Molavi Chapter 16 - Cervix and Vagina Flashcards
Adequacy for cytology samples: thin-prep, conventional, and anal
Thin prep: 5,000 cells
Conventional: 10,000-12,000 cells
Anal prep: 2,000-3,000 cells
LSIL cytology
Koilocytic change (without the tell-tale golden hue of glycogen) and nuclear atypia.
HSIL cytology
Cells with large nuclei (3-4x that of an intermediate cell) and a high N/C ratio with nuclear grooves and atypia.
By this stage koilocytic change is typically lost.
Endocervical cell cytology
Honey-comb arrangement of evenly spaced neat, dark oval nuclei
Typically come in tubular/glandular clusters like this
Endometrial cell cytology
Come in very dense clusters of nuclei with little cytoplasm, as opposed to the neat honeycomb arrangement of endocervical cells.
In a patient 45 years or older these should be reported, as they may be indicative of endometrial hyperplasia or endometrial intraepithelial neoplasia (EIN)
Navicular cell
Glycogen-filled epithelial cell. There is an almost koilocyte-like perinuclear clearing, but it is filled with golden-hued glycogen instead.
This slide is a bit exaggerated, it is more subtle than this in real life, but it is a good demonstration.
Some may be present at baseline, but they increase in number with hormonal stimulation (pregnancy, puberty, hormone supplements).
What’s going on in this pap smear?
There has been a shift in vaginal flora. Note the clue cell-like, dotted appearance of these squamous cells. They are covered in cocci, as opposed to the typical lactobacillus flora.
Reactive changes in a pap smear
Euchromasia, slight nuclear enlargement, and small, tight perinuclear clearing (cellular edema) may be present.
These are seen especially in the context of infection with candida, for example.
Superficial cell
Cell from the outermost layer of cervical epithelium
Pink cytoplasm on Papanikalau smear, pyknotic nucleus, and keratohyaline granules
Elements of a healthy pap smear from the cervical epithelium
Superficial cells
Intermediate cells
Navicular cells
Parabasal cells
Squamous metaplasia
Replacement of endocervical epithelia with squamous as a protective response.
These cells may exhibit a spectrum of variability from small, round cells with a 1:1 nuclear:cytoplasmic ratio, to larger cells with “spidery” cytoplasmic processes (both shown here).
They have a waxy, blue cytoplasm and nuclei similar to transitional cells.
Keratotic changes
Presence of keratin within cervical epithelia (a usually nonkeratinizing epithelium)
May be reactive or in association with HPV.
Range from finding keratin granules in intermediate cells to full-on hyperkeratosis
Hyperkeratosis in cervical epithelial cells
The extreme of keratotic cellular changes
“Ghost nuclei” may be noted.
Tubal metaplasia
Ciliated cells with prominent pseudostratification. May have enlarged nuclei that can be a look-alike for endocervical adenocarcinoma in-situ, but don’t be fooled!
Goblet cells are sometimes also seen in conjunction.
Atrophy
Indicated by a monolayer sheet of parabasal-type cells with preserved nuclear polarity.
Inflammation may also be present (atrophic vaginitis), in which case granular debris and neutrophils will also be seen. In this setting degenerating parabasal cells may be seen with a balloon/blob-like appearance. (shown)
Pregnancy-related hormonal changes
An intermediate-cell dominant pattern with many navicular cells.
Arias-Stella reaction
A benign process which involves gnandular epithelial cells (endovervical or endometrial) and is found in association with pregnancy or occasionally in nonpregnant hormonally stimulated patients. Manifests as pleomorphism in size and shape in glandular cell nuclei, often with bizarre forms, in association with a smudgy chromatin pattern.
HSIL nucleus
Very high N/C ratio (~4x or greater)
Fine or coarsely granular, evenly distributed chromatin with an irregular margin that frequently demonstrates prominent indentations. Nucleoli are generally absent or very sparse.
Adenocarcinoma
Nuclei are enlarged and pleomorphic with irreuglar chromatin distribution and prominent or macronucleoli. Cytoplasm is finely vacuolated.
There may be a blood-filled background or large groups of three-dimeisional cells.
Keratinizing squamous cell carcinoma
Enlarged, nucleated, hyperkeratinized cells are a dead giveaway, as are basaloid cells with red, partially keratinized cytoplasm.
Generally much easier to detect than nonkeratinizing SCC
Nonkeratinizing squamous cell carcinoma
Crowded groups of large-medium sized nonkeratinized cells with a high N/C ratio, rounded nuclei with irregular contours, coarse, irregularly distributed chromatin and macronuclei. Scant, dense basophilic cytoplasm.
Rarely single keratinized cells can be seen.
