Morphology & Grade

If the diagnostic term in the pathology report is not in the list below, be sure to consult your ICD-O manual.

  • Squamous cell carcinoma (80703; arises mostly in lower third of cervix; 90% of all cervical cancers; also called epidermoid carcinoma)
  • Squamous carcinomas can be subcategorized as keratinizing (80713) or non-keratinizing, which are further subcategorized as large cell nonkeratinizing (80723) or small cell nonkeratinizing (80733)
    • Squamous carcinoma, spindle cell type (80743)
    • Squamous carcinoma in situ (80702; no stromal invasion)
    • Squamous carcinoma in situ with questionable stromal invasion (80762)
    • Squamous carcinoma in situ with microinvasion (80763; a pathologic determination; invasion of stroma less than 3 mm)
  • Cervical intraepithelial neoplasia, grade III (80772; see comments below)
  • Adenocarcinoma (81403; 10% of all cases)
  • Adenosquamous carcinoma (85603—mixed adenocarcinoma and epidermoid carcinoma)
  • Small cell carcinoma (80413)
  • Sarcoma (cell types vary)
  • Lymphoma (many cell types)

Synonyms for in situ carcinoma: Bowen's disease, Stage 0, CIN grade III, confined to epithelium, intraepidermal, intraepithelial, involvement up to but not including the basement membrane, noninfiltrating, noninvasive, no stromal involvement, papillary noninfiltrating

Cervical Intraepithelial Neoplasia (CIN) This is a method of pathologic description that has been recently developed.

The Bethesda Cytology Reporting System

This descriptive system is comprised of two groups, low grade squamous intraepithelial lesions and high grade squamous intraepithelial lesions. The low grade is the equivalent of CIN I; the high grade is comprised of CIN II (moderate dysplasia) and CIN III (severe dysplasia and carcinoma in situ).

The mortality rate for cervical cancer has declined in the past 40 years due to improvements in the early detection of the disease. The 50% decrease in deaths from cervical cancer can be attributed almost entirely to the development of the Pap smear as a screening tool.

Pap Smears

The Pap smear was originally reported in the terms Class I through Class V (frank malignancy).

  • Papanicolaou's scale
  • I Absence of atypical or abnormal cells; negative
  • II Atypical cytology, dysplastic, borderline but not neoplastic
  • III Cytology suggestive of but not inclusive of malignancy (suspect is a term that is used)
  • IV Cytology strongly suggestive of or strongly suspect malignancy
  • V Cytology conclusive of malignancy; cancer cells present

A Class V Pap smear on this scale is the equivalent of carcinoma in situ.

However, the use of descriptive terms by the pathologist or cytologist conveys more information to the clinician. Suggested descriptive terminology includes:

  • Unsatisfactory specimen
  • No abnormal cells
  • Mild squamous atypia: metaplasia, inflammation, regeneration and repair, radiation or viral effect
  • Dysplastic or atypical cells—mild, moderate, severe (Cervical Intraepithelial Neoplasia)
  • Carcinoma in situ
  • Invasive malignant cells