Gynae Revision Flashcards
Endocervical Cells
Present in small strips, flat sheets, singly and in groups
Cytoplasm is cyanophilic and translucent or finely vacuolated
Nuclei are basal, round to oval
Fine chromatin pattern
1-2 nucleoli may be present
Cilia may be present
Mucin secreting goblet cells
Variation in size of cells
May be multinucleated
Endometrial Cells
Central core of stromal cells, peripheral rim of epithelial cells
Appear in 3 dimensional clusters or singly
Cell ball pattern with moulding
Often show degenerative changes
Cytoplasmic vacuoles with neutrophils
Hyperchromatic nuclei
May appear no larger than an inflammatory cell
Inflammatory/Reactive Changes in Cytoplasm
Perinuclear halos
Vacuolation
Engulfed polymorphism
Inflammatory/Reactive Changes in Nucleus
Pyknosis, karyorrhexis and karyolysis
Swelling
Wrinkling of the nuclear membranes
Enlargement
Hyperchromasia
Multinucleation/binucleation
Chromatin degeneration
Nuclear symmetry is maintained
Reparative Changes in Nuclei
Prominent nucleoli
Smooth nuclear membranes
Size may vary but shape remains round or oval
Nuclear enlargement
Hyperchromasia
Chromatin may be coarsely granular
Binucleation or multinucleation
Reparative Changes in Cytoplasm
Flat sheets
Large with tails (cytoplasmic projections) and distinct borders
Changes in staining reaction (polychromasia)
+/- engulfed polymorphs within sheet
How to Distinguish between Repair and Malignancy
Uniformity of cell nuclei within flat sheets
Lack of single cells
Coccoid Flora/Gardnerella Vaginalis
Clue cells
Common cause of DC in younger women
Thin milky d/c and foul fishy odour
Actinomyces
Usually seen in associated with IUCD
Variable inflammatory changes in squamous epithelium
Trichomonas Vaginalis
Unicellular, grey pear shaped, with oval eccentric hypochromic nucleus and eosinophilic granules in cytoplasm
Symptoms produce frothy +/- white/yellow d/c, vaginal dryness, postcoital or intermenstrual bleeding
Herpes Simplex Virus
Symptoms include headaches, fever, malaise and muscular pains
Multinucleation within squamous cells
Swollen enlarged nuclei
Hypochromatic chromatin pattern
What to Look for When Diagnosing LSIL/HSIL
Size of cell
Variability in nuclear size/shape
N/C ratio
Nuclear membrane
Chromatin pattern
LSIL - HPV
Single or sheets
Finely granular chromatin or pyknotic nuclei
Mild nuclear enlargement
Bi/multinucleation
Smooth nuclear membranes
Koilocytes
LSIL - CIN1
Single/sheets/flat cobblestone arrangement
Nuclei enlarged (3-4x the size of intermediate nuclei)
Increased N/C ratio
Course granular chromatin
Bi/multinucleation
Nuclear pleomorphism
Dense with/without koilocytes
LSIL - CIN2
Single or in loose sheets
Cell size = sq metaplastic or parabasal
Polygonal
N/C ratio is 1/3-1/2 of the cell
Enlarged nuclei
Hyperchromatic nuclei
Nuclear membranes irregular/notched
Dense basophilic cytoplasm
HSIL - CIN3
Small cells in groups, single
Syncytial sheets/aggregates
Irregular course clumped chromatin pattern
N/C ratio is > ½ of the cell size
Irregular nuclear membrane
Nuclei has irregular contours
Scanty cytoplasm
Clinical History of Patients with SCC
PCB
Abnormal bleeding
DUB
SCC
No feathering
Cells round/oval/elongated
High N/C ratio
Coarse granular chromatin
May have nucleoli
Nuclear pleomorphism
If see spindle like superficial cells or pearls = SCC
Endometrial Adenocarcinoma
Occurs in older females
Dirty background
Atypical malignant cells
Crowded groups with scalloped border
Eccentric nuclei
Nucleoli
Round/oval nuclei
Cytoplasm may be vacuolated with engulfed polymorphs
Bubbly cytoplasm
What Infections do Perinuclear Halos Suggest?
Trichomonads and Candida
AIS
Feathering
Crowded strips/rosettes
No tumour diathesis
Enlarged elongated nuclei
Coarse dark chromatin
More uniform nuclei than SCC
Nucleoli
Differences between AIS and Adenocarcinoma
Both show feathering, crowding and rosettes
AIS has more uniform nuclei compared to Adeno
AIS has less chromatin irregularity
AIS small indistinct nucleoli, adeno prominent
Adeno has tumour diathesis AIS doesn’t
SCC vs Adenocarcinoma
SCC has no feathering
SCC aggregates rougher and thicker with wispy cytoplasm
SCC has greater nuclear pleomorphism
Both have irregular nuclear thickening, but SCC has irregular borders and Adeno has smooth borders
SCC has small nucleoli and Adeno has prominent
SCC has dense cytoplasm while adeno has finely vacuolated cytoplasm
SCC shows lots of different cytoplasmic projections (long, thin cells etc.)
Tip to Disinguish HSIL from SCC and Adeno etc.
HSIL normally 2 or more layers of cells
SCC and adeno etc. normally one layer
Recommendations for HPV not detected, HPV detected (non 16, 18), HPV detected (16/18) and unsatisfactory
Not detected
- routine 5 yrs
HPV detected (not 16/18)
- if negative/LSIL: repeat 12 months
- if HSIL: colposcopy
HPV detected (16/18)
- colposcopy
Unsat
- repeat 6-12 weeks
