sft GYN Cytology

Question 1

Pap adequacy criteria

Answer 1

8k-12k cells for conventional paps; 5k cells for liquid-based; unsat if 75% is obscured by inflammation

Question 2

Adequate number of endocervs to confirm transformation zone sampling

Answer 2

at least 10 endocervical or metaplastic cells

Question 3

Cytotech slide limits and rescreening

Answer 3

No more than 100 slides or 8 hours per day; 10% of NILM get screened by 2nd tech

Question 4

High-risk pap criteria (Medicare)

Answer 4

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

Question 5

Normal cervical cell components in different hormone states

Answer 5

Estrogen therapy/Obesity ↑ superficial cells Progesterone therapy ↑intermediate cells Postmenopausal/Lactation state ↑parabasal cells

Question 6

When do you report endometrial cells?

Answer 6

>45 years of age

Question 7

Left dx? Right dx?

Answer 7

Repair on left; radiation change on right

Question 8

Pap smear, dx?

Answer 8

IUD change

Question 9

Buzz word?

Answer 9

Atrophic vaginitis; “blue blob”

Question 10

Trichomonas clinical presentation; associated co-infection? Epithelial changes?

Answer 10

Frothy green/yellow discharge, strawberry cervix; Leptothrix; indistinct, small, perinuclear halos (contrast with HPV related koilocytic change)

Question 11

Left dx? Right dx?

Answer 11

Candida on left; Trich on right

Question 12

Normal vaginal flora; flora associated with bacterial vaginosis? Cytologic appearance? Clinical association of Actinomyces?

Answer 12

Lactobacilli; Coccobacilli/Gardnerella vaginalis (clue cells); long duration of IUD

Question 13

Left dx? Right dx?

Answer 13

left: HSV viral cytopathic effect; right: clue cell (epithelial cell with coccobacilli)

Question 14

Pap smear, dx? Clinical association?

Answer 14

Actinomyces, associated with longstanding IUD

Question 15

LSIL criteria and clinical follow-up

Answer 15

Nuclear enlargement >3x size of intermediate cell nucleus; nuculear contours smooth or slightly irregular; repeat Pap in 1 year

Question 16

Pap smear, dx?

Answer 16

LSIL

Question 17

Pap smear, dx?

Answer 17

NILM, Navicular cells (LSIL mimic) in pregnancy

Question 18

HSIL criteria

Answer 18

Small, immature cells with increased N/C ratio and hyperchromatic nuclei with nuclear contour irregularities

Question 19

HSIL rescreening requirements

Answer 19

All negative Paps going back 5 years must be rescreened

Question 20

Pap smear, dx?

Answer 20

HSIL

Question 21

What’s different between right and left?

Answer 21

AIS with feathering on left; HSIL with smooth border on right

Question 22

ASCUS criteria

Answer 22

2.5-3x size of intermediate cell nucleus; up to mild variation in nuclear contours; not normal, not enough for LSIL

Question 23

Pap smear, dx?

Answer 23

ASCUS

Question 24

ASCH criteria

Answer 24

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

Question 25

Pap smear, dx?

Answer 25

ASCH (atypical metaplastic cells)

Question 26

Pap smear, dx?

Answer 26

Squamous cell carcinoma

Question 27

AIS buzz words

Answer 27

peripheral feathering; nuclei bulge like a "snake egg" (plus nuclear crowding and hyperchromasia)

Question 28

Pap smear, dx?

Answer 28

AIS with peripheral feathering

Question 29

Clues to endocervical adenocarcinoma on pap

Answer 29

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

Question 30

Pap, dx?

Answer 30

IUD change

Question 31

Pap, dx?

Answer 31

Arias-Stella reaction

Question 32

Pap, dx?

Answer 32

Endometrial adenocarcinoma; bad pleomorphism plus mucus

Question 33

Pap, dx?

Answer 33

Arrows are psammoma bodies, in ovarian serous papillary carcinoma

Question 34

What are the HPV genes involved in viral survival, and what host genes do they affect? What HPV gene causes koilocytic change?

Answer 34

E6 and E7 inhibit host apoptosis by blocking Rb and p53, leading to carcinogenesis. E4

Question 35

When is HPV testing done? What is the next step if positive or negative?

Answer 35

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))

Question 36

Who should get screened for Chlamydia? What are the risks of chlamydia during childbirth?

Answer 36

Pregnant women, sexually active \<25 years old; women with new or multiple sexual partners; pneumonia and conjunctivitis

Question 37

Anal pap adequacy criteria

Answer 37

2,000-3,000 nucleated squamous cells

Question 38

Basic pap guidlines (starting age, interval, etc...)

Answer 38

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

Question 39

Peritoneal fluid, dx?

Answer 39

Endometriosis; glandular and stromal cells in a bloody background.

Question 40

Ascitic fluid, dx?

Answer 40

High-grade serous carcinoma with psammoma body (can't distinguish between primary peritoneal or ovarian in origin)

Question 41

Ascitic fluid, dx?

Answer 41

Clear cell carcinoma (ovarian origin); tumor cells with irregular nuclei, vesicular chromatin, prominent nucleoli, and vacuolated cytoplasm

Question 42

Pap smear, dx?

Answer 42

LSIL

Question 43

Pap smear, dx?

Answer 43

HSIL, keratinizing variant

Question 44

Pap smear, dx?

Answer 44

ASCUS