Gyn Cytopathology

Front 1

Back 1

ATROPHY

Basal¶basal cells (can mimic HSIL-grooved nuc, crowded, but not chromatin)

Front 2

Maturation index in atrophy

Back 2

90/10/10

Predominance of PARABASALS

What is maturation index?

Front 3

Back 3

Transitional cell metaplasia
Basal & Parabasal cells
Can mimic HSIL with grooves, irreg membranes. BUT soft pale chromatin

Front 4

Maturation index at ovulation?

Menses?

Pregnancy?

Back 4

0/40/60 (Estrogen matures epith)

Left shifted

0/95/5 (PROGESTERONE)

Front 5

Back 5

Follicular cervicitis

TINGIBLE BODY MACS

Assoc with chlamydia

Front 6

When do you see endometrial cells in a pap?

Back 6

First 12d of cycle

Out-of-phase shedding:
-IUD
-itis
-polyp

Front 7

Back 7

reactive

Cohesive flat sheets, “streaming”, lrg nuc with marked size variation, lrg –oli, pale chromatin, mits
Individual abn cells rare
Mimics scc/adenoca

Front 8

Back 8

radiation change
Lrg bizarre cells (compare to PMN)
NORMAL N:C ratio
Cyt vacs
polychromasia
multinucleation

mimics HSV, ca, LSIL

Front 9

cancer?

Back 9

No

IUD!

-Vacuolated cells
- Sm dark cells scant cyt
- Sm grp or isolated
- Lrg nuc, -oli
- Shed endomets throughout cycle
- ACTINOMYCES

Front 10

What are the risk factors for cervical ca?

Back 10

Front 11

What part of the HPV genome binds p53? Rb?

Back 11

e6 binds p53 & blocks apoptosis

e7 binds Rb & blocks tumor suppression

Front 12

Back 12

Endocervs
honeycomb

Front 13

Back 13

endometrial cells
3-D
small dark balls

Mimics: HSIL (flatter), SCC (background diathesis), AIS (mits), small cell ca (darker, nuc smearing)

Front 14

Caused by?

Back 14

Shift

Clue cells
background should be CLEAN

Gardnerella vaginalis

Front 15

Back 15

Trichomonas
Strawberry cervix

• pear shaped
• pale, eccentrically placed nucleus
• red cytoplasmic granules

Front 16

Back 16

Candida

shish kabobs squamous cells

Front 17

Associated with?

Back 17

Actinomyces spp.

Assoc with IUDs. no treatment if asymptomatic. IUD can stay in.

Front 18

Back 18

HSV

Multinucleated
Margination
Molding

Front 19

Back 19

Chlamydia

Front 20

Back 20

CMV
usu infects endocervical cells

• mononuclear cells
• markedly enlarged
• basophilic intranuclear inclusion
• small granular cytoplasmic inclusions
Each cell has a large basophilic
intranuclear inclusion that is surrounded by a halo; the cytoplasm contains multiple small
basophilic inclusions as well.

Front 21

Back 21

Leptothrix

AND TRICH!

Leptothrix often assoc with trich

Front 22

Back 22

Alternaria in pap

water contaminant

Front 23

Back 23

Reactive endocervs
Prominent nucleoli

Front 24

characteristic finding of woman on birth control?

Back 24

Parakeratosis

Front 25

Low risk HPV?

High risk HPV?

Back 25

Low
6, 11, 42, 43, 44, 53, 54, 57, and 66

HIgh
16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 68

Which type most commonly seen in cervical ca?

Front 26

Back 26

LSIL

• intermediate-sized cells
• nuclear atypia:
• enlargement
• irregular contour
• hyperchromasia
• slight chromatin coarseness
• cytoplasmic cavities (koilocytes)

Front 27

Back 27

HSIL
• usually parabasal-sized cells
• discrete cells or syncytium-like groups (hyperchromatic
crowded groups)
• nuclear atypia
• enlargement
• marked irregularity in contour
• usually marked hyperchromasia
• marked chromatin coarseness

Front 28

Back 28

HSIL / CIS
-syncytial arrangements of high grade cells
-

Front 29

Back 29

SCC!

LOOK FOR NUCLEOLI AND IRREGULAR CHROMATIN PATTERN

Front 30

Features of SCC

Back 30

Features of SCC:
HSIL features, plus:
• macronucleolus
• irregular chromatin distribution
• tumor diathesis
• “tadpoles” and “fiber cells” (keratinizing type)

Front 31

Back 31

AIS
• hyperchromatic crowded groups
• glandular differentiation
• columnar cells
• strips and rosettes
• “feathering”
• neoplastic nucleus:
• hyperchromasia
• crowding, stratification
• inconspicuous nucleolus
• apoptosis
• mitoses
• no tumor diathesis
Pseudostratification
salt & pepper chromatin

Front 32

Back 32

Rosettes are highly characteristic of AIS

Front 33

Back 33

Endocervical adenoca

• tumor diathesis (< 50% of cases)
• large, round nucleus
• prominent nucleolus
• abundant cytoplasm
irregular nuclear contours
ROUND cells, vs AIS (columnar)

Front 34

Back 34

Endocervical adeno

These malignant cells show variation in nuclear size, with prominent nucleoli and
coarsely granular chromatin.

Front 35

Back 35

Minimal deviation adenocarcinoma.

The rare, extremely well-differentiated tumor known
as minimal deviation adenocarcinoma (or adenoma
malignum) is composed of mucinous glands that show
little if any atypia, and yet, if untreated, invade deeply
and metastasize. Patients sometimes present with
vaginal discharge. In most cases, the neoplastic cells
on the Pap test look entirely like normal endocervical
cells

Front 36

Back 36

Endometrial adenoca
ENGULFED POLYS
• round cells
• enlarged nucleus
• hyperchromatic
• prominent nucleolus
• scant or abundant vacuolated cytoplasm
• cytoplasmic neutrophils (“bags of polyps”)
3D groups with scalloped borders

Hint 36

Front 37

Back 37

Melanoma

Isolated cells
The malignant spindled and epithelioid cells are dyshesive. There is focal finely
granular melanin pigment

Front 38

# endocervs required in Bethesda?

Back 38

10 CELLS

Endocervical cells OR squamous met

Front 39

# cells required?

Back 39

5000

basically 9 per phf

<5000 is unsat; also if >75% obscured

Front 40

Back 40

KNOW THIS

Front 41

Back 41

IUD CELLS!

Single cells with increased N/C ratio, slight hyperchromasia and some irregularity to the nuclear membrane represent cellular changes caused by an IUD.

Front 42

Pap

Back 42

Cockleburr cells

radiate arrays of crystalline material often surrounded by macrophages.
Seen in pregnancy.
no significance

Front 43

pap

Back 43

ASCUS
Enlarged nuc
smooth contours
even chromatin

MORE REVIEW AT CYTOLOGYSTUFF.COM

Front 44

What HPV subtype is more common in glandular lesions?

Back 44

HPV18

Front 45

What type of cell does lactobacilli target?

what type of bacteria is it?

Back 45

INTERMEDIATE (eats the glycogen and leads to cytolysis)
Contributes to normal vaginal pH

Unencapsulated GPR

Front 46

Macrocytosis can occur in radiation and what other condition?

Back 46

B12 deficiency

Front 47

Cytologic patterns on Pap during pregnancy

Back 47

Predominantly intermediate cells (progesterone rich)

Cytolysis may be marked

Fetal distress can cause shift to SUPERFICIAL cells

IUFD can have shift to ATROPHY

Postpartum smears can show atrophic pattern more often with lactating moms

Front 48

HPV facts

Back 48

nonencapsulated ds virus
7900 base pairs
early and late genes
Integration of viral genetic material into host genome is critical malignant event (disrupts E1-E2)
INTEGRATION SITES ARE RANDOM
e6-p53; e7-Rb

Front 49

GYN tumor most frequently associated with "watery discharge"

Back 49

Fallopian tube tumors

Front 50

Clues to look for trichomonas

Back 50

thin perinuclear halos in squamous cells

Leptothrix