Histological terms and Dysplasia grading

Question 1

In histalogical terms define atypia

Answer 1

Changes to individual cell

Question 2

What is the managment of moderate dysplasia for small and large lesions?

Answer 2

Small lesion - Surgical excision

Large lesion - Multiple biopsies (1st appt), review & monitor, repeated biopsies as indicated

Question 3

What is the managment of mild dysplasia?

Answer 3

Review – every 3-6 months

Risk Factor advice:
* Alcohol, Tobacco & Betel cessation
* Nutritional assessment (Fe, B12, Folate)
* Anti-oxidant rich diet (green tea, tomatoes)

3-month biopsy to reassess dysplasia
Further biopsy (2-3 years) IF indicated

Question 4

In histalogical terms define parakeratosis

Answer 4

Flat, homogenous eosinophilic superficial cells BUT with pyknotic nuclei (dense & compact)

Question 5

What is the relationship between dysplasia grading and malignancy?

Answer 5

Degree of Dysplasia = best indication of malignant potential

Severe dysplasia’s are at most risk of becoming malignant

Question 6

In histalogical terms define keratosis

Answer 6

Keratinisation in an epithelium that is not normally keratinised

Question 7

In histalogical terms define atrophy

Answer 7

Decreased epithelial thickness
Loss of rete ridges
Epithelium may be roughly equal thickness throughout

Question 8

In histalogical terms define orthokeratosis

Answer 8

Flat, anucleate superficial cells with homogenous eosinophilic cytoplasm

Question 9

Explain the different gradings of dysplasia

None
Mild
Moderate
Severe

Answer 9

NONE – Epithelial cells appear normal

MILD – Few epithelial cells in basal layer cells show atypia

MODERATE – Most cells in basal layer (and some supra-basally) show atypia

SEVERE – Almost all cells show atypia but no evidence of invasion into underlying tissues

Question 10

In histalogical terms define hyperkeratosis

Answer 10

Increased keratin layer thickness

Question 11

In histalogical terms define acanthosis

Answer 11

Increased number of cells in prickle cell layer
Broadening of rete ridges *
Thicker epithelium

Epithelial extensions project into underlying CTs in skin & mucous membs

Question 12

What are the steps of histological change in dysplasia?

Answer 12

1. Nuclear hyperchromatism (increased DNA content)
2. Nuclear and cellular pleomorphism (variation in size/shape)
3. Increased nuclear to cytoplasmic ratio
4. Increased number and bizarre mitoses
5. Mitosis in prickle cell layer
6. Premature keratinisation in the prickle cell layer
7. Loss of basal cell polarity
8. Loss of epithelial stratification
9. Drop-shaped rete ridges
10. Loss of cell adherence

Question 13

What is the managment of severe dysplasia?

Answer 13

Surgical excision – Scalpel, Laser or Cryotherapy

Photodynamic Therapy – Topical/Systemic, can target multiple lesions & pt will have to stay in darkened room

Question 14

In histalogical terms define dysplasia

Answer 14

Changes to whole epithelium