A 27-year-old woman comes to the office for a health maintenance examination. The patient has no chronic medical conditions and no family history of cancer. She has had several sexual partners and takes oral contraceptives for birth control. Vital signs are normal. Physical examination, including pelvic examination, is normal. A Pap test is performed and reveals a squamous intraepithelial lesion that tests positive for human papillomavirus. A cervical biopsy is performed and reveals low-grade dysplasia. Which of the following features distinguishes this patient's lesion from cervical malignancy?

Question

A 27-year-old woman comes to the office for a health maintenance examination.  The patient has no chronic medical conditions and no family history of cancer.  She has had several sexual partners and takes oral contraceptives for birth control.  Vital signs are normal.  Physical examination, including pelvic examination, is normal.  A Pap test is performed and reveals a squamous intraepithelial lesion that tests positive for human papillomavirus.  A cervical biopsy is performed and reveals low-grade dysplasia.  Which of the following features distinguishes this patient's lesion from cervical malignancy?

Quizplus · Accepted Answer

11ec160b_39f1_9e25_9249_d9fcea8aa42e_MD0001_00 Squamous dysplasia is marked by a breakdown in the normal organized progression from tall cells in the basal layer to flattened cells on the surface. Individual cells are often pleomorphic (differing in shape and size) and also show significant abnormalities such as abundant mitotic figures and large hyperchromatic nuclei. The risk of progression to invasive carcinoma is directly linked to the degree of epithelial architecture disruption, as follows: Cervical dysplasia is almost always due to underlying infection with oncogenic serotypes of human papilloma virus (HPV). In infected cells, viral proteins (eg, E6, E7) bind to tumor-suppressing host proteins (eg, p53) and result in their destruction by the proteasome. This eliminates a crucial check on cellular growth and can lead to dysplasia. (Choices A, B, C, D, and E) Abundant mitoses, disordered maturation, changes in cell polarity, nuclear abnormalities, and pleomorphism can be seen in both dysplasia and invasive carcinoma. Educational objective: Dysplasia is characterized by disruption of organized epithelial cell differentiation with marked cellular pleomorphism. Although high-grade dysplasia (involving most or the entire epithelial layer) often progresses to invasive cancer, low-grade dysplasia (involving a small portion of epithelium) typically spontaneously regresses. Invasive cancer occurs when the abnormal cells penetrate the basement membrane.

A 27-Year-Old Woman Comes to the Office for a Health