1. ASC-H y H-SIL
Dra. Luisa Rojas Jaramillo
Diplomado en Colposcopia
Instituto Nacional de Perinatología
2. ASC-H: células escamosas atípicas,, no se puede descarta Lesion intraepitelial de alto grado.
Reservado para minoría de casos de ASC. (10%)
Ritu Nayar, ”The Bethesda system for reporting cervical pathology” thirs edition Ebook, 2015, Springer.
3. Son células generalmente escasas.
Diferentes patrones celulares
Ritu Nayar, ”The Bethesda system for reporting cervical pathology” thirs edition Ebook, 2015, Springer.
4. Patrones comunes ASC-H
Células pequeña con índice N/C elevado (metaplasia inmadura atípica)
Individual o grupos <10 cel.
Tamaño de una cel metaplásica con núcleo de 1.5-2.5 veces mayor que una célula normal.
Preparación
Base liquida: suelen aparecer un poco mas pequeñas con núcleos 2 a 3 veces el tamaño de los
neutrófilos.
Ritu Nayar, ”The Bethesda system for reporting cervical pathology” thirs edition Ebook, 2015, Springer.
5. Ritu Nayar, ”The Bethesda system for reporting cervical pathology” thirs edition Ebook, 2015, Springer.
6. Ritu Nayar, ”The Bethesda system for reporting cervical pathology” thirs edition Ebook, 2015, Springer.
7. Interpretación
Las células escasmosas metaplasicas normales pueden variar tamaño, forma, forma nuclear, Indice
N/C.
ASC-H puede presentarse como metaplasia inmadura atípica.
Nucleos irregulares, hipercromaticos, cromatina borrosa
Cel escasas
Ritu Nayar, ”The Bethesda system for reporting cervical pathology” thirs edition Ebook, 2015, Springer.
8. Ritu Nayar, ”The Bethesda system for reporting cervical pathology” thirs edition Ebook, 2015, Springer.
9. Hoja abarrotada
Una microbiopsia de células escamosas abarrotadas que contienen núcleos que pueden mostrar
características atípicas, pérdida de polaridad o son difíciles de visualizar.
En citologia convencional aparecen como células alargadas y planas
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10. Ritu Nayar, ”The Bethesda system for reporting cervical pathology” thirs edition Ebook, 2015, Springer.
11. Manejo
En general, se detecta más HSIL (CIN2 +) en el seguimiento de los resultados de ASC que los
interpretados como HSIL, porque ASC es una interpretación citológica mucho más común que
HSIL.
ASC-H con VPH negativo, 12%; y ASC-H con VPH positivo, 45%
Ritu Nayar, ”The Bethesda system for reporting cervical pathology” thirs edition Ebook, 2015, Springer.
12. ASC-H grupo 30-64 años– resultados basados en citología únicamente, desde que el test de VPH
no es necesario para el manejo de ASC-H: CIN 2+ (35 %); CIN 3+ (18 %); cancer cervical (2.6 %;
entre 1647 muestras ASC-H, fueron 18 carcinoma escamoso y 3 adenocarcinomas)
Grupo de 21-24 años de edad ASC-H – CIN 3+ (16 %)
Grupo 25-29 años ASC-H – CIN 3+ (24 %); cancer cervical (1.5 %)
Katki HA, Schiffman M, Castle PE, et al. Benchmarking CIN 3+ risk as the basis for incorporating HPV and Pap cotesting into cervical screening and
management guidelines. J Low Genit Tract Dis 2013; 17:S28.
13. Ritu Nayar, ”The Bethesda system for reporting cervical pathology” thirs edition Ebook, 2015, Springer.
16. Criterio
Celulas pequeñas con menos madurez citoplasmática que las cel LSIL.
Unicas, en grupos hojas, agregados sincitiales.
Agrandamiento nuclear
Indice N/C mayor que LSIL
Ritu Nayar, ”The Bethesda system for reporting cervical pathology” thirs edition Ebook, 2015, Springer.
17.
18. Núcleo puede ser hipercromático, normo o incluso hipocromático
Cromatina suele ser fina o gruesa
Contorno de la membrana nuclear puede ser irregular, pequeñas hendiduras
Apariencia del citoplasma puede ser transparente, delicado, o en ocasiones queratinizado
Ritu Nayar, ”The Bethesda system for reporting cervical pathology” thirs edition Ebook, 2015, Springer.
19. LSIL
HSIL
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20. Ritu Nayar, ”The Bethesda system for reporting cervical pathology” thirs edition Ebook, 2015, Springer.
21. Ritu Nayar, ”The Bethesda system for reporting cervical pathology” thirs edition Ebook, 2015, Springer.
22.
23. Ritu Nayar, ”The Bethesda system for reporting cervical pathology” thirs edition Ebook, 2015, Springer.
24. Riesgo de malignidad
Mujeres de 30-64 años HSIL
Incidencia para NIC2+ es de 69%
NIC3+ 47%
Cáncer cervical 7.3%
Ritu Nayar, ”The Bethesda system for reporting cervical pathology” thirs edition Ebook, 2015, Springer.
ASC-H ( LBP, ThinPrep ). A 27-year-old woman. ( a ) On the left are isolated small cells with variable N/C ratios and some cells displaying prominent nuclear irregularity. ( b ) On the right is a high-magnification view of six small cells with enlarged and irregular, but degenerated, nuclei. Follow-up was HSIL (CIN 3)
ASC-H ( LBP, SurePath ). Routine cytology for a 30-year-old woman. Rare metaplastic cells with dense cytoplasm and nuclear enlargement with hyperchromasia are present in a background of scattered acute inflammation. An interpretation of ASC-H was rendered. Follow-up cervical biopsies revealed immature squamous metaplasia. Immature squamous metaplasia is one of the most common mimics of HSIL. An interpretation of ASC-H is appropriate, especially when only rare abnormal cells with “metaplastic” cytoplasm and high nuclear to cytoplasmic ratio are present
ASC-H ( LBP, SurePath ). A group of atypical immature metaplastic cells with enlarged nuclei, high nuclear to cytoplasmic ratio, coarse chromatin and irregular nuclear contour. The cytologic features are worrisome but insuffi cient for an interpretation of HSIL. Follow-up biopsy
revealed HSIL (CIN3)
ASC-H ( CP ). Thick aggregate of cohesive, air-dried, overlapping cells containing
nuclei with even chromatin and regular borders. The thickness of the cluster makes it difficult to
determine if the cells are squamous or glandular. The disorganization of the cells within the group
is suggestive of a high-grade lesion; however, the individual nuclear features are insufficient for a
definitive interpretation
HSIL ( CP ). There is variation in nuclear size and shape, and the cells have delicate
cytoplasm
High-grade squamous intraepithelial lesion (HSIL) ( LBP , ThinPrep ). There is a mixture
of dysplastic cells here, one large LSIL cell, and four adjacent, small, high N/C ratio cells with
nuclear features consistent with HSIL
High-grade squamous intraepithelial lesion (HSIL) ( CP ). The dysplastic cells are seen
here in a syncytial cluster or hyperchromatic crowded group
HSIL ( CP ). Nuclear changes are HSIL; however, the nuclear/cytoplasmic (N/C) ratio is
on the low end for HSIL
HSIL-keratinizing lesion ( CP ). The criteria of nuclear to cytoplasmic ratio and degree
of nuclear abnormalities used for grading SIL may be more diffi cult to apply to keratinizing
lesions. The extent of abnormality here qualifi es for an interpretation of HSIL (contrast with
Figs. 5.8 and 5.9 )
HSIL ( LBP , ThinPrep ). A 32-year-old woman with a history of abnormal Pap tests and
positive hrHPV testing. A syncytial cluster of cells with overlapping of hypochromatic nuclei are
seen. The nuclei are often less hyperchromatic in liquid-based preparations. Follow-up cone
biopsy revealed HSIL (CIN 3)