Practical 4: Cancer:

Slide 20: Cervix- Carcinoma in Situ

HPV 16 and 18 is the most important, associated with neoplasm of uterine
cervix
35 y/o woman who had hx of multiple sex partners in the past was found
on routine gynecological check up to have an abnormal PAP (exfoliated
cells in cervix) smear. Pick up early uterine cervix neoplasm
Pay particular attention to the nucleus- enlarged nucleus,
prominent nucleoli and nuclear membrane i.e. evidence of
DYSPLASIA as danger sign
Otherwise asymptomatic. 2nd step: Biopsy performed for definitive
diagnosis
Exo-cervix- squamous epithelium transitioning to Endo-cervix which is
glandular, columnar epithelium
Test the zone of transition!!
In the slide:Abrupt change from both ends--> stain blue
Stain used: H&E; H stains nucleus blue, E stains cytoplasm red
Squamous cell has a lot of cytoplasm, usually stains red
The area of change is blue is because high density of nuclear material!
From bottom to top:
Basal layer is very blue --> natural since it is young and undifferentiated:
high nuclear content
Glycogen molecules
Nuclei becomes smaller, more condensed and flattened (Normal
maturation)
Carcinoma in situ tampers with maturation/ polarity (direction of change)
--> when the basement layer looks like the cells at the top
Heterochromatic nuclei extending from basal layer to the
surface/periphery
Dysplastic change has different gradings!
Lower 1/3 CIN1 ; 2/3- CIN2 ; whole thickness- CIN 3 which now on the
brink of carcinoma in situ (severe dysplasia)
Intra-epithelial neoplasia : despite of all the dysplastic changes, the
basement membrane remains intact
When the basement membrane is breached, then invasive carcinoma
1. Grading from CIN 1-3. Degree of abnormal epithelial maturation/
dysplasia
2.Asymptomatic

3. Aetiologic factor: HPV

Slide 21: Squamous cell carcinoma of Cervix
50 y/o woman with post coital bleeding moths ago. Has intermittent
spotting and vaginal discharge (even w/o friction- suggests ulcer). An
ulcerated exophytic growth was seen in the cervix. PAP smear (will look
dirty) was taken followed by definitive surgery (hysterectomy)
Left to right: Normal squamous epithelium w basement level and normal
polarity --> short zone of transition --> you see the tumour that has
broken through the basement membrane (malignant)
Features of Epithelial Tumour
- Cohesive (tend to cluster together)
o When they infiltrate, they come in cords, clumps and clusters!
- Advanced squamous differentiation
o Abundant red cytoplasm
o A lot of intercellular spaces: where the desmosomes attach to
each other i.e. intercellular bridging
o Form Keratin highly characteristic!! (keratin no nucleus?)
1. What are the histological features that indicate
a. Malignancy
Invasion into stroma, keratin pearls (3 features above)
b. Squamous differentiation
2. How doe tis lesion differ from CIN 3
a. Invasion into stroma
Slide 22 Uterus Leiomyoma:
45 y/o lady complains of heavy menses. FBC shows her to be anemic.
Appropriate investigations, undergoes hysterectomy
Multiple nodules: Think of secondary
Benign!- since a. well circumscribed!
Vs cancer (spreads like a crab LOL think the horoscope)
Histology slide well circumscribed (clear borders- differentiated well from
surrounding cells) but NOT ENCAPSULATION --> latches onto surrounding
muscle fibres
Clarification: Capsule= host cells laying down fibrous tissue around the
tumour (and implies it will be well circumscribed)
b. Expansile: pushes away the muscle (myometrium) instead of
infiltrating it
Spindle cells arranged in interlacing fashion within the benign tumour
know that it is mesenchymal in origin and not epithelial in origin -->
individual cells separated from each other; do not cluster

Rounded ends of nuclei, more eosinophilic (darkly pink cytoplasm), seagull

shaped nuclei= smooth muscle
Tapering ends of nuclei = fibroblasts
Since smooth muscle differentiation- leiomyoma
Histogenesis (from the pluripotent cells) more important then tissue of
origin
Demo Slide: Ovary- Mature cystic teratoma
Teratoma: Tumour derived form totipotent cell that can differentiate into a
variety of cells
Teratoma has cystic and solid areas- hematogenous appearance of
different colors morphologically and histologically!
Mostly benign --> but must look for the immature areas which may
potentially be maligant
- Pylo-sebaceous unit has a lot of hair
Kinds of cell you can find: Fat, cartilage , bone, glial tissue,GI or
respi epithelium, skin
Complication: Malignancy esp the epithelia layer (giving rise to
carcinoma)
POI: Even if undifferentiated , stains nowadays can roughly tell you
what the line of differentiation it is from