HISTOPATH- Lec-Gynecological Specimen Flashcards
Anatomic Sites for Cytologic Samples
- Upper (Proximal) Third of the Vaginal Wall
- Ectocervix
- Endocervix
Anatomic Sites for Cytologic Samples:
Ideal for studying hormonal status, evaluation of inflammatory
conditions, classification of the normal flora and rarely detection of
malignant vaginal lesions
Upper (Proximal) Third of the Vaginal Wall
Anatomic Sites for Cytologic Samples:
most common for cancer screening
use of Ayre’s spatula (can reach the T-zone)
Histology: Stratified Squamous Non-Keratinizing
Ectocervix
Anatomic Sites for Cytologic Samples:
for detection of endocervical lesions, intrauterine lesions
Histology: Simple Columnar Epithelium
Endocervix
Ectocervix histology?
Stratified Squamous Non-Keratinizing
Endocervix histology?
Simple Columnar Epithelium
Cytologic Collection and Preparation
Materials Used for Conventional Paps Smear:
Endocervical Brush
Vaginal Scrape
Lateral Vaginal Scrape
Four Quadrant Vaginal Scrape
Vulvar Scrape
Materials Used for Conventional Paps Smear:
-for endocervical canal
Endocervical Brush
Materials Used for Conventional Paps Smear:
- for patients with hysterectomy
Vaginal Scrape
Materials Used for Conventional Paps Smear:
-for Hormonal Cytology
Lateral Vaginal Scrape
Materials Used for Conventional Paps Smear:
- for localization of vaginal adenosis
Four Quadrant Vaginal Scrape
Materials Used for Conventional Paps Smear:
- for detection of herpetic lesions or carcinoma
Vulvar Scrape
Equipment for Vaginal, Endocervical and
Endometrial Aspirations
Glass Pipet and Rubber Bulb
Ayre’s Spatula
Laryngeal Cannula attached to 10cc syringe
-for vaginal aspiration
6-8 inches x ¼ inches
Glass Pipet and Rubber Bulb
Glass Pipet and Rubber Bulb size
6-8 inches x ¼ inches
swab smear
Ayre’s Spatula
-for endocervical/endometrial aspiration
Laryngeal Cannula attached to 10cc syringe
Antiseptic used
Zephiran
Papanicolau Smear and Stain
Developed by:
George Nicolas Papanicolau
Papanicolau Smear and Stain
Screening Test for:
Cervical Cancer
Screening Test for: Cervical Cancer
Papanicolau Smear and Stain
Papanicolau Smear and Stain
USES:
Determine certain infections (STD)
Determine ovarian function (Hormonal Cytology)
Asses infertility
Medico Legal Examination of Sexual Assault
Pap’s Stain:
nuclear stain (Primary Stain)
Harris Hematoxylin
Pap’s Stain ;
stains the cytoplasm of superficial cells (Counterstain)
-strong affinity for mature cells
Orange Green-6 (OG 6)
Pap’s Stain:
stains the cytoplasm of Parabasal cells and
intermediate cells (Counterstain)
-strong affinity for immature cells
Eosin Azure-50 (EA-50)
Pap’s stain: strong affinity for mature cells
Orange Green-6 (OG 6)
Pap’s stain: -strong affinity for immature cells
Eosin Azure-50 (EA-50)
Pap’s stain:
Harris Hematoxylin
Orange Green-6 (OG 6)
Eosin Azure-50 (EA-50)
PAP Stain Result:
Nucleus:
= Vesicular nucleus:
= pyknotic nucleus:
Vesicular nucleus: blue
Pyknotic nucleus: dark blue to black
PAP Stain Result:
Cytoplasm:
OG-6:
EA 36 to 50:
OG-6: Orange with a hint of green
EA 36 to 50: Olive Green with a hint of brown and red
PAP Stain Result:
Bacteria:
dark blue
PAP Stain Result:
Mycelia:
violet
PAP Stain Result:
Trichomonas vaginalis:
pale greenish blue blob of cytoplasm
PAP Stain Procedure
- Fix with 95% ethanol
- Hematoxylin
- Differentiate with Acid Alcohol the wash with water
- Ammonia water then wash
- OG6
- 95% ethanol (washing) (2 changes)
- EA 50 or 36
- Dehydration
- Xylol
- Mount
- Label
Cells Found in Cervicovaginal Smears
Superficial Cells (30-60u)
Intermediate Cells (20-30um)
most mature, polygonal cells with Dark pyknotic nuclei
Cells that exhibits “TRUE ACIDOPHILIA” characteristics of vaginal cell under the influence of ESTROGEN
Superficial Cells (30-60u)
influence desquamation of Superficial cells
ESTROGEN
influence desquamation of
intermediate cells
PROGESTERONE
most predominant during menopause
ESTRONE (E1)
most predominant during reproductive years
ESTRADIOL (E2)
plenty but least potent
ESTRIOL (E3)
Medium cells, polyhedral with basophilic & vacuolated cytoplasm
Intermediate Cells (20-30um)
Intermediate Cells (20-30um)
Navicular Cells
Parabasal Cells
Pregnancy Cells
found in the latter half of
menstrual cycle, menopause and during
pregnancy (presence suggest
Progesterone-Estrogen Effect)
Navicular cells
with a tendency to fold or curl on edges
Boat shaped cells
-fried egg appearance/ sunny side-up
-Round oval nucleus/cells
Normally found in: abortion, after
menopause, after childbirth, 2 week of Age of
puberty
Parabasal Cells (15-25um)
Parabasal Cells (15-25um)
Normally found in:
abortion, after menopause, after childbirth, 2 week of Age of puberty
Small, round slightly oval cells, with relatively
large nucleus that occupying half or more of
the cell volume
*Basal Cells (13-20um)
*Basal Cell’s cytoplasm is
strongly basophilic
Basal cells are Found in vaginal smears only ______ and _____
before pregnancy and after menopause
Nucleus pushed at periphery with double walled boundary appearance
Pregnancy Cells
Round oval shaped cell appearing boat cells with translucent basophilic cytoplasm due to glycogen
accumulation
Pregnancy Cells
-found during menstrual period (in groups)
Endometrial Cells
If seen in post- menopausal woman indicate a
possible endometrial carcinoma or endometrial
hyperplasia
Endometrial Cells
Endometrial Cells If seen in post- menopausal woman indicate a possible?
endometrial carcinoma or endometrial hyperplasia
Similar to parabasal cells but less basophilic
Endometrial Cells
Honey-comb appearance
Endocervical/Glandular Cells
Occurs in groups and strips of 3 or more cells
Endocervical/Glandular Cells
Slightly cylindrical appearance/ columnar epithelial cells
Endocervical/Glandular Cells
Normal vaginal flora
Doderlain Bacillus/Lactobacillus Acidophilus
Doderlain Bacillus/Lactobacillus Acidophilus increased in?
L- last trimester of pregnancy
I- infection
E- estrogen deficiency
D- diabetic patients
** PAPS smear should be done after______of LMP
10 days
yeast cell that is commonly seen in patients with
diabetes, taking contraceptive and with
immunocompromise state
Candida Albicans
STD
Pear-shaped organism
Greenish blue appearance in PAPs SMEAR
Eccentric dark nucleus
Trichomonas vaginalis
May appear as cells surrounded by bacilli “CLUE CELLS”
Gardnerella vaginalis
Cells that shows cytophatic effect of human papilloma virus
Nucleus: appears like “wrinkled prune” that is surrounded by a
perinuclear halo
Koilocytes
Mucus on drying exhibits a fern or palm leaf pattern
Ferning (Arborization)
Basis for the diagnosis of Early Pregnancy
Ferning (Arborization)
(+) Ferning: High Persistent
______ Effect in the absence of ______
Estrogen; progesterone
-assess the percentage of cells coming from the main layers of the epithelium
Maturation Index (M.I)
- Assess the percentage of cells appearance that stains pink-orange to red with Pap’s
Acidophilic/Eosinophilic Index (A.I)
-assess percentage of cells with shrunken, dark, small, structureless nucleus
Pyknotic Index (P.I)
Reporting Cancer Cytology: Class I
Absence of atypical cytologic picture
Reporting Cancer Cytology: CLASS II
Atypical cytologic picture present but no evidence of
malignancy
Reporting Cancer Cytology: Class III
Cytologic picture suggestive but not conclusive to
malignancy
Reporting Cancer Cytology: Class IV
Cytologic picture strongly suggestive of malignancy
Reporting Cancer Cytology: Class V
Cytologic picture conclusive of malignancy
Classification of PAP Test Results
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