Clinical History:

A 42 year-old woman, who had not had a medical pelvic examination for many years, noted the onset of postcoital bleeding. When she did seek medical attention, she was noted to have a red, roughened, friable area on the anterior lip of the cervix near the external os. A biopsy was followed by a radical hysterectomy. One pelvic lymph node contained a small focus of metastatic squamous cell carcinoma.

Image 5.1:

There is an exophytic lesion between 3 and 7 o'clock around the os.

Images 5.2 to 5.4:

The image shows a well-differentiated squamous cell carcinoma. Occasional keratin pearls are present. Multiple sections revealed that the lesion extended greater than 3 mm below the surface epithelial basement membrane.

Answers:

1. Grade the degree of differentiation of this lesion.

The image shows a well-differentiated squamous cell carcinoma. Occasional keratin pearls are present.

2. Is this a microinvasive carcinoma?

Multiple sections of the original tumor demonstrated invasion into the stroma greater than 3 mm below the surface epithelial basement membrane; thus, this is not a microinvasive carcinoma.

3. What can you do to prevent this disease?

This patient did not get routine examinations with Pap smear testing. Pap smears can greatly aid detection of cervical intraepithelial neoplasia (CIN), which can progress to carcinoma that can become invasive. CIN is curable, and even for microinvasive carcinomas the cure rate is nearly 100%. The rate of progression to carcinoma from CIN 1 takes years, so yearly Pap smear testing is useful, even if occasional sampling error or false negatives occur.