al-Nafussi A I, Hughes D E
Department of Pathology, University of Edinburgh Medical School, Scotland.
J Clin Pathol. 1994 Sep;47(9):799-804. doi: 10.1136/jcp.47.9.799.
To determine the histological features in CIN3 associated with or predictive of subsequent microinvasion.
The histological appearances of CIN3 accompanying 120 cases of microinvasive carcinoma of the uterine cervix were retrospectively studied. Major features were defined as those present in greater than 80% of cases of microinvasive carcinoma (MICA) and less than 10% of control cases of CIN3. One hundred cases of CIN3, 36 showing all, and 64 lacking all, of the major features associated with microinvasion, as defined in the retrospective study, were prospectively studied. Deeper levels were cut to exclude the presence of microinvasion in the original biopsy specimen and negative cases were followed up for a period of up to 18 months in order to assess rates of recurrence or progression.
The major features identified in CIN3 associated with microinvasive carcinoma were extensive involvement of surface epithelium and deep endocervical crypts by expansile CIN3, luminal necrosis, and intraepithelial squamous maturation. Other features more commonly present in MICA associated CIN3 than in controls included frequent mitosis and apoptosis, pericryptal concentric fibroplasia, pericryptal inflammatory infiltrate, pronounced cellular pleomorphism, nuclear changes (distinct nucleoli and chromatin clearing), and the emergence of streams of darkly stained spindle cells oriented at right angles to the basement membrane. In the prospective study 83% of cases illustrating the major MICA associated features revealed evidence of MICA or frank invasion either on serial sections of the original biopsy or on subsequent biopsy. None of the 64 cases of CIN3 that lacked these features showed evidence of invasion on serial sections or on further follow up over 18 months.
The data strongly suggest that cases of CIN3 which have a higher probability of association with or rapid progression to invasive disease can be identified. When these features are present in a biopsy specimen of CIN3, serial sections should be performed to exclude the presence of microinvasion. Closer clinical follow up of these patients may be needed.
确定与后续微浸润相关或可预测后续微浸润的宫颈上皮内瘤变3级（CIN3）的组织学特征。
回顾性研究120例宫颈微浸润癌伴发的CIN3的组织学表现。主要特征定义为在超过80%的微浸润癌（MICA）病例中出现且在少于10%的CIN3对照病例中出现的特征。前瞻性研究100例CIN3病例，其中36例具有回顾性研究中定义的与微浸润相关的所有主要特征，64例缺乏所有这些主要特征。切取更深层面以排除原活检标本中存在微浸润，对阴性病例随访长达18个月以评估复发或进展率。
在与微浸润癌相关的CIN3中确定的主要特征为膨胀性CIN3广泛累及表面上皮和深部宫颈隐窝、管腔坏死及上皮内鳞状化生。在与MICA相关的CIN3中比在对照中更常见的其他特征包括频繁的有丝分裂和凋亡、隐窝周围同心性纤维增生、隐窝周围炎性浸润、明显的细胞多形性、核改变（明显的核仁及染色质清晰）以及出现与基底膜成直角排列的深染梭形细胞束。在前瞻性研究中，83%具有与MICA相关主要特征的病例在原活检的连续切片或后续活检中显示有MICA或明显浸润的证据。64例缺乏这些特征的CIN3病例在连续切片或18个月的进一步随访中均未显示浸润证据。
数据强烈提示，可以识别出与浸润性疾病关联可能性较高或快速进展为浸润性疾病的CIN3病例。当这些特征出现在CIN3活检标本中时，应制作连续切片以排除微浸润的存在。可能需要对这些患者进行更密切的临床随访。
