What are pre-malignant cells, dyskaryosis, dysplasia and CIN?

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Fortunately, the cells of the cervix are not normal one day and malignant the next. It probably takes fifteen or more years before a normal cervix gradually becomes malignant. Not all pre-malignant changes progress to cancer: sometimes spontaneous return to normality may occur. Cells scraped from the cervix (PAP test (cervical smear)) can be analysed under the microscope and pre-malignant changes can be recognised. An estimate of the severity of change is generally reported (mild, moderate or severe dyskaryosis or dysplasia). These are the terms used in cytology, the study of cell structure, as a smear is sent for cytological assessment.

When the cytology indicates pre-malignancy of the cervix (Figure 21.7), a magnified assessment of the cervix (colposcopyFigure 21.8) may indicate where the abnormality is located (Figure 21.9) and a biopsy of the cervix may be obtained. The biopsies are sent for histological examination (high powered magnification of tissue;Figure 21.10). The cytological abnormalities mild, moderate and severe dyskaryosis tend to correspond to CIN I, II and III respectively (cervical intra-epithelial neoplasia (a neoplasm is a tumour). Mild, moderate and severe dysplasia are another set of histology terms for CIN I, II and III respectively). Just to complete the terminology, we sometimes call severe dysplasia (CIN III) - Carcinoma-in-situ). The important feature of pre-malignancy is that the abnormal cells are confined to the surface (epithelium).

Figure 21.7 A Pre-malignant Smear

Figure 21.8 Colposcopy

Figure 21.9

If a CIN III abnormality progresses, the abnormal cells penetrate through the basal layer. Provided they have not become deeper than 5mm, this abnormality (micro-invasive) can still be regarded as pre-malignant.

Related Medical Abstracts - Click on the paper title:-

• Outcome of women with index smear showing mild dyskaryosis: effects of age and evidence of HPV infection. (2005-01)
• A 5-year follow up of mildly dyskaryotic smears, comparing colposcopy with expectant management (1999)
• Glandular lesions of the cervix: diagnostic and therapeutic dilemmas (1995)

Please click on the required question.

• 1 What is the cervix?
• 2 What is a cervical polyp?
• 3 What is meant by cervical erosion (ectopy) and cervicitis?
• 4  What is the transformation zone?
• 5 What is a 'Paptest' (PAP test (cervical smear) test)
• 6  My PAP smear test (cervical smear) shows inflammation. Should I be worried?
• 7  What are cells and what is an abnormal (pre- malignant) cell?
• 8 My PAP smear test (cervical smear) shows abnormal cells. Does this mean that I have cancer?
• 9  What is meant by the terms pre-malignant cells, dyskaryosis, dysplasia and CIN?
• 10  What are the symptoms of pre-malignancy of the cervix?
• 11  What are benign and malignant tumours?
• 12  Why have I developed a pre-malignant condition of my cervix?
• 13  What is colposcopy?
• 14  What treatments are available for pre-malignant conditions of the cervix?
• 15  Can pre-malignant conditions of the cervix be cured?
• 16  How can I be re-assured that the pre-malignant changes will not recur?
• 17  How can we prevent carcinoma of the cervix?
• 18  Is there a reason to screen for HPV?
• 19  Support Groups.
• 20  Are there any support groups?

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This is the personal website of David A Viniker MD FRCOG, Consultant Obstetrician and Gynaecologist at Whipps Cross University Hospital, London - Specialist Interests - Reproductive Medicine including Infertility, PCOS, PMS, Menopause and HRT.

I do hope that you find the answers to your women's health questions in the patient information and medical advice provided.