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Pathology Boards > Gynecologic Cytopathology > Flashcards

Gynecologic Cytopathology Flashcards

1
Q

What is the minimum amount of cells for most women in a liquid based pap preparation? What kind of cells should these be?

How many cells should be present in a conventional cervical preparation?

A

5000, well preserved, well visualized squamous cells for most women (some women post hysterectomy and with atrophy may be accepable with fewer cells

8000-12000 well preserved, well visualized squamous epithelial cells

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2
Q

What are the rules regarding the transformation zone and cervical cytology specimens?

A

You do not have to have cervical glandular cells, only squamous cells. However, cervical glandular cells should be reported.

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3
Q

What percentage of obscured squamous cells is considered unsatisfactory for cervical cytology specimens?

A

Greater then 75% of squamous cells obscured

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4
Q

How soon should a women will an unsatisfactory cervical cytology specimen get a repeat procedure?

When should a colposcopy be performed in women with unsatisfactory cervical cytology?

A

2-4 months

If she has two consecutative unsatisfctory tests

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5
Q

In what condition would you expect a pap to have many superficial cells?

What do you see lots of intermediate cells?

Parabasal cells?

A

High estrogen states, at the time of ovulation/midcycle peak

The secretory phase or when the women is lactating

Atrophy (post-menopausal), and young girls before menses

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6
Q

Identifiy these cells in cervical cytology…..

What condition is associated with an abdundance of these cells?

A

Superficial squamous cells

High estrogen states, such as the mid-cycle estrogen peak during ovulation

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7
Q

Identifiy these cells in a cervical cytology specimen?

In what condition(s) would you see an abundnce of these cells?

A

Intermediate squamous cells

Secretory phase endometrium, during lactating

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8
Q

Identifiy these cells in a cervical cytology specimen?

What condition(s) are associated with an abundance of these cells?

A

Pre-menopausal, post-menopausal (atrophy)

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9
Q

Identify these cells in context of a cervical cytology specimen? What is their special name?

When are they usually found?

A

Endometrial cells forming an “exodus ball”. These represent the last remenants of endometrial shedding.

Days 6-10 of the menstrual cycle.

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10
Q

What are these cells in context of cervical cytology?

What two special terms are used to describe these?

A

Metaplastic squamous cells

“Cookie cutter” cytoplasmic borders with “spider-like” cytoplasmic processes

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11
Q

What do these cells represent in the context of cervical cytology?

A

Reactive changes associated with an intrauterine device , cytoplasmic vacuoles displacing nuclei

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12
Q

Identify this in context of cervical cytology? What is it associated with?

A

Ferning, high estrogen states such as mid-cycle

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13
Q

What does this represent in context of pap cytology?

A

Radiation effect (multinucleation, vacuolization)

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14
Q

What is this in context of cervical cytology?

A

syncytiotrophoblast, pregnancy

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15
Q

Identify in context of cervical cytology?

A

Herpes (Margination, multinucleation)

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16
Q

What does this represent in context of urine cytology?

A

Atrophic vaginitis.

We see lots of parabasal cells, inflammation, and a “grundgy” background

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17
Q

What does this represent?

In what condition would you commonly see this?

A

A “blue blob”

Atrophic vaginitis

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18
Q

Identifiy in context of cervical cytology?

Describe features….

A

Trich

Pear-shaped with ecentric nucleas and eosinophillic cytoplasmic granules

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19
Q

What does this represent in context of cervical cytology?

A

Cocco-baccili, shift in vaginal flora

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20
Q

Name features of LSIL cells

Nuclear chromicity?

Nuclear size?

Chromatin pattern?

Nuclear membrane contour?

Nucleoli?

Cytoplasmic changes?

A

Often hyperchromatic, may be normochromatic

3 times larger then an intermediate squamous cell

Coursely granular to smudgy

Can be smooth or irregular

Nucleoli usually absent

Perinuclear cavitation with a clear, perinuclear zone and a peripheral rim of more “bunched up” densely staining cytoplasm. Is not mandatory for a diagnosis of LSIL!

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21
Q

How are women under 25 managed clinically with a diagnosis of LSIL?

Older then 25 with HPV negative test? HPV positive Unknown HPV status?

A

Follow up cytology in 12 months

Over 25 and LSIL with negative HPV test- HPV and cytologic testing in 3 years

Over 25 and LSIL with positive HPV test- Colposcopy

Over 25 and unknown HPV status- Repeat cytology in 12 months

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22
Q

Describe the cytologic features of HSIL….

Cell size?

N/C ratio compared to LSIL?

Nuclear size compared to LSIL?

Nuclear chromicity?

Nuclear contrours?

A

Usually smaller then LSIL cells

Higher N/C ratio

Nuclear size is the same to decreased compared to LSIL

Usually hyperchromatic but variable

Often irregular contours

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23
Q

What types of HPV are known for association with endocervical dysplasia?

A

HPV 16 and 18

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24
Q

What does the following image represent in the context of cervical cytology?

A

Tubal metaplasia, should not be overcalled as malignant or atypical, look for the cillia and terminal bar

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25
Q

What are the features of atypical endocervical cells…

In terms of how the cells group?

In terms of nuclear size?

A

Sheets or strips of cells with some cell crowding and overlapping

Nuclei enlarged, 3-5X larger then typical endocervical cells

26
Q

Name some features of atypical cervical cells, favor malignant?

How the cells grouped?

Nuclear size?

Chromatin?

Mitotic activity?

N/C ratio?

A

In sheets and strips with nuclear crowding, overlap, and possibly pseudostratification. The cell groups can sometimes form rosettes and can have feathering (individual cells hanging out of the main cluster)

Nuclei are enlarged and sometimes elongated

The chromatin should be course

Occasional mitosis can be present

N/C ratio is increased

27
Q

How would you diagnose this? (cervical cytology)

A

Atypical endocervical cells, this later turned out to be tubal metaplasia according to the book, but the cilia and terminal bars were difficult to visualize

28
Q

How would you diagnose this? (cervical cytology)

A

Atypical endocervical cells. LIkely from a reactive process, follow-up showed no epithelial cell abnormality

We have nuclear enlargement, increased N/C ratio, prominant nucleoli, and mitotic activity.

29
Q

How would you diagnose this? (cervical cytology)

A

Atypical endocervical cells, favor neoplastic

We have feathering at the edges, mitosis (?), and crowded cells

F/u showed endocervical AIS.

30
Q

How would you diagnose this? (cervical cytology)

Describe features

A

Atypical endocervical cells, favor neoplastic

We have atypical endocervical cells with crowding, disorganization, and some nucleoli

F/U showed endocervical AIS

31
Q

How would you diagnose this? (cervical cytology)

A

Atypical endocervical cells, favor neoplastic

Enlarged elongated nuclei with pseudostritification

32
Q

Identifiy in context of cervical cytology?

Describe features….

A

Repairative change

Streaming, “school of fish” appearence. We can have variation in nuclear size, with prominant nucleoli and rare intracytoplasmic PMNs.

33
Q

Small cell carcinoma of the cervix is associated with which HPV type?

A

HPV 18

34
Q

Identify in the context of cervical cytology…..

Describe features

Cellularity/architecture?

Nuclear features?

A

Small cell carcinoma

Uniform cells with scant cytoplasm, occuring singly and in small loosely cohesive groups. Often nuclear molding, crush artifact, and finely stippled chromatin.

35
Q

Identify in the context of cervical cytology…..

Describe features

A

Squamous cell carcinoma

Marked variation in size and shape, cytoplasmic keratinization, tumor diathesis (necrosis, hemorrhage, inflammatory cells), cytoplasmic keritinization

36
Q

How would you diagnose this? (cervical cytology)

Describe features

A

Endocervical adenocarcinoma in situ

Elongated crowded nuclei with overlapping and hyperchromasia. This one has a rosette formation.

37
Q

How would you diagnose this? (cervical cytology)

Describe features

A

Endocervical adenocarcinoma in situ

Elongated crowded nuclei with overlapping, hyperchromasia, peripheral feathering

38
Q

Name some features of endocervical adenocarcinoma in situ

Architectural arrangement?

Nuclear size?

Nucleoli?

Chromicity?

Mitotic activity?

N/C ratio?

A

Sheets, clusters, strips, and rosettes with nuclear crowding and overlap.Can have “feathering” with cytoplasmic tags protruding from the cluster.

Enlarged nuclei

Nucleoli are small or inconspicuous (in contrast to adenocarcinoma)

Hyperchromicity

Mitosis are common

N/C ratio increased

39
Q

Name some features of endocervical adenocarcinoma

Architectural arrangement?

Nuclear size?

Nucleoli?

A

Can be single cells or 3D clusters

Enlarged and pleomorphic nuclei

Macronucleoli, in contrast to adenocarcinoma in citu

Also remember we can have clinging tumor diathesis

40
Q

How would you diagnose this? (cervical cytology)

Describe features

A

Adenocarcinoma, endocervical

Large nuclei, macronucleoli

41
Q

How would you diagnose this? (cervical cytology)

Describe features

A

Adenocarcinoma, endocervical

Large nuclei, macronucleoli

Some tumor diathesis is seen clinging at the edges

42
Q

Name some features of endometrial adenocarcinoma?

Architectural arrangement?

Nuclear size?

Nucleoli?

Cytoplasmic features?

Intracytoplasmic neutrophils?

How does the tumor diathesis look?

A

Sinigly or small clusters

Both nuclear size and nucleoli increase with higher-grade tumors, and are smaller with more well differentiated tumors

The cytoplasm is scant and blue, often vaculoated

Present

“Watery” tumor diathesis, especially in conventional preps

43
Q

Compare the cytologic features of endocervical vs endometrial CA…

Cellularity?

Cell size?

Cell shape?

Archtecture?

PMNs associated?

A

Endocervical is more cellular, has larger cells

Endocervical has columnar cells, endometrial has round cells

Endocervical and rosettes and crowded sheets, endometrial cancer has balls of cells

Endocervical is not usually associated with PMNs, endometrial usually is

44
Q

What is associated with this in terms of cervical cytology? 4

A

Benign AND malignant conditions including IUDs, Endosalpingosis, TB endometritis, Benign endometrial and ovarian lesions, serous papillary carcinoma and other malignancies

45
Q

Identifiy this lesion in context of cervical cytology?

Features common with this lesion?

A

Metastatic colonic adenocarcinoma

Some features are a dirty background, elongated cigar shaped nuclei

46
Q

Identify in context of cervical cytology?

What is this associated with?

A

Follicular cervicitis (you can see the diverse populatin of lymphocytes with tingible body macrophages)

Chlamydia

47
Q

Identify in context of cervical cytology?

A

Chlamydia

48
Q

Identify in context of cervical cytology?

A

Pinworm (enterobius vermicularis)

49
Q

What is routine screening for women 21-29?

30-64?

A

Pap every 3 years

Pap every 5 years

50
Q

How should women 30+ be managed with a negative cytology but positive HPV test? (2 options)

A

Repeat cotesting at 1 year or DNA typing (with DNA typing move to colposcopy if 16 or 18 positive, 1 year cotesting if negative fpr 16 and 18)

51
Q

How should ASC-US be managed? (Women 24+)

Women 21-24?

A

Repeat Cytology in 1 year or HPV cotesting (preferred, if positive, move to colposcopy)

For women 21-24 preferred method is repeat cytology in 12 months

52
Q

LSIL with negative HPV management?

LSIL with no HPV test management?

HPV with postive HPV test management?

A

Repeat cotesting in 1 year (preferred)

LSIL with no HPV test and with positive test should both get colposcopy

53
Q

Pregnant women with LSIL management?

A

Colposcopy is preferred

54
Q

Management of women with ASC-H (excluding women age 21-24 and pregnant) ?

A

Colposcopy no matter HPV status

55
Q

Management of women 21-24 with ASC-H or HSIL?

A

Colposcopy (NOT YET LEEP)

56
Q

Management of women with HSIL (except 21-24 and pregnant)?

2 options

A

Immediate LEEP or Colposcopy

57
Q

What situtation would qualify for Atypia of Undetermined Significance for thyroid in terms of….

Microfollicles?

Hurthle cells?

Follicular cell atypia?

Features of papillary carcinoma?

Lymphoid cells?

A

Sparsely cellular but the cells that are present form microfollicles

Sparsely cellular with mainly Hurtle cells

Atypia uncertain due to possible artifact (larger due to airdrying, smudgy chromatin, etc..)

Features of PTC (pale chromatin, grooves, enlarged nuclei) but the vast majority of the sample has benign follicular cells and/or abdundant colloid

Lymphoid cells are atypical but not so much so that a malignant diagnosis can be reached

58
Q

Does convential or liquid based pap specimens need less cells to be adequate? What are the numbers?

A

Conventional: 8,000 at least

Liquid: 5,000 at least

59
Q

A liquid based pap is found to have less then 5000 cells but is still considered adqquate, why?

A

The women had radiation, chemotherapy, or is post-menopausal

60
Q

What are the primary HPV oncogenes and what proteins are they associated with?

A

E6 and E7. E6 with p53, E7 with rb.

(E)6 with 5(3)

or 53 before rb

61
Q

Do intracytoplastic neutrophils favor endocervical or endometrial adenocarcinoma?

A

Endometrial

62
Q
A

Pathology Boards (7 decks)

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