Low-grade Cervical Dysplasia -cellular alteration & prognosis

A common finding with Papanicolaou tests (aka pap smear or pap test) is low-grade cervical dysplasia, most often occurring in the squamocolumnar junction, the area of the cervix where the squamous and columnar cells meet (Lim, Lee, Cho, Hong, Lim, 2016). Alterations expected at the cellular level would show chaotic, non-uniform growth of cervical cells, as well as loss of organization of grouped cells (Hammer & McPhee, 2019).

Low-grade cervical dysplasia, otherwise referred to as low-grade squamous epithelial lesions,  are most often attributed to human papillomavirus (HPV), with more than 90% of cases, regardless of etiology, spontaneously regressing (Tornesello, Buonaguro, Giorgi-Rossi, & Buonaguro, 2013). Specific high-risk serotypes of HPV have a more significant impact on cervical cells, increasing risk for malignancy if left untreated (Hammer & McPhee, 2019). With more than 100 strains, HPV is broken into “low risk” and “high risk” categories. The difference between the two seems to be how the HPV genome encodes oncoproteins, E6 and E7, and the level of expression of each (Hammer & McPhee, 2019).

For the best odds at the most favorable prognosis, options and suggested screenings should be discussed with S.V., with a personalized plan in alignment with her needs and preferences, considering her personal and familial health history. Possible options could include an HPV screen to determine if this is a factor (Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 2019). If HPV is present and deemed to be “low risk” to cervical health, a 6 month repeat pap smear (Behnamfar, Zafarbakhsh, & Allameh, 2015), an HPV screen, or a combination of both may be scheduled (Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 2019). With negative findings at that time, based on S.V.’s age of 35, screening could be resumed at the CDC recommendation of every three years for just a pap smear, or every 5 years for a negative primary HPV or negative co-testing (Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 2019).


Behnamfar, F., Zafarbakhsh, A., & Allameh, T. (2015). Study of 2 years follow-up of referral patients with abnormal pap smear. Journal of Research in Medical Sciences, 20(12) doi:http://dx.doi.org.americansentinel.idm.oclc.org/10.4103/1735-1995.172981

Division of Cancer Prevention and Control, Centers for Disease Control and Prevention (2019 August 20). Cervical Cancer: What should I know about screening? Retrieved from Centers for Disease Control and Prevention: https://www.cdc.gov/cancer/cervical/basic_info/screening.htm

Hammer, G. & McPhee, S. (2019). Pathophysiology of disease: An introduction to clinical medicine (8th ed.). New York, NY: McGraw-Hill Education /Medical

Lim, S., Lee, M. J., Cho, I., Hong, R., & Lim, S. C. (2016). Efficacy of p16 and ki-67 immunostaining in the detection of squamous intraepithelial lesions in a high-risk HPV group. Oncology Letters, 11(2), 1447. doi:http://dx.doi.org.americansentinel.idm.oclc.org/10.3892/ol.2015.407

Tornesello, M. L., Buonaguro, L., Giorgi-Rossi, P., & Buonaguro, F. M. (2013). Viral and cellular biomarkers in the diagnosis of cervical intraepithelial neoplasia and cancer. BioMed research international2013, 519619. https://doi.org/10.1155/2013/519619


Discussion 1

See Van, a 35-year-old married Hmong-American woman recently underwent an annual Papanicolaou test (Pap smear) at her Certified Nurse Midwife’s practice, and the results were abnormal.  Her provider diagnosed her with low-grade cervical dysplasia.  What alterations at the cellular level would you expect to see with this diagnosis? Provide and discuss with your colleagues S. V.’s prognosis. Support your discussion with citations from the textbook, external credible literature and/or reliable electronic sources.

Remember to respond to at least two of your peers. Please refer to the Course Syllabus for Participation Guidelines & Grading Criteria.

The terms cervical dysplasia and cervical intraepithelial neoplasia can be used interchangeably. Malignancies of the epithelial region are termed carcinomas. Dysplasia is a broad term that can refer to the abnormal development of cells. Cervical dysplasia is a pathologic finding associated with a predisposition and can progress further, according to Hammer and McPhee (2019). This disease can be found with a cervical biopsy or examination.

There are some alterations at the cellular level with this disease. It can start with either genomic instability, impaired DNA repair, or lack of cell cycle checkpoint control. It then turns to enhanced proliferation, abnormal cell cycle control, and autonomous growth. This leads to an evasion of the immune system and later, tissue. There is enhanced cell motility and the ability to gain access to blood vessels, which can eventually lead to the ability to recruit vascularization to support the growth of a tumor (Hammer & McPhee, 2019).

S.V’s prognosis is fairly good. Cervical intraepithelial neoplasia is graded by levels 1, 2 and 3. Level 1 is considered low grade. Because of this, S.V. has the highest rate of spontaneous regression, according to Flagg et al. (2016). Since she caught it early, she should have access to aggressive treatment early on.

There is a 40% incidence rate in women with HPV related cervical dysplasia. Without proper treatment and screening, this can progress to invasive cervical carcinoma, according to Hammer and McPhee (2019). This means that the basement membrane has been broken and can now metastasize to other areas of the body. Usually, epithelial neoplasms spread to regional nodes. Receiving the HPV vaccine is a valuable tool considering the prognosis of this disease, according to Hong et al. (2016). High-grade lesions are less likely to form if the vaccine is given. According to Flagg et al. (2016), declines in cervical dysplasia are most noted in countries with higher insurance coverage, thus leading more people to receive the vaccine.



Flagg, E. W., Torrone, E. A., & Weinstock. H. (2016). Ecological association of human papillomavirus vaccination with cervical dysplasia prevalence in the United States. American Journal of Public Health, 106(12).

Hammer, G.D. & McPhee, S.J., (2019). Pathophysiology of disease: An introduction to clinical medicine (8th ed.). New York, NY: McGraw-Hill Education/Medical.

Hong. C., Liu, X., & Xu, L. (2016). Incisal margin condition after LEEP for cervical intraepithelial neoplasia patients and prognosis. Experimental and therapeutic medicine, 12 (1).

See Van does have a heightened risk for cervical cancer based on her ethnicity. Cervical cancer is among the top 5 cancers affecting Asian-American and Pacific Islander (AAPI) women (Hee Yun et al, 2015). Noting this factor before discussing her results and treatment plan is important because it could impact her decision for future testing. This patients Pap smear showed dysplasia which shows, a reversion to more immature cells without a committed identity (Hammer & McPhee, 2019). There are several ways that this diagnosis can be handled, some of the treatment methods depend on what the patient wants and what options are provided for them to choose from.  In the Hmong-American culture it is important to note that, spiritually-based health beliefs can be a barrier to cancer screening because the individual will try to turn to spiritual remedies instead of seeking preventive Western care, such as a Pap test (Hee Yun et al, 2015). See Van may already have a predisposition to avoid modern testing and medicine due to her cultural beliefs. Cervical dysplasia, without proper screening for early detection and treatment, can progress to invasive cervical carcinoma (Hammer & McPhee, 2019). This is important to share with the patient as one of the options is to wait and see if new changes occur on the next Pap smear. If a pap test is positive recommendations can include an immediate colposcopy, repeat cytology at 6 and 12 months, or HPV testing with a referral for colposcopy (Rebar et al. 2019). If further testing revealed a need for treatment then there are other options including cryosurgery, laser ablation, and loop electrosurgical excisional procedure for preinvasive lesions. Overall, her prognosis could be very good if she chooses to undergo further testing and treatment, however, if she chooses to wait or not seek treatment then the cervical dysplasia may progress into cervical cancer leading to further complications and poorer prognosis.


Hammer, G., & McPhee, S. (2019). Pathophysiology of disease: An introduction to clinical medicine 8e (8th ed.). Mcgraw-hill Education / Medical.

Hee Yun Lee, Pa Nhia Yang, Do Kyung Lee, & Rahel Ghebre. (2015). Cervical Cancer Screening Behavior among Hmong-American Immigrant Women. American Journal of Health Behavior, 39(3), 301–307. https://doi-org.americansentinel.idm.oclc.org/10.5993/AJHB.39.3.2

Rebar Cherie R., Heimgartner Nicole M., Gersch Carolyn J, (2019). Pathophysiology made incredibly easy! (6th ed.). Wolters Kluwer.

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