A 34-year-old woman comes to the office for follow-up after 2 abnormal Papanicolaou test results. The patient has had 4 lifetime sex partners, uses oral contraceptive pills, and has never been pregnant. She has no other medical problems and does not use tobacco, alcohol, or illicit drugs. Her mother has breast cancer. Physical examination is normal. A cervical biopsy reveals high-grade cervical intraepithelial neoplasia. Which of the following is the most likely finding on histopathology?

Question

A 34-year-old woman comes to the office for follow-up after 2 abnormal Papanicolaou test results.  The patient has had 4 lifetime sex partners, uses oral contraceptive pills, and has never been pregnant.  She has no other medical problems and does not use tobacco, alcohol, or illicit drugs.  Her mother has breast cancer.  Physical examination is normal.  A cervical biopsy reveals high-grade cervical intraepithelial neoplasia.  Which of the following is the most likely finding on histopathology?

Quizplus · Accepted Answer

11ec160b_3920_44ea_9249_fd8b88478f92_MD0001_00 Human papillomavirus (HPV) infection of basal cervical cells can progress to malignancy. Cervical cancer screening is initially done with cervical cytology in Papanicolaou (Pap) tests, which sometimes leads to further evaluation (eg, colposcopy, biopsy) if certain squamous or glandular abnormalities are seen. This patient had 2 abnormal Pap test results and now has a biopsy showing cervical intraepithelial neoplasia (CIN), which indicates one of the following types of squamous abnormalities: (Choices A and D) Basement membrane invasion (eg, atypical cells in subepithelial stroma) signifies carcinoma. When atypical glandular cells (originating from the endocervix) are seen on Pap tests, a biopsy is often required and can reveal squamous CIN, despite the original glandular findings. (Choice E) HPV infection can cause perinuclear vacuolization (koilocytic change) due to viral proteins. This does not reflect any malignant or premalignant conditions. Educational objective: Human papillomavirus infection of basal cervical cells can progress to premalignant and cancerous lesions. Cervical intraepithelial neoplasia refers to atypical squamous cells and is classified as low-grade squamous intraepithelial lesions (if extending <1/3 of the epithelium) or high-grade squamous intraepithelial lesions (if extending beyond). Basement membrane breach signifies invasive disease. __________ References: The Pap Test and Bethesda 2014. "The reports of my demise have been greatly exaggerated." (after a quotation from Mark Twain). (http://www.ncbi.nlm.nih.gov/pubmed/25997404) A fusion-based approach for uterine cervical cancer histology image classification. (http://www.ncbi.nlm.nih.gov/pubmed/24075360) The Lower Anogenital Squamous Terminology Standardization project for HPV-associated lesions: background and consensus recommendations from the College of American Pathologists and the American Society for Colposcopy and Cervical Pathology. (http://www.ncbi.nlm.nih.gov/pubmed/23202792)

A 34-Year-Old Woman Comes to the Office for Follow-Up After