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relating to or associated with the neck
of or relating to the cervix of the uterus; "cervical cancer"
the pathological process that results in the formation and growth of a tumor

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/09/04 17:20:55」(JST)

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Cervical intraepithelial neoplasia (CIN), also known as cervical dysplasia and cervical interstitial neoplasia, is the potentially premalignant transformation and abnormal growth (dysplasia) of squamous cells on the surface of the cervix.^[1] CIN is not cancer, and is usually curable.^[2] Most cases of CIN remain stable, or are eliminated by the host's immune system without intervention. However a small percentage of cases progress to become cervical cancer, usually cervical squamous cell carcinoma (SCC), if left untreated.^[3] The major cause of CIN is chronic infection of the cervix with the sexually transmitted human papillomavirus (HPV), especially the high-risk HPV types 16 or 18. Over 100 types of HPV have been identified. About a dozen of these types appear to cause cervical dysplasia and may lead to the development of cervical cancer. Other types cause warts.

The earliest microscopic change corresponding to CIN is dysplasia of the epithelial or surface lining of the cervix, which is essentially undetectable by the woman. Cellular changes associated with HPV infection, such as koilocytes, are also commonly seen in CIN. CIN is usually discovered by a screening test, the Papanicolau or "Pap" smear. The purpose of this test is to detect potentially precancerous changes. Pap smear results may be reported using the Bethesda System. An abnormal Pap smear result may lead to a recommendation for colposcopy of the cervix, during which the cervix is examined under magnification. A biopsy is taken of any abnormal appearing areas. Cervical dysplasia can be diagnosed by biopsy.

Risk factors[edit source | edit]

Some risk factors that have been found to be important in developing CIN are:^[1]

Women who become infected by a "high risk" type of HPV, such as 16, 18, 31, or 45
Women who are immunodeficient
Women who give birth before age 17

A number of risk factors have been shown to increase a woman's likelihood of developing CIN,^[4] including poor diet, multiple sexual partners, lack of condom use, and cigarette smoking.

Classification[edit source | edit]

Depending on several factors such as the type of HPV and the location of the infection, CIN can start in any of the three stage, and can either progress, or regress.^[1]

CIN is classified in grades::::

Histology Grade	Corresponding Cytology	Description
–	–	Normal cervical epithelium
CIN 1 (Grade I)	LSIL^[5]	The least risky type, represents only mild dysplasia, or abnormal cell growth.^[3] It is confined to the basal 1/3 of the epithelium. This corresponds to infection with HPV, and typically will be cleared by immune response in a year or so, though can take several years to clear.
CIN 2/3	HSIL	Formerly subdivided into CIN2 and CIN3.
CIN 2 (Grade II)		Moderate dysplasia confined to the basal 2/3 of the epithelium
CIN 3 (Grade III)		Severe dysplasia that spans more than 2/3 of the epithelium, and may involve the full thickness. This lesion may sometimes also be referred to as cervical carcinoma in situ.

Treatment[edit source | edit]

CIN 1 does not require treatment if it lasts less than 2 years.^[6] Treatment for higher grade CIN involves removal or destruction of the neoplastic cervical cells by cryocautery, electrocautery, laser cautery, loop electrical excision procedure (LEEP), or cervical conization. Therapeutic vaccines are currently undergoing clinical trials. The lifetime recurrence rate of CIN is about 20%,^{[citation needed]} but it isn't clear what proportion of these cases are new infections rather than recurrences of the original infection.

Epidemiology[edit source | edit]

Between 250,000 and 1 million American women are diagnosed with CIN annually. Women can develop CIN at any age, however, women generally develop it between the ages of 25 to 35.^[1]

References[edit source | edit]

^ ^a ^b ^c ^d Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson; & Mitchell, Richard N. (2007). Robbins Basic Pathology (8th ed.). Saunders Elsevier. pp. 718–721. ISBN 978-1-4160-2973-1.
^ Cervical Dysplasia: Overview, Risk Factors
^ ^a ^b Agorastos T, Miliaras D, Lambropoulos A, Chrisafi S, Kotsis A, Manthos A, Bontis J (2005). "Detection and typing of human papillomavirus DNA in uterine cervices with coexistent grade I and grade III intraepithelial neoplasia: biologic progression or independent lesions?". Eur J Obstet Gynecol Reprod Biol 121 (1): 99–103. doi:10.1016/j.ejogrb.2004.11.024. PMID 15949888.
^ Murthy NS, Mathew A. (February 2000). "Risk factors for pre-cancerous lesions of the cervix". European Journal of Cancer Prevention 9 (1): 5–14. doi:10.1097/00008469-200002000-00002. PMID 10777005. 10777005.
^ Park J, Sun D, Genest D, Trivijitsilp P, Suh I, Crum C (1998). "Coexistence of low and high grade squamous intraepithelial lesions of the cervix: morphologic progression or multiple papillomaviruses?". Gynecol Oncol 70 (3): 386–91. doi:10.1006/gyno.1998.5100. PMID 9790792.
^ Wright TC, Jr; Massad, LS; Dunton, CJ; Spitzer, M; Wilkinson, EJ; Solomon, D; 2006 American Society for Colposcopy and Cervical Pathology-sponsored Consensus, Conference (2007 Oct). "2006 consensus guidelines for the management of women with cervical intraepithelial neoplasia or adenocarcinoma in situ.". Journal of lower genital tract disease 11 (4): 223–39. PMID 17917567.

UpToDate Contents

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1. 子宮頸部上皮内腫瘍：治療およびフォローアップ cervical intraepithelial neoplasia treatment and follow up
2. 子宮頸部上皮内腫瘍：用語、発生率、病因、および予防 cervical intraepithelial neoplasia terminology incidence pathogenesis and prevention
3. 子宮頸部上皮内腫瘍：低悪性度および高悪性度病変のマネージメント cervical intraepithelial neoplasia management of low grade and high grade lesions
4. 子宮頸部上皮内腫瘍：治療の生殖への影響 cervical intraepithelial neoplasia reproductive effects of treatment
5. 子宮頸部上皮内腫瘍：アブレーション治療 cervical intraepithelial neoplasia ablative therapies

English Journal

Impact of immunosuppression and region of birth on risk of cervical intraepithelial neoplasia among migrants living with HIV in Sweden.

Carlander C1,2, Wagner P2, Svedhem V1, Elfgren K3, Westling K1, Sönnerborg A1,4, Sparén P5.
International journal of cancer.Int J Cancer.2016 Oct 1;139(7):1471-9. doi: 10.1002/ijc.30188. Epub 2016 Jun 2.
Little is known about the incidence and risk of cervical intraepithelial neoplasia (CIN) grade 3, adenocarcinoma in situ and invasive cervical cancer (CIN3+) among migrants living with HIV in a European setting. We assessed the cumulative incidence (CuI) and hazard ratio (HR) of CIN2+ and CIN3+ in a
PMID 27177207

Length but not transverse diameter of the excision specimen for high-grade cervical intraepithelial neoplasia (CIN 2-3) is a predictor of pregnancy outcome.

Liverani CA1, Di Giuseppe J, Clemente N, Delli Carpini G, Monti E, Fanetti F, Bolis G, Ciavattini A.
European journal of cancer prevention : the official journal of the European Cancer Prevention Organisation (ECP).Eur J Cancer Prev.2016 Sep;25(5):416-22. doi: 10.1097/CEJ.0000000000000196.
The objective of this study was to analyze the impact of cone characteristics (depth, transverse diameter, and volume) on subsequent pregnancies after the loop electrosurgical excision procedure (LEEP) for cervical intraepithelial neoplasia (CIN 2-3). Pregnancy outcomes (preterm birth, gestational a
PMID 26317385

Phylogenetic and functional analysis of sequence variation of human papillomavirus type 31 E6 and E7 oncoproteins.

Ferenczi A1, Gyöngyösi E1, Szalmás A1, László B1, Kónya J1, Veress G2.
Infection, genetics and evolution : journal of molecular epidemiology and evolutionary genetics in infectious diseases.Infect Genet Evol.2016 Sep;43:94-100. doi: 10.1016/j.meegid.2016.05.020. Epub 2016 May 16.
High-risk human papillomaviruses (HPV) are the causative agents of cervical and other anogenital cancers as well as a subset of head and neck cancers. The E6 and E7 oncoproteins of HPV contribute to oncogenesis by associating with the tumour suppressor protein p53 and pRb, respectively. For HPV type
PMID 27197052

Japanese Journal

Trend of Human Papillomavirus Genotypes in Cervical Neoplasia Observed in a Newly Developing Township in Yangon, Myanmar

Mu Mu Shwe,Kyi Kyi Nyunt,Okada Shigeru,Harano Teruo,Hlaing Myat Thu,Hla Myat Mo Mo,Mo Mo Win,Khin Khin Oo,KhinThet Wai,Khin Saw Aye,Myo Khin
Acta Medica Okayama 69(1), 51-58, 2015-02
… Persistent infection with oncogenic types of human papillomavirus (HPV) is the most important risk factor associated with cervical cancer. … This study detected the oncogenic HPV genotypes in cervical neoplasia in relation to clinicopathological findings using a cross-sectional descriptive method in 2011 and 2012. …
NAID 120005549928