1. 44

2. Squamous cell carcinoma
Non-keratinizing

9. Keratinizing Squamous Cell Carcinoma
Singly or less commonly in aggregates
Cell의 size와 shape의 marked variation 
주로 orangeophilic cytoplasm을 가지는 caudated and spindle cell이 관찰
Nuclei도 size와 configuration이 상당히 다양하고 dense opaque nuclear form도 보임
Chromatin은 구분할 수 있으면 coarsely granular and irregulary distributed with parachromatin clearing

10. Keratinizing Squamous Cell Carcinoma
Macronuclei may be seen but less common than Nonkeratinizing Squamous Cell Carcinoma
A tumor diathesis may be present

11. 45

16. Atypical Squamous Cell of Undetermined Significance (ASCUS)
Morphologic changes exceed the parameters of benign reactive process but are insufficient for a definitive diagnosis of a lesion(SIL)
A spectrum of cellular changes reflecting
a variety of pathologic processes that for
one reason or another cannot be specifically categorized

17. 정의
반응성 변화(reactive cellular change) 범주에 포함시키기에는 세포의 비정형성(atypia)이 심하나 편평상피내 병변(SIL) 으로 진단하기에는 그 질적, 양적 변화가 부족한 경우를 말한다.

18. Atypical Squamous Cell of Undetermined Significance (ASCUS)
Criteria ;
Nuclear enlargement가 intermediate cells의
2.5 ~ 3배 정도이고 N/C ratio가 약간 증가
Nuclear size와 shape의 variation과 binucleation이 관찰 되기도
Mild hyperchromasia
Chromatin: evenly distributed without granularity
Nuclear outlines는 smooth and regular: very limited irregularity

19. Reactive cellular change-repair

20. ASCUS, Favor reactive 18

21. 19
ASCUS, Favor reactive

22. ASCUS 21

23. 22

24. 25

25. 26

26. 27

27. 28
ASCUS asso. with Atrohy

28. ASCUS asso. with Atrophy29

29. 31
ASCUS, favor LSIL

30. Laboratory Reporting of ASCUS
May be qualified to indicate whether a reactive process or SIL is more likely
Should communicate as much information as possible to assist the clinician
- Atypical squamous cells, possibly HSIL
- Atypical squamous cells, probably reactive
- ASCUS, in the setting of marked atrophy

31. Clinical Management of ASCUS
Further evaluation will detect SIL in 25-60%
(1) Follow-up by repeat smears every 4-6 months for 2 years
(2) Colposcopy in a high-risk patient or if another abnormal smear is reported in the follow-up period
(3) Repeat smear after treatment, if associated with severe inflammation and a specific infectious agent
(4) Repeat smear after estrogen stimulation, if associated with atrophy

32. ASCUS vs LSIL ASCUS LSIL Nuclear size/intermediate 2.5-3X > 3X
Increased N/C Slight Moderate
Nuclear pleomorphism Slight Moderate
Binucleation Occasional Often
Hyperchromasia Mild Definite
Chromatin distribution Even Even, smudged
Nuclear outline Smooth Slight irregularity
with rare irregularity

33. The Bethesda System 2001 Squamous cells abnormality:
ASC-US, ASC-H (cannot exclude HSIL)
Low grade SIL (HPV/ mild)
High grade SIL (moderate/ severe/ CIS), with features suspicious for invasion (if invasion is suspected)
Squamous cell carcinoma

34. ASC-US
ASC-H

35. 수고하셨습니다~~!!