Sexual Activity HPV HPV exposure (millions/yr) Immune status Genetic vulnerability Other factors Low-risk HPV(6,11) High-risk HPV episomal infection (16,18,others) viral integration Condyloma CIN(million/yr) (hundreds of thousands/yr) Persistent infection Higher-grade CIN(300,000/yr) ↓ Invasive cancer(15,000/yr) ↓ Metastasis (5000/yr) Figure 19-6 An attempt to depict the sequence of events that may follow human papil- lomavirus (HPV)infection.CIN,cervical intraepithelial neoplasia
(I)Cervical Intraepithelial Neoplasia 1.Cervical Epithelial Dysplasia It is a precancerous lesion On the basis of histology,epithelial dysplasia are graded as follows: Mild dysplasia <1/3 layers of the epithelium Moderate dysplasia 113-213 Severe dysplasia >23
(I) Cervical Intraepithelial Neoplasia 1. Cervical Epithelial Dysplasia It is a precancerous lesion On the basis of histology, epithelial dysplasia are graded as follows: Mild dysplasia <1/3 layers of the epithelium Moderate dysplasia 1/3-2/3 Severe dysplasia >2/3
Grade and Pathological change CIN I:mild dysplasia atypical cells limited in the basal 1/3 of the epithelium ◆ CIN II:moderate dysplasia cellular atypia in the lower 2/3 of the epithelium CIN III:severe dysplasia atypical cells involve more the 2/3 of the epithelium carcinoma in situ involve all layers of the epithelium,but not pierce into the GBM,partially or completely replace the columnar epithelium of the endocervical glands
Grade and Pathological change CIN I: mild dysplasia atypical cells limited in the basal 1/3 of the epithelium CIN II: moderate dysplasia cellular atypia in the lower 2/3 of the epithelium CIN III: severe dysplasia atypical cells involve more the 2/3 of the epithelium carcinoma in situ involve all layers of the epithelium, but not pierce into the GBM, partially or completely replace the columnar epithelium of the endocervical glands
Normal CIN I CIN II CIN III
Normal CIN I CIN II CIN III
CIN I,I1,III
CIN I，II，III