Bethesda Cervical Cytology Criteria

Question 1

LSIL

Answer 1

mature cells in singles or sheets
large cells with matures well-defined cytoplasm
nuclear enlargement > 3X intermediate cell
variable nuclear hyperchromasia
variations in nuclear size, number or shape
irregular nuclear contours
uniformly distributed chromatin but can be coarse or smudges or densely opaque
can have: multinucleation, inconspicuous nucleoli, perinulcear cavitation

Question 2

HSIL

Answer 2

smaller and less mature cells than LSIL
singles, sheets or syncytial-like aggregates
hyperchromatic clusters
cell size variable
nuclear hyperchromasia with variation in nuclear size and shape
variable nuclear enlargement - but always high NC ratio
Chromatin fine or coarsely granular
very irregular nuclear contour
nucleoli generally absent but can be seen
cytoplasm variable: immature, lacy, delicate or densely metaplastic or keratinised

Question 3

keratinising SCC

Answer 3

isolated single cells and less commonly aggregates
variation in cellular size and shape
caudate and spindle cells
dense oragneophlic cytoplasm
variation in size
nuclear membranes irregularity
dense opaque nuclei
chromatin pattern coarsely granular and irregularly distributed with parachromatin clearing
macronucleoli may be seen but less common than in nonkeratinising SCC
associated keratotic changes
tumour diathesis

Question 4

Nonkeratinising SCC

Answer 4

isolated single cells and less commonly aggregates
poorly defined cell borders
cells usually smaller than those of HSIL
markedly irregular distribution of coarsely clumped chromatin
tumour diathesis
may have prominent macro-nucleoli and basophilic cytoplasm

Question 5

Atypical endocervical cells NOS

Answer 5

sheets ans strips with some cell crowding and nuclear overlap
nuclear enlargement up to 3-5X normal endocervical nuclei
variation in nuclear size and shape
mild hyperchromasia
may have nucleoli
abundant cytoplasm but NC ratio increase
distinct cell borders

Question 6

Atypical endocervical cells, favour neoplastic

Answer 6

abnormal cells in sheets, 3D groups or strips with nuclear crowding and overlap
rare cell groups with rosetting or feathering
nuclei are enlarged with some hyperchromasia
occasional mitoses
NC ratio increased
quantity of cytoplasm is diminished and cell borders may be ill defined

Question 7

Atypical endometiral cells

Answer 7

small groups or 3D groups
nuclei slightly enlarged compared to normal
mild herypchromasia
small nuceoli
scant cytoplasm occ vacuolated
cell borders ill-defined

Question 8

AIS

Answer 8

sheets, clusters, strips and rosettes with nucelar crowding and overlap and loss of honeycomb pattern
singles uncommon
cell clusters have palisading nuclear arrangement
cytoplasmic tags protruding from periphery (feathering)
enlarge nuclei with variable size
oval or elongated in shape
stratification
nuclear hyperchromasia with evenly dispersed, coarsely granular chromatin
nucleoli are small or inconspicuous
mitoses and apoptotic boides commonly seen
NC ratio increased
clean background with no diathesiss
abnormal squamous cells may be present

Question 9

Endocervical adenocarcinoma

Answer 9

abundant abnormal cells with columnar configuration
single cells, 2D or 3D groups and syncytial aggregates are commonly seen
enlarged pleomorphic nuclei with irregular chromatin distribution
nuclear membrane irregularities
macronucleoli may be present
cytoplasm finely vacuolated
tumour diathesis
abnormal squamous cells may be present

Question 10

Endometrial adenocarcinoma

Answer 10

single or small tight clusters
well-diff: slightly enlarged nuclei
variation in nuclear size and loss of nuclear polarity
moderate hyperchromasia, irregular chromatin distribution and parachromatin clearing
small to prominent nucleoli
cytoplasm typically scant or cyanophilic and vacuolated
intracytoplasmic neutorphils common
water/granular tumour diathesis clinging to clusters

Question 11

ASC-H

Answer 11

single or small fragments of <10 cells
cells size of metaplastic cells with nuclei 1.5-2.5X intermediate but may be rather small
NC ratio approx HSIL but missing adequate nuclear abN: hyperchromasia, chromatin irregularity and abN nuclear shapes

Question 12

ASC-US

Answer 12

nuclei 2.5-3X intermediate squamous cell
slightly increased NC ratio
minimal nuclear hyperchromasia and irregularity in chromatin distribution or nuclear shape
nucelar abN assoc eit hdense oragneophilic cytoplasm

Question 13

Adequacy

Answer 13

able to make any non-NIL dx OR
estimated minimum of 5000 well-visualised squamous cells with endocervical cells or metaplastic cells present showing transformation zone sampling

Question 14

Radiation

Answer 14

increased cell size
near normal NC
bizarre cell shapes
degenerative changes (nuclear pallor, wrinkling or smudging of chromatin, vacuolisation)
prominent single or multiple nucleoli
cytoplasmic vacuolization and/or cytoplasmic polychromatic staining

Question 15

What are some low estrogen states associated with increased parabasal cells other than menopause?

Answer 15

Premenarche
Postpartum
Turner syndrome
Status post bilateral oophrectomy

Question 16

Features of exfoliated endometrial cells

Answer 16

Balls of small cells, isolated small cells
Scant cytoplasm
Dark nucleus
Nuclear molding
Nuclear fragmentation

Question 17

When are endometrial cells expected? When must they be reported?

Answer 17

First 12 days of menstrual cycle in pre-menopausal women.

Must report at age > 40

Question 18

Ddx for Shedding of endometrial cells out of phase (after day 12)?

Answer 18

endometritis
endomeitrial polyps
IUD

Question 19

Features of LUTS

Answer 19

large and small tissue fragments
glands and stroma
stromal cells: uniform, oval or spindle, finely granular chromatin, occasional mitoses, capillaries)
glands (tubular, straight or branching, mitoses, extreme nuclear crowding, scant cytoplasm)