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.
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Introduction:
Low-grade cervical dysplasia refers to abnormal changes in the cells of the cervix, which can be detected through a Papanicolaou test (Pap smear). These abnormal cells are considered precancerous and have the potential to progress to more severe forms of dysplasia or cervical cancer if left untreated. Understanding the alterations at the cellular level and prognosis associated with low-grade cervical dysplasia is crucial for appropriate management and counseling of patients.
Answer:
In cases of low-grade cervical dysplasia, certain alterations can be observed at the cellular level. These changes are primarily seen in the squamous epithelial cells of the cervix. The cellular characteristics associated with low-grade dysplasia include increased nuclear-to-cytoplasmic ratio, nuclear hyperchromatism, variation in nuclear size and shape, and irregular epithelial stratification (Kumar et al., 2020).
Low-grade dysplasia represents mild cellular changes and is often caused by persistent infection with high-risk human papillomavirus (HPV) types, particularly HPV 16 and 18 (Kumar et al., 2020). The majority of low-grade dysplasia cases either regress spontaneously or progress to high-grade dysplasia and cervical cancer if left untreated. Therefore, it is essential to monitor the progression or regression of low-grade dysplasia through regular follow-up examinations and Pap smears.
Regarding the prognosis of S. V. (the patient in this scenario), several factors influence the likelihood of disease progression or regression. These factors include the specific cellular features observed, concurrent HPV infection, age of the patient, and immune status. Some studies suggest that in younger individuals, the immune response may be more effective at clearing HPV infection and allowing regression of low-grade dysplasia (Bosch, 2000). However, further investigations are required to fully understand the prognostic factors associated with low-grade dysplasia and individualize the management approach.
To provide a reliable prognosis for S. V., additional diagnostic evaluations such as colposcopy, biopsy, or HPV genotyping might be necessary to further characterize the extent of cellular abnormalities and determine the risk of disease progression. The combination of thorough clinical evaluation, regular follow-up, and appropriate interventions can optimize the prognosis for individuals with low-grade cervical dysplasia.
References:
1. Bosch, F. X. (2000). Epidemiology and natural history of human papillomavirus infections and type-specific implications in cervical neoplasia. Vaccine, 19(Supplement 1), S1-S7.
2. Kumar, V., Abbas, A. K., Aster, J. C., & Robbins, S. L. (2020). Robbins & Cotran Pathologic Basis of Disease (10th ed.). Elsevier.
