Grades of CIN
CIN is divided into three grades: CIN 1: Mild dysplasia involving about one-third of the thickness of the cervical epithelium.
CIN 2: Moderate dysplasia involving up to two-thirds of the epithelial thickness.
CIN 3: Severe dysplasia, also known as carcinoma in situ (CIS), involving more than two-thirds of the epithelial thickness up to the full thickness.
Histological Features of CIN
The histological examination of CIN reveals specific changes in the cervical epithelium. These include: Nuclear atypia: Enlarged, hyperchromatic nuclei with irregular contours.
Increased
mitotic activity: Presence of mitotic figures, especially in the upper layers of the epithelium.
Dyskeratosis: Abnormal keratinization within the epithelial cells.
Loss of normal epithelial architecture: Disordered maturation of cells from the basal layer to the surface.
Causes and Risk Factors
The primary cause of CIN is infection with
Human Papillomavirus (HPV), particularly high-risk strains like HPV 16 and HPV 18. Other risk factors include early onset of sexual activity, multiple sexual partners, smoking, and immunosuppression.
Diagnosis
The diagnosis of CIN involves several steps: Pap smear: Initial screening test to detect abnormal cells.
Colposcopy: A detailed examination of the cervix using a special microscope to identify areas of abnormality.
Biopsy: Tissue samples are taken for histological examination to confirm the presence and grade of CIN.
Treatment Options
The treatment of CIN depends on the grade of the lesion and the patient's age and preferences. Options include:Prognosis
The prognosis for CIN is generally good, especially with early detection and treatment. However, if left untreated, CIN 3 has a higher risk of progressing to
invasive cervical cancer. Regular screening and follow-up are crucial for managing CIN effectively.
Prevention
Prevention strategies for CIN include: HPV vaccination to protect against high-risk HPV strains.
Regular cervical screening with Pap smears and HPV testing.
Safe sexual practices, including the use of condoms and limiting the number of sexual partners.
