Module 8 Part 1 - Gynae Reactive Changes Flashcards
Natural Protection Methods of the Cervix
Competent immune system
Presence of intact stratified squamous epithelium
Acid pH of the vagina
Equilibrium between various microorganisms
- if this equilibrium is disturbed then may lead to inflammation/infection of cervix
Inflammation of the cervix depends on whether 1 or more of the following has occurred:
Damage to squamous epithelium
Presence of an ectropion with its thin covering of endocervical cells which is more easily penetrated by bacteria
Decrease in thickness of squamous epithelium
Change in vaginal pH from acidic to neutral or to an alkaline environment
Rapid increase in or abundance of microorganisms
Clinical Features of Vaginal and Cervical Infections
Most patients with vaginitis or cervicitis have excessive vaginal discharge
- white (leukorrhoea DC), discoloured or bloodstained
In vaginitis women complain about burning or dryness of vagina
Histological Findings in Cervicitis
Acute inflammatory process develops in the stroma close to capillaries
Local reaction consists of:
- hyperaemia: exudation of fluid and migration of polymorphonuclear leukocytes (polys/PML’s) from blood to site of infection
- polys and macrophages involved in phagocytosis of organism and debris
- eosinophils found when inflammation due to allergy or parasite
Cytological Features of Inflammation - Background
Marked increase in inflammatory cells
Epithelial cells covered by an exudate of polymorphs and polymorphs may be seen permeating the cytoplasm of epithelial cells
Lymphocytes present with or without plasma cells
Reactive/regenerative and degenerative changes seen in epithelial cells
Fibrinous and proteinaceous material may form a granular or smooth usually eosinophilic background in the smear
Cytological Features of Inflammation - Cytoplasm
Vacuolation Perinuclear halos Altered staining patterns Abnormal keratinisation Cytolysis (frayed edges) Engulfed polymorphism
Cytological Features of Inflammation - Nucleus
Pyknosis, karyorrhexis and karyolysis Swelling - due to fluid absorption Wrinkling of the nuclear membranes Enlargement Hyperchromasia Multinucleation/binucleation Chromatin degeneration Nuclear symmetry is maintained
Repair
Refers to a specific cytomorphological pattern associated to injury from an external stimulus
Proliferation and amoeboid motion of epithelial cells at the edge of injury to cover denuded area
Classified as ‘negative for malignancy’ but most commonly misclassified as HSIL or Malig
Repair - Cell Architecture
Cohesive flat sheets of very active cells
Cell polarity is maintained (nuclei oriented in the same direction)
Equality in cell and nuclear size, distribution of chromatin and number of nucleoli
The cells remain cohesive, have distinct cell borders and single cells are rarely seen
Streaming (toffee-pull effect/spinous processes)
Repair - Nucleus
Prominent nucleoli Smooth nuclear membranes Size may vary but shape remains round or oval Nuclear enlargement Hyperchromasia Chromatin may be coarsely granular Mitotic activity Binucleation or multinucleation
Repair - Cytoplasm
Large with tails and distinct borders
Retains evidence of squamous or glandular differentiation
Changes in staining reaction (polychromasia)
+/- engulfed polymorphs
How to tell the difference between Reparative and Malignant Cells
Uniformity of cell nuclei within flat sheets and lack of single cells distinguishes reparative from malignant cells
Chronic Inflammation - Follicular Cervicitis
Streaks of small and large lymphocytes
Macrophages (often with debris in them = tingible)
Multinucleated histiocytes
Plasma cells ‘clock face pattern’
Lymphocytes on their own can’t be reported as follicular cervicitis without the presence of tingible body macrophages
Common in post meno women
Benign Proliferative Reactions
Squamous metaplasia
Keratosis (primary function of these is protection)
- hyperkeratosis
- parakeratosis
As a protective measure the glandular epithelium of the cervix changes into a squamous epithelium by metaplasia
As a protective measure the non-keratinising squamous epithelium of the cervix and vagina can undergo keratosis
Caused by:
- changes in pH
- endocrine changes
- inflammation
- trauma
Where does Squamous Metaplasia Occur?
- Squamoucolumnar junction
- transition between the squamous and columnar epithelium of the cervix
- metaplastic change generally occurs at this site after puberty
- this area change is referred as the transformation zone - Transition zone
- area between the original SCJ and the new SCJ where the new columnar epithelium has been replaced by the new metaplastic squamous epithelium
- metaplastic area between squamous and glandular epithelium known as the transformation zone
