Hyriavenko N. I., Lуndіna Y. S., Shyrai A. M., Tsepochko D. G., Sikora K. O., Romaniuk A. M.

PATHOMORPHOLOGICAL CHARACTERISTICS OF CERVICAL SQUAMOUS INTRAEPITHELIAL LESIONS

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About the author:

Hyriavenko N. I., Lуndіna Y. S., Shyrai A. M., Tsepochko D. G., Sikora K. O., Romaniuk A. M.

Heading:

PATHOMORPHOLOGY

Type of article:

Scientific article

Annotation:

Squamous intraepithelial lesion (SIL) of the cervix is a precancerous condition that requires accurate diagnosis to prevent progression to invasive cancer. One practical approach to verifying such lesions is to combine morphological analysis with immunohistochemical methods, which improves diagnostic accuracy and identifies prognostically important criteria. The study analysed cervical biopsy material obtained from 54 patients with a clinical diagnosis of dysplasia. The proteins p16 and Ki-67 were used as immunohistochemical markers. In 33 cases (61%), SIL was morphologically confirmed. Of these, 17 patients had low-grade lesions (LSIL), which mostly had negative or weakly positive p16 expression and limited Ki-67 accumulation in the lower third of the epithelium. High-grade lesions (HSIL) were recorded in 16 women, characterised by intense block expression of p16 and extensive Ki-67 labelling in 2/3 or the entire thickness of the epithelial layer. In 21 cases (39%), histological examination did not confirm the presence of SIL, indicating a risk of overdiagnosis based solely on clinical or cytological data. The results confirm the usefulness of immunohistochemical verification as a tool for early diagnosis, lesion type differentiation, and informed clinical decision-making in the management of patients with suspected cervical dysplasia.

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Bibliography:

1. Crum CP, Nucci MR, Lee KR, editors. Diagnostic Gynecologic and Obstetric Pathology. 3rd ed. Philadelphia: Elsevier; 2018. Сhapter, Cervical squamous neoplasia. p. 298–374. DOI: 10.1016/B978-1-4377-0764-9.00013-5.
2. Adiga D, Eswaran S, Pandey D, Sharan K, Kabekkodu SP. Molecular landscape of recurrent cervical cancer. Crit Rev Oncol Hematol. 2021;157:103178. DOI: 10.1016/j.critrevonc.2020.103178.
3. Ghosh S, Jayaram P, Kabekkodu SP, Satyamoorthy K. Targeted drug delivery in cervical cancer: Current perspectives. Eur J Pharmacol. 2022;917:174751. DOI: 10.1016/j.ejphar.2022.174751.
4. Global Medical Knowledge Alliance. Likuuvannia raku shyjky matky – novyj pidkhid pokrashchuie vyzhyvanist i znyzhuie ryzyk retsydyvu. Global Medical Knowledge Alliance; 2024. Dostupno: https://gmka.org/ uk/news/proryv-u-likuvanni-raku-shyjky-matky-novyj-pidhid- znyzhuye-smertnist-na-40-i-ryzyk-retsydyvu-na-35/. [in Ukrainian].
5. Gelband H, Jha P, Sankaranarayanan R, Horton S, editors. Cancer: Disease Control Priorities. 3rd Edition (Volume 3). Washington (DC): The World Bank; 2015. 360 p.
6. Alrajjal A, Pansare V, Choudhury MSR, Khan MYA, Shidham VB. Squamous intraepithelial lesions (SIL: LSIL, HSIL, ASCUS, ASC-H, LSIL-H) of Uterine Cervix and Bethesda System. Cytojournal. 2021;18:16. DOI: 10.25259/Cytojournal_24_2021.
7. Huang EC, Tomic MM, Hanamornroongruang S, Meserve EE, Herfs M, Crum CP. p16ink4 and cytokeratin 7 immunostaining in predicting HSIL outcome for low-grade squamous intraepithelial lesions: a case series, literature review and commentary. Mod Pathol. 2016;29(12):1501-1510. DOI: 10.1038/modpathol.2016.141.
8. Ince U, Aydin O, Peker O. Clinical importance of "low-grade squamous intraepithelial lesion, cannot exclude high-grade squamous intraepithelial lesion (LSIL-H)" terminology for cervical smears 5-year analysis of the positive predictive value of LSIL-H compared with ASC-H, LSIL, and HSIL in the detection of high-grade cervical lesions with a review of the literature. Gynecol Oncol. 2011;121(1):152-6. DOI: 10.1016/j.ygyno.2010.12.004.
9. Lawson JS, Glenn WK, Heng B, Ye Y, Tran B, Lutze-Mann L, et al. Koilocytes indicate a role for human papilloma virus in breast cancer. Br J Cancer. 2009;101(8):1351-6. DOI: 10.1038/sj.bjc.6605328.
10. Torous VF. Challenging lesions in cervical cytology: The elusive HSIL. Cytopathology. 2024;35(1):48-59. DOI: 10.1111/cyt.13303.
11. Tainio K, Athanasiou A, Tikkinen KAO, Aaltonen R, Cárdenas J, Hernándes, et al. Clinical course of untreated cervical intraepithelial neoplasia grade 2 under active surveillance: systematic review and meta-analysis. BMJ. 2018;360:k499. DOI: 10.1136/bmj.k499.
12. Mureşan D, Rotar IC, Apostol S, Coroiu G, Stamatian F. HPV immunohistochemical testing and cervical dysplasia. Clujul Med. 2016;89(2):236-40. DOI: 10.15386/cjmed-653.
13. Martin CM, O’Leary JJ. Histology of cervical intraepithelial neoplasia and the role of biomarkers. Best Pract Res Clin Obstet Gynaecol. 2011;25(5):605-15. DOI: 10.1016/j.bpobgyn.2011.04.005.
14. Tamminen E. Fine structure and enzyme histochemistry of stratified squamous epithelium in the human uterine cervix with reference to the epidermis in the female thigh. Acta Obstet Gynecol Scand Suppl. 1970;8(8):1-67. DOI: 10.3109/00016347009155070.
15. del Pino M, Garcia S, Fusté V, Alonso I, Fusté P, Torné A, et al. Value of p16(INK4a) as a marker of progression/regression in cervical intraepithelial neoplasia grade 1. Am J Obstet Gynecol. 2009;201(5):488.e1-7. DOI: 10.1016/j.ajog.2009.05.046. 16.
16. Alrajjal A, Pansare V, Choudhury MSR, Khan MYA, Shidham VB. Squamous intraepithelial lesions (SIL: LSIL, HSIL, ASCUS, ASC-H, LSIL-H) of Uterine Cervix and Bethesda System. Cytojournal. 2021;18:16. DOI: 10.25259/Cytojournal_24_2021.
17. Iovan L, Liliac IM, Istrate-Ofiteru AM, Rosu CG, Mogoanta L. Clinical and Morphological Study of Cervical Squamous Intraepithelial Lesions. Curr Health Sci J. 2023;49(2):220-229. DOI: 10.12865/CHSJ.49.02.220.
18. Darragh TM, Colgan TJ, Thomas Cox J, Heller DS, Henry MR, Luff RD, et al. The Lower Anogenital Squamous Terminology Standardization project for HPV-associated lesions: background and consensus recommendations from the College of American Pathologists and the American Society for Colposcopy and Cervical Pathology. Int J Gynecol Pathol. 2013;32(1):76-115. DOI: 10.1097/PGP.0b013e31826916c7.
19. Kamal M. Cervical Pre-cancers: Biopsy and Immunohistochemistry. Cytojournal. 2022;19:38. DOI: 10.25259/CMAS_03_13_2021.
20. Liu J, Su S, Liu Y. The value of Ki67 for the diagnosis of LSIL and the problems of p16 in the diagnosis of HSIL. Sci Rep. 2022;12(1):7613.DOI: 10.1038/s41598-022-11584-z.

Publication of the article:

«Bulletin of problems biology and medicine», 2025 Issue 3,178, 458-469 pages, index UDC 618.146-006.52-022.7-093/-098

DOI:

10.29254/2077-4214-2025-3-178-458-469