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Dysplasia

Dysplasia (latin for 'bad form') is an abnormality in the appearance of cells indicative of an early step towards transformation into a neoplasia. It is therefore a pre-neoplastic or pre-cancerous change. This abnormal growth is restricted to the epithelial layer, not invading into the deeper tissue. Though dysplasia may regress spontaneously, persistent lesions must be removed, either with surgery, chemical burning, heat burning, burning with laser, or freezing (cryotherapy). more...

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The best know form of dysplasia is the precursor lesions to cervical cancer, called cervical intraepithelial neoplasia (CIN). This lesion is caused by an infection with the human papilloma virus (HPV). Dysplasia of the cervix is almost always unsuspected by the woman. It is usually discovered by a screening test, the pap smear. The purpose of this test is to diagnose the disease early, while it is still in the dysplasia phase and easy to cure.

Dysplasia vs carcinoma in situ vs invasive carcinoma

These terms are related since they represent the three steps of the progression towards cancer:

  • Dysplasia is the earliest form of pre-cancerous lesion recognizable in a biopsy by a pathologist. Dysplasia can be low grade or high grade (see CIS below). The risk of low grade dysplasia transforming into high grade dysplasia and, eventually, cancer is low. Treatment is usually easy.
  • Carcinoma in situ is synonymous with high grade dysplasia in most organs. The risk of transforming into cancer is high. Treatment is still usually easy.
  • Invasive carcinoma, commonly called cancer, is the final step in this sequence. It is a disease who, when left untreated, will invade the host (hence its name) and will probably kill him. It can be often, but not always, be treated successfully.

Metaplasia is a situation where cells have changed from their original mature differentiated type into another mature differentiated cell type as an adaptive response to exposure to chronic irritation, or to a pathogen or carcinogen. It also occurs where one normal cell type changes into another normal cell type as in the cervix where squamous epithelium on the exo-cervix changes to normal columnar epithelium in the endo-cervix. This area is also known as the transformation zone and is the location of many dyplastic lesions thus the sampling of this area during a pap test is critical. Metaplasia is distinct from dysplasia because in a dysplastic cell these changes have become encoded into the genome and so are heritable or passed on to daughter cells during cell replication.

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History and ENG findings in a patient with fibrous dysplasia of the skull base
From Ear, Nose & Throat Journal, 5/1/04 by Kenneth H. Brookler

A 40-year-old woman presented with a 5-year history of dizzy spells. They did not occur very often; the most recent two spells occurred during the preceding 5 weeks. During these spells, her balance was poor, she became hot, sweaty, and nauseous, and she felt that she might black out. Her initial spells lasted approximately 15 to 20 minutes; the spells were relieved by vomiting. Between spells, she had difficulty standing.

Approximately 12 years earlier, she had hit her nose on a hardwood floor. As a result of this accident, her nose was fractured and she began to experience a problem with aural fullness in the left ear. Eleven years prior to presentation, she developed tinnitus in the left ear. She characterized it as a constant sound similar to a seashell-type noise. Her only other hearing symptom was a vibration or echo in the left ear that primarily occurred when she was in the shower. She also had a 2-year history of constant aural fullness in the left ear.

Clinical examination revealed a scarred left tympanic membrane that moved well on pneumatic otoscopy. Paresthesias of the second and third divisions of the trigeminal nerve on the left were present, and there was tenderness on palpation of the left nuchal area where the muscle attaches at the occiput.

Electronystagmography elicited no spontaneous or positional nystagmus. The alternate binauralbithermal stimulus yielded a 35% reduced vestibular response left and a 29% directional preponderance right. The simultaneous binaural

bithermal test elicited a type 2 response, confirming that the left side was the source of the dizziness. Findings on audiology and speech testing were normal for both ears, and there was no difference between ears. Acoustic immittance was normal in the left ear.

Findings on magnetic resonance imaging of the skull base were compatible with fibrous dysplasia. A biopsy of the temporal bone squama was positive for fibrous dysplasia.

From Neurotologic Associates, P.C., New York City.

COPYRIGHT 2004 Medquest Communications, LLC
COPYRIGHT 2004 Gale Group

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