Describe the classification of cervical intraepithelial neoplasia/squamous intraepithelial lesion. Write a note on the role of Human papilloma virus in the pathogenesis of cervical carcinoma.
Classification of Cervical Intraepithelial Neoplasia (CIN) / Squamous Intraepithelial Lesion (SIL):
Cervical lesions are classified by the degree of epithelial dysplasia.
CIN I / Low-grade SIL (LSIL): Mild dysplasia involving the lower one-third of the epithelium; often linked to transient HPV infection.
CIN II / High-grade SIL (HSIL): Moderate dysplasia affecting two-thirds of the epithelium.
CIN III / HSIL: Severe dysplasia or carcinoma in situ involving more than two-thirds or full-thickness epithelium without stromal invasion.
Invasive Squamous Cell Carcinoma: Malignant cells breach the basement membrane and invade the stroma.
Role of HPV:
Persistent infection with high-risk HPV types (16, 18) drives cervical carcinogenesis. Viral oncoproteins E6 and E7 inactivate tumor suppressors p53 and Rb, respectively, inhibiting apoptosis, promoting uncontrolled proliferation, and causing genomic instability. These changes facilitate progression from CIN lesions to invasive carcinoma, making HPV infection the central etiological factor in cervical cancer.
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