Abnormal PAP Smear Flashcards
Who Gets Paps
Asymptomatic patients aged 21-69 with a cervix who have ever had any sort of intercourse, digital, or oral sexual activity with any partner, three years after onset of sexual activity or 25, whichever is later.
- either at 25 and has had sex before
- or 3 years after sexual debut if they had sex after 25.
- >70 yo and never screened -3 annual tests negative then choice to STOP
- >70 yo and screened routinely -3 negative tests in 10 yrs prior then choice to STOP
- HPV vaccinated and pregnant still gets them
- Pregnant
T/F you don’t need paps if you are hpv vaccinated
false. still need it
- Identify patients at high risk for cervical dysplasia.
Who is At Risk?
Anyone with a cervix with HPV
Increased risk: previous high grade lesions or cancer, some immunosuppressed patients.
Risk factors for cervical dysplasia: early onset sexual intimacy, smoking, immunosuppression, increased sex partners and parity
Cervical dysplasia exists as a spectrum of disease: asymptomatic, genital warts, cervical dysplasia, and cervical malignancy
how does HPV cause dysplasia?
HPV interferes with the cell cycle, making cells replicate when they’re not supposed to, and thus initiating neoplastic transformation, aka dysplasia
HPV infects the cells in the transformation zone (immature squamous cells)
Not all HPV infections result in dysplasia or malignancy
Dispersed, mature squamous cells with lots of cytoplasm and tiny, dark nuclei (look like fried eggs)
Difference in cytoplasm colour is a marker of distance from basement membrane
what is this histological outcome on pap?
this is NILM: negative for intraepithelial lesion
Squamous cells have larger nuclei and peri-nuclear halo or clearing
Sometimes crinkled nuclear membrane “rainoid”/”koilocyte”
LSIL
Squamous cells have even larger nuclei, with a more open/stippled chromatin appearance. The nucleus: cytoplasm is INCREASED
Not every cell shows these features, some are normal.
HSIL
Squamous cells have even larger nuclei, with a more open/stippled chromatin appearance. Cells are pleomorphic. The nucleus:cytoplasm is increased
Necrotic debris in the background.
Squamous Cell Carcinoma:
if the first pap was NILM, when do you screen again?
in 3 years
in a patient 25-29 years with LSIL, when do you screen again?
repeat PAP test every six months for one year.
a 26 yo patient has LSIL. you screen 6 months later and its LSIL again. what do you do now?
refer to colpo
a person 25-29yo has ASC-US. when do you screen next?
repeat Pap test every six months for one year. if both are neg, follow up again every 3 years. if its ASC-US again, refer to colpo
a patient is 30 yo with ASC-US. what do you do now?
lab will automatically perform HPV reflex testing to increase sensitivity. if HPB negative, risk level is equivalent to NILM. if positive, go to colpo.
patient is >50 with LSIL. Now waht?
lab will automatically perform HPV reflex testing.
