Abstract
Cervical squamous precursor lesions precede invasive carcinomas by 10–15 years and, therefore, are highly amenable to screening and early detection. This section reviews squamous intraepithelial lesions from low-grade to high-grade, as well as their benign and neoplastic morphologic mimics. Low-risk human papillomaviruses (HPV) cause condylomas and low-grade lesions characterized by productive viral infections with little to no risk for progression to carcinoma. High-risk HPV, on the other hand, causes low-grade and high-grade lesions with a significantly higher risk of progression to invasive carcinoma. The diagnostic reproducibility of CIN 1, CIN 2, and CIN 3 is only moderate at best and the use of ancillary studies to adjudicate difficult cases is encouraged in the appropriate setting. Immunohistochemistry for p16 and Ki-67 can be very helpful in the distinction between benign and high-grade intraepithelial lesions, yet these should not be used to differentiate benign from low-grade lesions. HPV in-situ hybridization (mRNA-based) is a highly sensitive and specific marker for the detection of HPV transcription in suspected lesions and is a useful addition to standard immunohistochemistry. Other neoplastic lesions, such as stratified mucin-producing intraepithelial lesion (SMILE) and metastatic urothelial carcinoma, can also mimic HSIL. Clinical history and careful examination of the histologic features are key to arriving at the correct diagnosis.
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Park, K.J. (2021). Precursor Lesions of the Cervix: Squamous Precursor Lesions. In: Soslow, R.A., Park, K.J., Stolnicu, S. (eds) Atlas of Diagnostic Pathology of the Cervix. Springer, Cham. https://doi.org/10.1007/978-3-030-49954-9_5
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