sft GYN Cytology Flashcards
Pap adequacy criteria
8k-12k cells for conventional paps; 5k cells for liquid-based; unsat if 75% is obscured by inflammation
Adequate number of endocervs to confirm transformation zone sampling
at least 10 endocervical or metaplastic cells
Cytotech slide limits and rescreening
No more than 100 slides or 8 hours per day; 10% of NILM get screened by 2nd tech
High-risk pap criteria (Medicare)
Sexually active at <16 yr old >5 sexual partners Hx STD <3 negative paps in past 7 years Daughter of woman who received DES during pregnancy Abnormal pap <3yrs in women of child bearing age
Normal cervical cell components in different hormone states
Estrogen therapy/Obesity ↑ superficial cells Progesterone therapy ↑intermediate cells Postmenopausal/Lactation state ↑parabasal cells
When do you report endometrial cells?
>45 years of age
Left dx? Right dx?
Repair on left; radiation change on right
Pap smear, dx?
IUD change
Buzz word?
Atrophic vaginitis; “blue blob”
Trichomonas clinical presentation; associated co-infection? Epithelial changes?
Frothy green/yellow discharge, strawberry cervix; Leptothrix; indistinct, small, perinuclear halos (contrast with HPV related koilocytic change)
Left dx? Right dx?
Candida on left; Trich on right
Normal vaginal flora; flora associated with bacterial vaginosis? Cytologic appearance? Clinical association of Actinomyces?
Lactobacilli; Coccobacilli/Gardnerella vaginalis (clue cells); long duration of IUD
Left dx? Right dx?
left: HSV viral cytopathic effect; right: clue cell (epithelial cell with coccobacilli)
Pap smear, dx? Clinical association?
Actinomyces, associated with longstanding IUD
LSIL criteria and clinical follow-up
Nuclear enlargement >3x size of intermediate cell nucleus; nuculear contours smooth or slightly irregular; repeat Pap in 1 year
Pap smear, dx?
LSIL
Pap smear, dx?
NILM, Navicular cells (LSIL mimic) in pregnancy
HSIL criteria
Small, immature cells with increased N/C ratio and hyperchromatic nuclei with nuclear contour irregularities
HSIL rescreening requirements
All negative Paps going back 5 years must be rescreened
Pap smear, dx?
HSIL
What’s different between right and left?
AIS with feathering on left; HSIL with smooth border on right
ASCUS criteria
2.5-3x size of intermediate cell nucleus; up to mild variation in nuclear contours; not normal, not enough for LSIL
Pap smear, dx?
ASCUS
ASCH criteria
Often used for atypical metaplastic cells; nucleus 1.5-2.5x intermediate nucleus with nuclear changes that fall short of HSIL; hyperchromatic sheets with difficult to visualize details
Pap smear, dx?
ASCH (atypical metaplastic cells)
Pap smear, dx?
Squamous cell carcinoma
AIS buzz words
peripheral feathering; nuclei bulge like a “snake egg” (plus nuclear crowding and hyperchromasia)
Pap smear, dx?
AIS with peripheral feathering
Clues to endocervical adenocarcinoma on pap
columnar configuration but with more pleomorphism and loss of polarity; tumor diathesis; this one is well-differentiated but still has features of AIS plus diathesis
Pap, dx?
IUD change
Pap, dx?
Arias-Stella reaction
Pap, dx?
Endometrial adenocarcinoma; bad pleomorphism plus mucus
Pap, dx?
Arrows are psammoma bodies, in ovarian serous papillary carcinoma
What are the HPV genes involved in viral survival, and what host genes do they affect? What HPV gene causes koilocytic change?
E6 and E7 inhibit host apoptosis by blocking Rb and p53, leading to carcinogenesis. E4
When is HPV testing done? What is the next step if positive or negative?
Triage for colposcopy after ASCUS; cotesting for high-risk HPV with cytology in women over 30 (if cyto and HPV are negative, can go longer without screening (3-5 years))
Who should get screened for Chlamydia? What are the risks of chlamydia during childbirth?
Pregnant women, sexually active <25 years old; women with new or multiple sexual partners; pneumonia and conjunctivitis
Anal pap adequacy criteria
2,000-3,000 nucleated squamous cells
Basic pap guidlines (starting age, interval, etc…)
Start at 21 with Paps every 3 years, no HPV testing. At 30, can start cotesting (HPV plus Pap) every 5; Can stop at 65 if no CIN2+ in the last 20 years.; See ASCCP guidelines for detailed algorithms
Peritoneal fluid, dx?
Endometriosis; glandular and stromal cells in a bloody background.
Ascitic fluid, dx?
High-grade serous carcinoma with psammoma body (can’t distinguish between primary peritoneal or ovarian in origin)
Ascitic fluid, dx?
Clear cell carcinoma (ovarian origin); tumor cells with irregular nuclei, vesicular chromatin, prominent nucleoli, and vacuolated cytoplasm
Pap smear, dx?
LSIL
Pap smear, dx?
HSIL, keratinizing variant
Pap smear, dx?
ASCUS
