Gynecological Pathology Image Atlas

Low grade squamous intraepithelial lesion: Cervix

Overview

Low grade intraepithelial lesions (LSIL) of the cervix are HPV_induced dysplastic changes within the squamous epithelium of the cervix. Most LSIL are induced by oncogenic HPV types and few are induced by non_oncogenic HPV type 11. Classically, LSIL are characterized by the presence of koilocytes, which are HPV_infected cells showing increased nuclear size, irregular nuclear membrane, cytoplasmic halo, binucleation, and coarse chromatin. A full_blown LSIL is easily recognized by most pathologists (Fig.1). However, whenever the LSIL shows only discrete cytological changes (Fig.2) or when it involves squamous metaplasia (Fig.3), it is very challenging to diagnose and then there may be important inter_observer and intra_observer variations regarding the diagnosis.  Careful observation of the nuclear features will help to distinguish LSIL from benign squamous metaplasia and from reactive changes.

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