Cervical Intraepithelial Neoplasia and Condyloma

The nomenclature and classification of intraepithelial squamous lesions of the cervix have a controversial history,17 now further complicated by the introduction of new terminology for the classification of cervical human papillomavirus (HPV) infection.39 The classic terminology separates noninvasive cervical lesions into two groups: dysplasia and carcinoma in situ (CIS), implying a biologic distinction between these two entities that can be reproducibly distinguished histologically.21,151 In the cytologic nomenclature using this system, dysplasia is considered a benign to possibly malignant squamous epithelial atypia, whereas CIS is designated as positive for malignant cells. In 1961, at the First International Congress on Exfoliative Cytology, the Committee on Histological Terminology for Lesions of the Uterus Cervix defined CIS as follows231: “Only those cases should be classified as CIS which, in the absence of invasion, show a surface lining epithelium in which, throughout its whole thickness, no differentiation takes place. The process may involve the lining of the cervical glands.” It is recognized that the cells of uppermost layers may show some slight flattening. The very rare case of an otherwise characteristic CIS that shows a greater degree of differentiation belongs to the exceptions for which no classification can provide. Dysplasia of the cervix was defined as 231: “... all other (than CIS) disturbances of differentiation of the squamous epithelial lining of surface and glands.... They may be characterized as of high or low degree, terms which are preferable to suspicious and non-suspicious, as the proposed terms describe the histological appearance and do not express an opinion.” The narrow and arbitrary definition of CIS and the broad, all encompassing definition of dysplasia led to diagnostic uncertainties and to a classification based solely on histology, divorced from clinical and therapeutic considerations. 21,102,173