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Atypical hyperplasia**

Severe dysplasia

SIN 3***

Atypical hyperplasia**

Carcinoma in-situ

SIN 3***

Carcinoma in-situ

* Basal/parabasal cell hyperplasia may histologically resemble mild dysplasia, but the former is conceptually benign lesion and the latter the lower grade of precursor lesions. ** 'Risky epithelium'. The analogy to moderate and severe dysplasia is approximate. *** The advocates of SIN combine severe dysplasia and carcinoma in-situ.

the earliest manifestations of dysplasia and no single combination of the above features allows for consistent distinction between hyperplasia and the earliest stages of dysplasia. Dysplasia is a spectrum and no criteria exist to precisely divide this spectrum into mild, moderate and severe categories.

Mild dysplasia

In general architectural disturbance limited to the lower third of the epithelium accompanied by cytological atypia define the minimum criteria of dysplasia.

Table 4.02 Criteria used for diagnosing dysplasia

Moderate dysplasia

Architectural disturbance extending into the middle third of the epithelium is the initial criterion for recognizing this category. However, consideration of the degree of cytologic atypia may require upgrading.

Severe dysplasia

Recognition of severe dysplasia starts with greater than two thirds of the epithelium showing architectural disturbance with associated cytologic atypia. However, as noted in the previous para-

Table 4.02 Criteria used for diagnosing dysplasia

Architecture

Cytology

Irregular epithelial stratification

Abnormal variation in nuclear size (anisonucleosis)

Loss of polarity of basal cells

Abnormal variation in nuclear shape (nuclear pleomorphism)

Drop-shaped rete ridges Increased number of mitotic figures

Abnormally superficial mitoses

Abnormal variation in cell size (anisocytosis) Abnormal variation in cell shape (cellular pleomorphism) Increased nuclear-cytoplasmic ratio

Premature keratinization in single cells (dyskeratosis)

Keratin pearls within rete pegs

Increased nuclear size Atypical mitotic figures

Increased number and size of nucleoli

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