44
Squamous cell carcinoma Non-keratinizing
Keratinizing Squamous Cell Carcinoma Singly or less commonly in aggregates Cell의 size와 shape의 marked variation 주로 orangeophilic cytoplasm을 가지는 caudated and spindle cell이 관찰 Nuclei도 size와 configuration이 상당히 다양하고 dense opaque nuclear form도 보임 Chromatin은 구분할 수 있으면 coarsely granular and irregulary distributed with parachromatin clearing
Keratinizing Squamous Cell Carcinoma Macronuclei may be seen but less common than Nonkeratinizing Squamous Cell Carcinoma A tumor diathesis may be present
45
Atypical Squamous Cell of Undetermined Significance (ASCUS) Morphologic changes exceed the parameters of benign reactive process but are insufficient for a definitive diagnosis of a lesion(SIL) A spectrum of cellular changes reflecting a variety of pathologic processes that for one reason or another cannot be specifically categorized
정의 반응성 변화(reactive cellular change) 범주에 포함시키기에는 세포의 비정형성(atypia)이 심하나 편평상피내 병변(SIL) 으로 진단하기에는 그 질적, 양적 변화가 부족한 경우를 말한다.
Atypical Squamous Cell of Undetermined Significance (ASCUS) Criteria ; Nuclear enlargement가 intermediate cells의 2.5 ~ 3배 정도이고 N/C ratio가 약간 증가 Nuclear size와 shape의 variation과 binucleation이 관찰 되기도 Mild hyperchromasia Chromatin: evenly distributed without granularity Nuclear outlines는 smooth and regular: very limited irregularity
Reactive cellular change-repair
ASCUS, Favor reactive 18
19 ASCUS, Favor reactive
ASCUS 21
22
25
26
27
28 ASCUS asso. with Atrohy
ASCUS asso. with Atrophy 29
31 ASCUS, favor LSIL
Laboratory Reporting of ASCUS May be qualified to indicate whether a reactive process or SIL is more likely Should communicate as much information as possible to assist the clinician - Atypical squamous cells, possibly HSIL - Atypical squamous cells, probably reactive - ASCUS, in the setting of marked atrophy
Clinical Management of ASCUS Further evaluation will detect SIL in 25-60% (1) Follow-up by repeat smears every 4-6 months for 2 years (2) Colposcopy in a high-risk patient or if another abnormal smear is reported in the follow-up period (3) Repeat smear after treatment, if associated with severe inflammation and a specific infectious agent (4) Repeat smear after estrogen stimulation, if associated with atrophy
ASCUS vs LSIL ASCUS LSIL Nuclear size/intermediate 2.5-3X > 3X Increased N/C Slight Moderate Nuclear pleomorphism Slight Moderate Binucleation Occasional Often Hyperchromasia Mild Definite Chromatin distribution Even Even, smudged Nuclear outline Smooth Slight irregularity with rare irregularity
The Bethesda System 2001 Squamous cells abnormality: ASC-US, ASC-H (cannot exclude HSIL) Low grade SIL (HPV/ mild) High grade SIL (moderate/ severe/ CIS), with features suspicious for invasion (if invasion is suspected) Squamous cell carcinoma
ASC-US ASC-H
수고하셨습니다~~!!