2.b Atrophy and Transitional Metaplasia

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Atrophy and Transitional Metaplasia

Atrophy and Transitional Metaplasia

Atrophy and Transitional Metaplasia

Atrophy and


Transitional Metaplasia

The cervical epithelium can undergo atrophy post-menopausal women and present with a spectrum of changes. Classically, the atrophic exocervical epithelium becomes hypercellular because the normal maturation process is lost and the squamous cells have an increased nucleo-cytoplasmic ratio with some degree of nuclear hyperchromasia. Therefore, atrophy can be misdiagnosed as a high grade squamous intraepithelial lesion (HSIL). However, careful evaluation of nuclear morphology is the key of establishing a diagnosis of atrophy. Atrophic epithelium shows monomorphous, round to ovoid nuclei which are often grooved, and the mitotic activity is inconspicuous. Sometimes, atrophic epithelium can show some cytoplasmic halo which produces pseudo-koilocytosis that can be mistaken for a low grade squamous intra-epithelial lesion (LSIL). Pathologists should be careful before diagnosing a LSIL in a background of atrophic epithelium; correlation with the concurrent Pap test, the colposcopic impression and the patient's past history is crucial. In difficult cases where the differential diagnosis between atrophy and HSIL is challenging, immunohistochemistry is usually helpful. Atrophic epithelium should be negative for the p16 antibody and have a low proliferation rate with the ki67 antibody. To learn more about the interpretation of immunohistochemical stains in cervical biopsies, take a look at our tutorial.