INVASIVE SQUAMOUS-CELL CARCINOMA AND CERVICAL INTRAEPITHELIAL NEOPLASIA-III OF UTERINE CERVIX - MORPHOLOGIC DIFFERENCES OTHER THAN STROMAL INVASION

The authors compared 69 cases of surgically proven invasive squamous c ell carcinoma (ISCC) of uterine cervix with 48 cone biopsy specimens t hat showed cervical intraepithelial neoplasia (CIN) grade III. Histolo gic features that were preferentially associated with ISCC included th e following: giant bizarre cells (66.7% in ISCC, 6.26% in CIN III, P< .01); large keratinized cells (87% in ISCC, 0% in CIN III, P < .01); k eratin pearls (40.6% in ISCC, 0% in CIN III, P < .01); necrosis (79.7% in ISCC, 8.3% in CIN III, P < .01); and neovascularization (56.5% in ISCC, 0% in CIN III). In 51 (74%) cases of ISCC, a CIN III component w as present, of which 18 (35.3%) showed large keratinized cells or kera tin pearls in the in situ components. None of the CIN III cases showed more than one of the above features. In the ISCC group, the above fea tures occurred with similar frequency in microinvasive and frankly inv asive tumors. The authors' results agree with previous Papanicolaou-sm ear cytologic studies, which found that ISCC can be distinguished accu rately from CIN III by the morphology of the neoplasm. The authors con cluded that cervical biopsy specimens that show two or more of the abo ve features are highly suggestive of ISCC, even when stromal tissue is absent or insufficient for the assessment of invasion. Furthermore, i n cervical biopsy specimens showing CIN III, the presence of large ker atinized cells or keratin pearls may signify the presence of invasive lesions elsewhere in the cervical mucosa.