[Morphological observation of cone biopsy and hysterectomy specimens of high-grade cervical intraepithelial neoplasia].

OBJECTIVE

To study the histopathological features, growth pattern and distribution on the uterine cervix of high-grade cervical intraepithelial neoplasia (CIN).

METHODS

Cone biopsy and hysterectomy specimens of 592 women with high-grade CIN (CIN II or III) were reviewed morphologically. Of all cases, the gross appearance of the external os was recorded, and the frequency of cervical quadrants involved in high-grade CIN was assessed. Two hundred specimens were selected randomly to observe micrographical changes, including the extent, depth, growth pattern and cell types of high-grade CIN and the alteration of stroma surrounding CIN.

RESULTS

Of 592 specimens, external os showed smoothness in 46 cases (7.8%), mild erosion in 151 cases (25.5%), moderate or severe erosion in 395 cases (66.7%), hypertrophy in 48 cases (8.1%), and neoplasm in 4 cases (0.7%). High-grade CIN involvement was equally frequent on each quadrant of cervix (P>0.05). Of 200 cases of high-grade CIN reviewed micrographically, the depth of the deepest involved crypt was less than 3 mm in 188 specimens (94.0%), between 3 to 5 mm in 12 specimens (6.0%), and more than 5 mm in none. High-grade CIN with isolated endocervical crypt involvement was detected in 77 cases (38.5%), multiple crypt involvement in 143 cases (71.5%), and confluent crypt involvement in 73 cases (36.5%). High-grade CIN showed explanate in 81.0% (162/200) of cases, endophytic in 49.0% (98/200) of cases, and exophytic in 6. 5% (13/200) of cases. Abrupt transition between CIN and normal epithelia were found in 167 specimens (83.5%), whereas gradual transition in 66 specimens (33.0%). A variety of cell types, but basaloid type predominantly, were observed in high-grade CIN. In 28.5%-45.0% of cases, the stroma surroundin CIN displayed oedema, desmoplastic and lymphocytic responses.

CONCLUSIONS

Our data suggest that gross examination is of little importance for diagnoses of CIN. CIN trend to spread horizontally and along the endocervical crypts, and are mainly distributed to a depth less than 3 mm. These data also suggest that there are a variety of cell types of CIN, and stroma responses to CIN may exist in part of high-grade CIN.