Female gentila tract histology Flashcards
What is cervical cytology and why use it
Study of clells from the cervix. Used to reduce incidence of cervical cancer by detecting pre-invasive lesions.
Early detecion ha sproved to decrease mortality from cervical cancer
Who gets cervical screening?
All woman aged 25-64 were invited from screening at 3 to 5 yearly intervals depending on their age.
Only for asymtpoamtic. If you have any symptoms you need gynae referral for investiagtions
What is the role of cytology
- Cytology is the study of cells and is used to detect abnormalities in cells the cervix that are dyskaryotic or pre-cancerous
- These changes are graded from borderline to severe dyskaryosis and depending on both persistent of abnormality or severity, women will be referred into colposcopy for further treatment
Role of Colposcopy
- Colposcopy is used to obtain tissue samples of the cells that have been called abnormal on cytology
- Flood cervix and where the samples need ot be taken from will turn white
- These samples are graded as Cervical intraepithelial neoplasia and grades range from 1 to 3 depending on their severity
- Any major discrepancies between the cytology and histology result are discussed as an MDT meeting where patient follow up and treatment are decided.
Liquid based cytology - what is this used for
- Preferred method of sampel colelction, fixation, preparation and screenign in cervical cytology
- Cells removed from cervix using the “cervex” brush and a 360degree rotation of the cervical os and ectocervix. This is repeated 5time. Previously this was done using aylesbury spatula.
- The cells colelcted on the brush ar eplaced immediately into pot of alcohol base dpreservative fluid. This is to prevent “drying out” of the sample which can cause diagnostic problems when screening.
- Sample processing - A hologic T5000 fully automated processing machine prepares the samples producing a circular preparation of the cells onto a slide. These are then stained with papaniolau staining technique on a fully automated platform.
- HMR 101 form or electornic ICE request to match sample pot and sent to lab. If discrepencies betwene pot and form then not accepted.
- Each slide takes 5-12mins to screen
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WHat do staff look for in screenig of the cervical sample
Mostyl all normal but abnroamity indicators are:
- Increased nuclear/cytoplasmic ratio
- Irregular nuclea outline
- Hyperchromasia (darkening) of nuclear chromatin and bi/multi nucleation of cells.
WHta is the only epithelium that repsonds to changes in oestrogen levels during menstrual cycle
Cervical epithelium
When does the cervical epithelium achieve full thickness
- Day 14 as oestrogen levels peak and cervicla epitheliuma chieves full thickness. This offers protection against infectiona nd therefore this is “optimal” time ot take the sample.
Negative cells in cervical epithelium
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What is ectropian in the cervix?
- When Oestrogen levels are high the cervix “bulks” up and causes the cells from the endocervical canal to evert out over the ectocervix and form a reddened area.
- This is known as an ECTROPIAN and is a normal condition.
- The cells causing the red area are endocervical cells from the canal.
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The hsitolgoy and cytology appearance of endocervical cells
Picket fence.
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Endocervicals - What happens when ectocervix eposed to acidity of vaginal canal
- The ectocervix is exposed to the acidity of the vaginal canal.
- Because of the fragile nature of endocervical cells, when they are exposed to this acid environment the cells undergo transformation into squamous cells to offer protection . This process is continuous, it is “normal” and is known as squamous metaplasia.
Squamous Metaplasia - how to recognise
- Recognsided by dense opaqu blue cytoplasm and bizarre shapes/forms
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Where do endometial cells shed from?
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Endometrial cells - when are they seen normally
- Higher in the uterine body we find glandular cells called endometrials.
- These cells are seen “normally” at days 1- 14 and days 26-27 of the menstrual cycle it is therefore important for the patient to know the 1st day of her last menstrual period.
- If LMP is unknown, the patient is over 40 , and these cells are present they will be treated as suspicious and the patient will be referred for further treatment in gynaecology.
Infections in cervical samples
- ¢All infections produce an excess of white blood cells (usually polymorphs) which can be troublesome when screening.
- ¢They can obscure the cells and make the sample “inadequate” for interpretation and a repeat test will be requested by the laboratory.
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Trichomonas Vaginalis
Can infect both men and women and patient spresent with yellow/green foul smelling discharge. It is a parasite and has no link to cervical cancer.
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Candida albicans (thrush)
- Yeats infection which occurd mainly in 16-35year old women
- Hyphae and spores cna be observed whcih stain red
- Inflammatory changes occur alongside infection
- Treatable with drugs or cream (canesten)
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What ar acitonomyces like organisms/ALO’s?
- These are related to true bacteria and are found in women using Intra Uterine Contraceptive Devices (IUCD).
- They usually appear as dark dense clusters with a central core and filaments protruding from the structure. The filaments aid in their identification.
- They are not linked to cervical cancer.
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Herpes simplex virus (HSV)
- 2 Types: Type 1 (lips + nose). T2 (genitalia)
- Sexually transmtited and incurable ]Appears cyologically as large multinucleated cells with dense central cores.
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