Asc h y hsil
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Este documento resume las definiciones de ASC-H (células escamosas atípicas de significado incierto) y HSIL (lesión intraepitelial escamosa de alto grado) según el sistema Bethesda. ASC-H se reserva para una minoría de casos de ASC y puede indicar una lesión de alto grado. HSIL se caracteriza por células pequeñas con núcleos agrandados e índice N/C mayor que LSIL, con riesgo de malignidad de hasta 69% para CIN2+, 47% para CIN3+ y 7.3%
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Asc h y hsil
- 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 Ritu Nayar, ”The Bethesda system for reporting cervical pathology” thirs edition Ebook, 2015, Springer.
- 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.
- 15. H-SIL
- 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.
- 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 Ritu Nayar, ”The Bethesda system for reporting cervical pathology” thirs edition Ebook, 2015, Springer.
- 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.
- 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.
Notas del editor
- Celulas metaplasicas inmaduras atípicas, células abarrotadas, atrofia severa, reparación celular atípica.
- 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)