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Micro-biopsies
and 'nasty dark cell groups' where multiple criteria (architecture
and cytolnuclear changes) must be applied.
Features
of CIN 3 micro-biopsies
- crowded cellular
sheets with cellular overlapping and/or multi-layering
- multi-layered
cellular sheets exhibiting steep relief (mountain-like e.g.Ayers
Rock)
- sheets with
frayed or circumscribed edges
- chaotic uneven
spaced cells
- lack of intracellular
borders
- increased
nuclear size
- high nuclear/cytolplasmic
ratio
- abnormal
chromatin pattern
- nuclear pleomorphism
Problems
- partial involvement
of benign cell sheets - interphase of CIN 3 with normal cells
- deep fracturing
of stromal tissue plane
- CGIN - less
multi-layered and less steep relief
- parabasal
sheets can lead to false positive results as multi-layered however,
they have shallow relief and taper out at the edges. With this
difficult area there are two choices: refer or repeat after oestrogen
cream.
- follicular
cervicitis.
- lower uterine
segment sampling
- TEM - following
cone biopsy, difficult to distinguish from endometriosis, but
associated with shallow relief.
Tips
- Examine edges
- look for abnormal cytonuclear detail.
- Look for
dis-cohesive cells.
- Focus in
and out of grops.
- Look for
mitotic figures.
- Steep
relief - groups of cells coming up out of the slide at you,
almost a 3D appearance as opposed to shallow relief, likened to
a the seashore (slight incline).
- Dispersed
dyskaryotic cells.
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