- CIN I: including condyloma, dysplasia limited to lower third of epithelium, may have Koilocyte,
- CIN II: dysplasia involving mid third of epithelium
- CIN III: dysplasia involving upper third of epithelium
Markers of dysplasia
- Diffuse p16 reactivity
- Proliferation (Ki67 reactivity) beyond basal layer
Management
- LSIL: Controversial since most lesions regress
- HSIL:
Cone biopsy
LEEP
Electrodiathermy
Cryosurgery
Laser
Long term followup
Intraepithelial lesions in
anogential areas
- Similar etiology and terminology
- Same morphology in cytological examination
- Vulva: Vulvar intraepithelial neoplasm; incidence increasing; more common in women 20 to 35 years; multifocal, VIN I-III
- Vagina: Vaginal intraepithelial neoplasia; uncommon; Mean age ~50-60 years; VAIN I-III
- Anus: Anal intraepithelial neoplasia; perianal skin or anal canal in flat mucosa or with condyloma acuminatum; HIV+ patients are at increased risk, often have high risk HPV types within low grade lesions; AIN I-III
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