Is cervical intraepithelial lesion serious?

Cervical intraepithelial neoplasia may develop into cancer, so if it is serious, it must be taken seriously, and cervical intraepithelial neoplasia may require hysterectomy. Although the uterus is very important for a woman, it is more important to treat the disease. Otherwise, it is not just a matter of not having a uterus. In serious cases, it will affect life.

Cancer

1. Definition:

The International Federation of Gynecology and Obstetrics (FIGO) considers invasive cancer to be less than 5 mm in depth, and the Society of Gynecologic Oncology considers invasive cancer to be less than 3 mm in depth and less than 7 mm in lateral width, which is called microinvasive cancer. In the FIGO staging of cervical cancer, microinvasive carcinoma is stage 1a.

Microinvasive carcinoma must be distinguished from HSIL, as the prognosis and treatment principles of the two are different. Although the management varies among hospitals, most hospitals perform hysterectomy for clear microinvasive carcinoma.

2. Evidence for diagnosis of microinvasive carcinoma

A pro-fibrotic reaction can be seen around the cancer nest;

Very irregular borders;

Pseudoglandular structures formed by central necrosis;

Blunt tongue-like flat-push growth;

Reverse cell maturation;

Capillary-lymphatic space invasion

(III) Insufficient evidence for diagnosis of microinvasive carcinoma

Small squamous epithelial lesions surrounded by numerous inflammatory cells;

Numerous inflammatory cells obscure the basement membrane area;

Placental implant nodules are sometimes easily misdiagnosed as microinvasive carcinoma.

4. Diagnosis of microinvasive carcinoma

The diagnosis can only be made with certainty on cone biopsy specimens, not on biopsy specimens; cone biopsy specimens should be taken in 2 mm thick slices, and all samples should be embedded.

The pathology report should provide the following information:

★ The penetration depth is best measured using an eyepiece with a ruler;

★ The width of the lesion;

★ Is it continuous or multifocal?

★ Is there any capillary-lymphatic space infiltration?

★ What are the inner, outer and bottom cutting edges? If negative, how far are they from the lesion? Is there any SIL and its relationship with the cutting edge?

★ Is there adenoid differentiation?

Conclusion

In daily work, a lot of cervical biopsy specimens are collected, and medical disputes caused by under-diagnosis or over-diagnosis are often heard. In recent years, the international obstetrics and gynecology community has been working tirelessly to refine the treatment of cervical squamous cell lesions, creating greater pressure on pathology diagnosis. Although the current trend is that diagnosis is becoming increasingly simplified, a correct diagnosis can only be made after strictly following the diagnostic criteria and differentiating it from similar diseases. Therefore, strengthening contact with obstetricians and gynecologists, and always paying attention to, learning and absorbing relevant pathological and clinical progress can help us take the initiative and make fewer mistakes.

1. Clinical characteristics of cervical squamous epithelial lesions

The lesions always occur at the squamocolumnar junction (transition zone), so if the transition zone is not seen in the section, it is necessary to inform the clinician;

Most LSILs regress, with only a few continuing to progress, while HSILs are often accompanied by high-risk HPV infection and are more likely to develop into cancer; the time it takes for SIL to develop into cancer can be as long as several years to 20 years;

Although it is very important to distinguish between LSIL and HSIL, in terms of tissue morphology, the two are continuous lesions without a clear dividing line. There are always individual cases at the intersection, making it difficult for the diagnostician to make a decision.