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Case 147

A 60 year old male with an anal biopsy.


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  1. What's your interpretation?

    A: Metaplasia

    B: LSIL

    C: HSIL

    D: SCC

Answer

The correct answer is C.


Category

Previous Terminologies Included

Histologic Features

Clinical Notes

Immunohistochemistry

LSIL (Low-grade Squamous Intraepithelial Lesion)

Mild dysplasia, AIN I, anal SIL I, condyloma acuminatum

- Cytologic atypia and mitoses in lower 1/3 of epithelium


- Koilocytotic atypia present


- If condyloma acuminatum: papillomatous growth, parakeratosis, broad rete pegs

- May coexist with HSIL


- Often associated with multiple HPV subtypes

p16 IHC not recommended; may be confusing

HSIL (High-grade Squamous Intraepithelial Lesion)

Moderate dysplasia, severe dysplasia, carcinoma in situ, Bowen disease, Bowenoid papulosis

- Involves ≥2/3 of epithelium


- Marked cytological atypia


- Atypical mitoses in upper layers


- Loss of nuclear polarity

- Bowen disease: plaque-like lesion with chronic inflammation


- Bowenoid papulosis: papular lesion, more indolent, may regress

p16 IHC: diffusely positive, helpful in distinguishing from reactive changes

Case credit: UCSD Pathology

Author: Wangpan Jackson Shi, MD

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