Test Revision Flashcards
Small cells that give rise to squamous cells Rarely recognised in a Pap smear Seen in short rows Sparse green cytoplasm Oval nuclei High N/C ratio Fine granular chromatin pattern Small chromocenters
Basal cells
Round to oval cells Dense green (cyanophilic cytoplasm) May stain pink (orangeophilic) if not well preserved Nucleus occupies ½ of cell Fine chromatin pattern May present in sheets, singly Commonly found in post menopausal women/post partum Indicates oestrogen deficiency
Parabasal cells
If these cells found in cervical smear may indicate:
- the smear was taken in the distal 1/3 of the vagina
- the specimen was taken from an ectocervix that contained an area of leucoplakia (hyperkeratosis)
- the specimen was taken from a pregnant patient whose fetal membranes had ruptured with secretions containing said cells
Anucleate squamous cells
Found in the superficial stroma and deep stroma
Central core of stromal cells, peripheral rim of epithelial cells
Appear in 3 dimensional clusters or singly
Cell ball pattern with moulding
Often show degenerative changes
Cytoplasmic vacuoles with neutrophils
Hyperchromatic nuclei
May appear no larger than an inflammatory cell
Presence of endometrial cells after 12 day of cycle is considered abnormal
Noted on sample to make sure they are not confused with lesions
Endometrial cells
What kind of change in cytoplasm do these relate to?
- Perinuclear halos
- Vacuolation
- Altered staining pattern
- Abnormal keratinisation
- Cytolysis
- Engulfed polymorphism
Inflammatory
What kind of change in nucleus do these relate to?
- Pyknosis, karyorrhexis and karyolysis
- Swelling - due to fluid absorption
- Wrinkling of the nuclear membranes
- Enlargement
- Hyperchromasia
- Multinucleation/binucleation
- Chromatin degeneration
- Nuclear symmetry is maintained
Inflammatory
What kind of change in cell architecture do these relate to?
- 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 projections
Reparative
What kind of change in nucleus do these relate to?
- 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
Reparative
What kind of change in cytoplasm do these relate to?
- Large with tails and distinct borders
- Retains evidence of squamous or glandular differentiation
- Changes in staining reaction (polychromasia)
- +/- engulfed polymorphs
Reparative
How to Distinguish Reparative from Malignant Cells?
Uniformity of cell nuclei within flat sheets and lack of single cells distinguishes reparative from malignant cells
What infection is this?
- Streaks of small and large lymphocytes
- Macrophages
- Multinucleated histiocytes
- Plasma cells ‘clock face pattern’
- Lymphocytes on their own can’t be reported as [blank] without the presence of tingible body macrophages
- Common in post meno women
Follicular cervicitis
What infection is this?
- Clue cells
- Common cause of DC in younger women
- thin milky d/c and foul fishy odour
- Shift from lactobacilli to coccobacilli
- Considered venereal disease (STD)
- Uncommon in Pmeno women, except those on HRT
- Risk factors includes multiple sexual partners, IUCD, prior pregnancy, spermicides and smoking
- Increases vaginal pH (> 4.5)
Gardnerella vaginalis
Reported as Profuse Coccoid Flora
What infection is this?
- Suspect if ulcerative lesion seen on cervix
- Venereal infection common in women in the tropical climates
- Indicates granulomatous inflammation with caseous necrosis mainly of the skin and external genitalia
- Skin scrapings show predominance of histiocytes with vacuoles containing straight and curved dumbbell shaped rods
- Stain pos with Warthin Starry method
Klebsiella granulomatis
What infection is this?
- Bacteria capable of forming large colonies
- Usually seen in associated with IUCD
- Saprophytic organism with no clinical symptoms
- Colonies on filamentous organism
- Staining dark blue in central area
- Thin radiating filament
- Variable inflammatory exudate
- Variable inflammatory changes in squamous epithelium
- If left can lead to pelvic inflammatory disease => infertility
Actinomyces
What infection is this?
- Unicellular, grey pear shaped, with oval eccentric hypochromic nucleus and eosinophilic granules in cytoplasm
- Considered venereal disease
- Symptoms produce frothy +/- white/yellow d/c, vaginal dryness, postcoital or intermenstrual bleeding
- Punctate haemorrhagic spots may develop on the mucosa of vaginal cavity known as ‘strawberry vagina’
Trichomonas vaginalis
What stage of the menstrual cycle is this?
- Desquamated endometrial cells
- Blood
- Polymorphonuclear leukocytes
- Predominantly intermediate cells in clumps and folded cytoplasm
Menstrual phase
What stage of the menstrual cycle is this?
- Gradual disappearance of blood
- Endometrial cells with small histiocytes up to day 12
- Basophilic intermediate cells become replaced with mature, flat eosinophilic superficial cells
Proliferative phase
What stage of the menstrual cycle is this?
- Intermediate cells increase in numbers
- Cytolysis occurs with lactobacilli and moth eaten cytoplasm and naked nuclei
- Background of cytoplasmic debris
- Increase in polymorphonuclear leukocytes
Secretory phase
What stage of the menstrual cycle is this?
- Predominantly flat, superficial squamous cells
- Nipple-like protrusions occasionally seen in endocervical cells
- Thick cervical mucous forms fern-like crystalline structures
Ovulation
What stage of the menstrual cycle is this?
- Mature squamous show glycogen deposits
- Clusters of intermediate cells
- Navicular cells
- Cytolysis
Pregnancy
What stage of the menstrual cycle is this?
- No evidence of estrogen
- Atrophic smear pattern - predominance of parabasal cells especially in lactating women
- May find endometrial cells
- Polymorphonuclear leukocytes
Post partum
What infection is this?
- Single/sheets/flat cobblestone arrangement
- Mature squamous/metaplastic cells
- Nuclei enlarged (3-4x the size of intermediate nuclei)
- Increased N/C ratio
- Course granular chromatin
- Bi/multinucleation
- Nuclear pleomorphism
- Dense with/without koilocytes
LSIL/CIN1
What infection is this?
- Single or in loose sheets
- Cell size = sq metaplastic or parabasal
- Polygonal
- Some irregular polarity
- N/C ratio is 1/3-1/2 of the cell
- Enlarged nuclei
- Hyperchromatic nuclei
- Nuclear membranes irregular/notched
- Dense basophilic cytoplasm
HSIL/CIN2
What infection is this?
- Small cells in groups, single
- Squamous or metaplastic cells
- Syncytial sheets/aggregates
- Irregular course clumped chromatin pattern
- N/C ratio is > ½ of the cell size
- Irregular nuclear membrane
- Nuclei has irregular contours
- Scanty cytoplasm
HSIL/CIN3
What part of respiratory cytology is this?
- Cytoplasm finely vacuolated and usually contains phagocytosed dust particles
- Oval or bean shaped, eccentric nucleus
- Chromatin finely and evenly distributed, occasionally prominent nucleoli is visible
- Characterised by their cytokine profile
- They fight against pathogens by activating multiple immunological pathways and serve as a first line of defence
- Have anti-inflammatory response to protect excessive tissue damage
- Normal part of smear
Pulmonary macrophages
What part of respiratory cytology is this?
- Granulomatous reaction
- Acute or Suppurative
- Caseous necrotic debris
- Mixed inflammatory exudate
- Epithelioid histiocytes
- Langerhans giant cells
- AFB organism demonstrated by ZN stain
Tuberculosis
What part of respiratory cytology is this?
- Septate fungal organism with hyphae 3-4um in width
- Dichotomous branching - 45 degree angles
- Fruiting heads form in aerobic conditions
- Stained by Papanicolaou and Grocott methods
- Branches are refractile under polarized light microscopy
Aspergillosis
What part of respiratory cytology is this?
- Multinucleation
- Nuclear moulding
- ‘Ground glass’ appearance
- Loss of chromatin pattern
- Nuclear inclusions
- Clean background
- Exclude contaminant from URT
HSV
What part of respiratory cytology is this?
- Commonly seen in immunocompromised individuals, premature babies and malnourished infants
- CXR – bilateral infiltrates
- Amphophilic proteinaceous alveolar casts
- Honeycomb appearance of unstained cysts on Pap stain
- Casts 5-8um in diameter
- Trophozoites outside cyst are not visible
- If untreated, it often leads to death
Pneumocystis Jirovecii (Carinii)
What part of respiratory cytology is this?
- Striking pleomorphism with sharp cell outlines
- Chromatin irregularly dispersed and densely hyperchromatic
- Karyopyknosis
- Irregular keratinization
- Irregular cytoplasmic thinning manifested as caudate cells and spindle cells
- Ghost cells
- Abnormal keratin pearl formations
- Background of necrosis
Squamous cell carcinoma
What part of respiratory cytology is this?
- Ball like clusters of cells
- Papillary fronds
- Nuclei round to oval with bland, finely granular chromatin
- Nucleoli but inconspicuous
- Single cells may bear a strong resemblance to alveolar macrophages, which may be present in large numbers
- Cytoplasmic villi may mimic cilia
- Cells may or may not exhibit secretory vacuoles
- Can have bubbly cytoplasm
Lipid adenocarcinoma
What part of respiratory cytology is this?
- Very small cells arranged in loose clusters with some dispersed single cells
- Individual cell is ~1.5 times the size of a lymphocyte
- Nuclei are usually round to irregular in shape
- Chromatin is hyperchromatic and dense ‘classical salt and pepper’
- Karyopyknosis
- Extremely scanty cytoplasm
- Intercellular nuclear moulding
- Fragile cells – smearing artefact/streaking
- Mitotic figures
- Prominent apoptosis
Small cell anaplastic carcinoma
What part of respiratory cytology is this?
- Mixture of large single cells and syncytial groupings
- Nuclei round to lobulated with irregularly dispersed, intensely hyperchromatic chromatin
- Macronucleoli, may be multiple
- Tumour giant cells
- Cytoplasmic outline frequently ill defined
Large cell anaplastic carcinoma
What part of urinary cytology is this?
- Present in all urine samples
- Voided urine they occur singly or form loosely cohesive clusters or sheets
- Cytoplasm is opaque or granular
- Usually stain basophilic with Pap stain
- Renal tubular cells are rarely found in the voided urine usually seen in catheterised specimens
- May be multinucleated
Normal transitional epithelium
What part of urinary cytology is this?
- Usually occur singly with eccentric, enlarged nuclei
- Nuclei appear homogenous and clear
- Nuclear inclusions often fills entire nucleus
- With only a small rim of often basophilic cytoplasm
- Diagnostic pitfalls:
- mimics TCC
Polyomavirus
What part of urinary cytology is this?
- Clusters of urothelial epithelial cells with smooth borders
- Papillary groups
- Central nuclei
- Dark, dense chromatin
- Normal nuclear size and shape
Urinary calculi
What part of urinary cytology is this?
- Moderate to high cellularity
- Syncytial or papillary clusters
- Loss of polarity
- Nuclear pleomorphism
- High NC ratio
- Irregular nuclear borders
- Coarsely granular chromatin pattern
- Large, irregular nucleoli
- Necrosis
High grade papillary tumor
What part of urinary cytology is this?
- Highly cellular with more than 1/4th of the cell population neoplastic
- Predominantly single cell presentation with few clusters
- Nuclear pleomorphism
- High NC ratio
- Coarsely granular chromatin pattern
- Macronucleoli
- Glandular and squamoid component may be seen
- Necrosis
Invasive non-papillary tumors
What part of urinary cytology is this?
- Increase PMNs
- Necrotic cell debris
- Urothelial cells with degenerative changes
- Reactive urothelial atypia
Cystitis
What is this the DDx for?
- Repair
- Squamous metaplasia
- Cavitating lung infections
- e.g. mycetoma
- Pulmonary infarction
- Mesothelial cells
- Vegetable cells
- Radiation/chemotherapy effect
- Contamination by Ca upper airway
SCC
What is this the DDx for?
- Lymphocytes
- Lymphoma
- Degenerate bronchial cells
- Poorly differentiated SCC/NSCLC
SCA
