title: Diagnostic cellular abnormalities in neoplastic and non-neoplastic lesions of the epidermis: a morphological and statistical study.
abstract: BACKGROUND
  Distinguishing cellular abnormalities in reactive and malignant lesions is challenging. We compared the incidence and severity of cytological abnormalities in malignant/premalignant and benign epidermal lesions.
  
  
  METHODS
  One hundred fifty-two biopsies representing 69 malignant/premalignant squamous lesions and 83 benign conditions were studied. Cytological features, including nuclear hyperchromasia, nuclear overlap (crowding), irregular nuclei, high nuclear/cytoplasmic (N/C) ratio, conspicuous nucleoli, delicate inconspicuous nucleoli, clumped chromatin, pleomorphic parakeratosis, normal and abnormal mitotic figures and necrotic keratinocytes, were evaluated and graded. Statistical analysis was performed.
  
  
  RESULTS
  Irregular nuclei, increased N/C ratio, conspicuous single prominent nucleoli, nuclear overlap (crowding), pleomorphic parakeratosis, nuclear hyperchromasia, necrotic keratinocytes, normal and abnormal mitotic figures and coarse chromatin were seen more frequently in malignant neoplasms (p < 0.05). Abnormal mitotic figures, although uncommon (20.3%), were only noted in the malignant/premalignant group. Certain cytological features were common among both malignant and benign lesions, suggesting that they are of little value.
  
  
  CONCLUSIONS
  In the setting of an atypical cutaneous squamous proliferation, nuclear irregularity, increased N/C ratio, conspicuous nucleoli, crowding and hyperchromasia are the most useful indicators of malignancy. In contrast, mitotic figures, necrotic cells and coarse chromatin are less useful. The presence of abnormal mitotic figures is very helpful when present; however, their overall rarity limits their utility.
authors: Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
authors: Saurabh
authors: S
authors: Malhotra
authors: Viktoryia
authors: V
authors: Kazlouskaya
authors: Christian
authors: C
authors: Andres
authors: Jiang
authors: J
authors: Gui
authors: Dirk
authors: D
authors: Elston
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000473:pathology*; D002467:Cell Nucleus / Q000473:pathology; D002908:Chronic Disease; D003593:Cytoplasm / Q000473:pathology; D016208:Databases, Factual; D004485:Eczema / Q000473:pathology; D004817:Epidermis / Q000473:pathology*; D006801:Humans; D015603:Keratinocytes / Q000473:pathology; D055623:Keratosis, Actinic / Q000473:pathology*; D008010:Lichen Planus / Q000473:pathology; D008938:Mitosis; D009336:Necrosis; D009450:Neurodermatitis / Q000473:pathology; D011230:Precancerous Conditions / Q000175:diagnosis*; D011565:Psoriasis / Q000473:pathology; D012878:Skin Neoplasms / Q000473:pathology*
references: J Otolaryngol Head Neck Surg. 2009 Jun;38(3):348-54
references: 19476767
references: J Low Genit Tract Dis. 2010 Apr;14(2):90-6
references: 20354415
references: Am J Dermatopathol. 1996 Feb;18(1):19-23
references: 8721586
references: Ophthalmology. 1999 Sep;106(9):1756-60; discussion 1761
references: 10485547
references: Fam Med. 1999 Jun;31(6):432-7
references: 10367208
references: Br J Dermatol. 1985 Aug;113(2):185-8
references: 4027186
references: Am J Pathol. 1952 Jan-Feb;28(1):105-27
references: 14885409
references: Cancer. 2001 Feb 25;93(1):29-34
references: 11241263
references: J Cutan Pathol. 1993 Apr;20(2):143-7
references: 8320359
references: Oral Oncol. 1997 Mar;33(2):110-8
references: 9231168
references: Pathology. 2011 Apr;43(3):183-200
references: 21436628
references: J Cutan Pathol. 2012 Feb;39(2):225-33
references: 22236073
references: Acta Otolaryngol. 1978 Nov-Dec;86(5-6):473-9
references: 82365
references: Adv Anat Pathol. 2008 Sep;15(5):263-78
references: 18724100
references: Cancer. 1956 May-Jun;9(3):470-9
references: 13329996
references: Acta Cytol. 1993 Sep-Oct;37(5):699-704
references: 8362581
references: Am J Clin Pathol. 2005 May;123(5):699-706
references: 15981809
references: Med Hypotheses. 2004;63(2):281-2
references: 15236791
references: Mod Pathol. 2010 Jun;23(6):799-803
references: 20190731
references: Anal Quant Cytol Histol. 1996 Oct;18(5):374-82
references: 8908309
references: Am J Surg Pathol. 2001 May;25(5):652-6
references: 11342778
references: Acta Cytol. 1977 Mar-Apr;21(2):298-300
references: 266341
references: Dermatology. 1992;185(3):190-5
references: 1446084
references: Am J Pathol. 2003 Sep;163(3):1091-100
references: 12937150
references: Histopathology. 2001 Jan;38(1):68-72
references: 11135049
references: Cancer Causes Control. 2002 Nov;13(9):813-23
references: 12462546
references: Acta Cytol. 2012;56(1):62-7
references: 22236747
references: Cancer. 2007 Jun 25;111(3):160-5
references: 17506090
references: Cancer. 1953 Mar;6(2):224-34
references: 13032911
references: Br J Dermatol. 1980 Apr;102(4):401-5
references: 7387882
references: Anal Quant Cytol Histol. 1994 Aug;16(4):284-6
references: 7945703
references: Cancer. 1951 Mar;4(2):255-60
references: 14821917
references: Acta Cytol. 1985 May-Jun;29(3):269-73
references: 3859124