PAPANICOLAU METHOD (PAP'S SMEAR) Flashcards
______________ is the SECOND BEST CHOICE for routine cytologic examination, AFTER PAPANICOLAU with a greater possibility for immediate microscopic examination used for hormonal evaluation of gynecologic specimen and for cancer detection
PHASE-CONTRASTE MICROSCOPY
APPLICATIONS OF PAPANICOLAU METHOD (PAP’S SMEAR)
- SCREEN CERVICAL CANCER
- To determine the cause of certain infection
- Hormonal cytology
- Medico-legal examination of sexual assault
PAP SMEAR PROCEDURE PREPARATION
- PATIENT SHOULD ABSTAIN FROM COITUS
- Do not douche the vagina for at least a day
- Do not apply intravaginal preparations for at least one week before the examination
- SMEARS SHOULD NOT BE TAKEN DURING MENSTRUAL BLEEDING, because contamination with blood, endometrial and tissue debris can obscure the cells in examination
Pap smear should be done at least _____ days after the last menstrual period
at least 10 DAYS AFTER THE LAST MENSTRUAL PERIOD
STAINS FOR PAP’S SMEAR:
- Harris hematoxylin
- Orange green 6 (OG-6) stain
- Eosin Azure 50 (EA-50) stain
Pap smear stain that stains the NUCLEUS:
Harris hematoxylin
Pap smear stain that stains the CYTOPLASM OF MATURE CELL and stains KERATIN
ORANGE GREEN 6 (OG-6) stain
Pap smear stain that sta8ins the CYTOPLASM OF IMMATURE CELL
EOSIN AZURE 50 (EA-50) stain
COMPONENTS OF EA-50 STAIN:
- Light green SF
- Bismarck brown Y
- Eosin Y
- Phosphotungstic acid
- Lithium carbonate
Stains the CYTOPLASM OF OTHER CELLS, including non-keratinized squamous cells.
LIGHT GREEN SF
STAINS NOTHING and in contemporary formulants it is often omitted
Bismarck Brown Y
Stains the superficial epithelial squamous cells, nucleoli, cilia, and red blood cells
EOSIN Y
This method provides OPTIMUM NUCLEAR DETAIL information, which is important for cytologic evaluation of PAP’s smears, non-gynecological and FNA cytologic specimens
MODIFIED PAPANICOLAU STAIN
In Modified Papanicolau stain, to produce a more distinct color differentiation:
BISMARCK BROWN IS OMOTED from the EA 50 formula
Routine Pap’s procedure staining time
FIRST STAIN:
FIRST STAIN:
Stain in Harri’s hematoxylin, 5 minutes
Routine Pap’s procedure staining time
SECOND STAIN:
SECOND STAIN:
Stain in OG-6, 2 minutes
OG-6 is the FIRST COUNTERSTAIN in PAP’s smear
Routine Pap’s procedure staining time
THIRD STAIN:
THIRD STAIN:
EA-50 is the SECOND COUNTERSTAIN in PAP’s smear
PAP’S SMEAR STAINING REACTION:
Nucleus:
CYTOPLASM, Keratinizing cells:
CYTOPLASM, Non-keratinizing cells:
NUCLEUS: BLUE or BLACK
CYTOPLASM, Keratinizing cells: PINK or ORANGE
CYTOPLASM, Non-keratinizing cells: BLUE or GREEN
For vaginal hormonal cytology, smears are best taken from the __________________________ because it is more accessible and less likely to be contaminated by cellular debris and vaginal discharge
UPPER LATERAL THIRD OF VAGINAL WALL
Estrogen effect:
Progesterone effect:
Estrogen effect: INCREASED SUPERFICIAL CELLS
E—->S
Progesterone effect: INCREASED INTERMEDIATE CELLS
P—->I
In hormonal cytology, slide is checked under the ________________ to assess the quality of the smear and staining; quantitative evaluation is done using the ______
Hormonal cytology:
LPO: Quality
HPO: Quantity
Different cytologic samples:
- Upper lateral third of the vaginal wall
- Ectocervix
- Endocervix
Cytologic sample ideal for vaginal HORMONAL STATUS:
UPPER LATERAL THIRD OF THE VAGINAL WALL
MOST COMMON SITE FOR CANCER SCREENING because this is where malignancies arise
ECTOCERVIX
For the detection of ENDOCERVICAL AND INTRAUTERIN LESIONS
ENDOCERVIX
Tools for gynecologic specimen collection:
- Glass pipette and bulb
- Ayre’s spatula
- Laryngeal cannula
Tool used for vaginal aspiration:
Glass pipette and bulb
Tool used for swab smears
Ayre’s spatula
Tool sued for endocervical or endometrial aspiration:
Laryngeal cannula
Cells found in cervico-vaginal smear:
- mature superficial cells
- Intermediate cells
- Parabasal cells
- Endometrial cells
- Endocervical glandular cells
These polyglonal squamous cells measures 45 to 50 um and are identified by the presence of pale, pink-standing cytoplasm and DARK PYKNOTIC NUCLEI
MATURE SUPERFICIAL CELLS
Medium-sized polyhedral or elongated cells with BASOPHILIC VACUOLATED CYTOPLASM
INTERMEDIATE CELLS
Boat shaped intermediate cells with strong tendency to fold/curl on edges and its presence suggests a combined estrogen-progesteron effect
NAVICULAR CELLS
Round/oval boat shaped intermediate cells with translucent basophilic cytoplasm observed greatest at the center of the cell
PREGNANCY CELLS
Round or oval cells with small dense basophilic cytoplasm; similar to ‘FRIED FRESH EGGS” with sunny-side up 15-30 um
PARABASAL CELLS
Small cells, slightly cylindrical with less basophilic cytoplasm occurs in a tightly-packed groups of 3 or more; found during 1-10 DAYS AFTER MENSTRUATION
ENDOMETRIAL CELLS
Note: Smears taken during menstruation is UNSATIFACTORY because it will yield to a high level of WBCs, RBCs, and endometrial cells
Occur in large groups or small sheets; Cytoplasm stains pale blue/gray and finely vacuolated, often with indistinct cell borders and nuclei with finely granular chromatin; “HONEYCOMB” appearance when viewed on end
ENDOCERVICAL GLANDULAR CELLS
Small, round to slightly oval cells with relatively large nuclei normally found in PUBERTY and AFTER MENOPAUSE:
BASAL CELLS
Most common organism of the nromal vaginal flora that maintains the ACIDIC pH of the vagina; stains BLUE TO LAVENDER with Pap’s method:
DODERLAIN BACILLUS
Budding yeast seen in DIABETIC patients, people taking oral contraceptives and immunocompromised patients
Candida albicans
Pear-shaped organism that stain BLUE-GREEN with a slit-like eccentric nucleus “PING=PONG DISEASE”
Trichomonas vaginalis
Long thin filamentous bacilli, increased in high vaginal pH
Leptothrix spp.
Abnormal variation of squamous epithelial cells that suggests the presence of Gardnerella vaginalis
CLUE CELLS
Contaminant due to gloves (powder in gloves)
TALCUM
Squamous epithelial cell that show the cytopathic effect of Human Papilloma Virus (HPV)
KOILOCYTES
Also known as ARBORIZATION and the ferning is due to formation of SALT CRYSTALS in high NaCl concentration in cervical mucus under the influence of estrogen; sign/basis for early detection of EARLY PREGNANCY:
FERN or PALM=LEAF PATTERN
Manner of reporting Pap’s smear:
- Class system
- Bethesda system
Reporting of Pap’s smear based on the presence of malignant cells; obsolette:
Class system
ABSENCE of atypical or abnormal cells
Class:
Class I
Atypical cytological picture but NO EVIDENCE of malignancy
Class:
Class II
Cytologic picture SUGGESTIVE BUT NOT CONCLUSIVE of malignancy
Class:
Class III
Cytologic picture STRONGLY SUGGESTIVE of malignancy
Class:
Class IV
Cytologic picture CONCLUSIVE of malignancy
Class:
Class V
New manner of reporting for cervical and vaginal cytologic diagnosis
Bethesda system
Format of reporting using Bethesda system:
Specimen adequacy,
General categorization,
Descriptive diagnosis
In collection of sputum, absence of alveolar macrophages suggest ________ rather than sputum and results an UNSATISFACTORY SPECIMEN
SALIVA
For respiratory tract specimen, obtain at least _______________ sputum specimen
3 CONSECUTIVE MORING SPUTUM SPECIMEN
Collect early morning sputum by DEEP COUGH in a wide-mouthed jar containing _______________________
SACCOMANO’S FLUID (50% Ethyl alcohol and 2% Carbowax)
Respiratory tract specimens:
- SPUTUM
- Bronchoalveolar lavage (BAL)/ Bronchial washing (BW)
- Bronchial brushing (BB)
For Gastrointestinal specimen, the patient should have fasted for _________ before gastring washing is performed
8 hours
For peritoneal, pleural and pericardial fluid, jelly-like clots may be prevented by adding ___________ for every _______ of aspirate
300 units of heparin for every 100 mL aspirate
When breast secretion is BLOODY, a _______________ should be considered clinically
BENIGN INTRADUCTAL PAPILLOMA
Preferred urinary tract specimen:
Second urine
Urine specimen volume needed to be centrifuged after collection::
at least 50 mL IS NEEDED, which must be CENTRIFUGED
For CSF specimens, how much is the minimum volume necessary for cytologic evaluation?
1cc
