32-year old woman, gravida XII, para V, unmarried, unemployed. Noted increased vaginal discharge and "spotting" after intercourse. Otherwise has no evidence of disease.

Cervical smear ("Pap-smear") taken from this patient shows considerable atypia (variation in cell and nucleus size and shape).

A biopsy of the cervix was performed and the findings are shown here. What is your impression? Benign or malignant?

The diagnosis is cervical intraepithelial neoplasia.

This surgical specimen of the cervix shows pathologic changes. Describe what you see.

Carcinoma of the cervix usually starts at the squamo-columnar junction. Initially the malignant cells are found only in the epithelium and are delimited from the underlying stroma by an intact basement membrane. On the basis of severity and extent of neoplastic changes this preinvasive cervical intraepithelial neoplasia (CIN) is classified into three grades: CIN-I, -II, and -III.

Invasive keratinizing squamous cell carcinoma (a different case).

Squamous cell carcinoma of the cervix invades and spreads into the vagina, parametria and metastasizes to local lymph nodes.

Question for Class Discussion