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[[Image:Low grade squamous intraepithelial lesion.jpg|thumb|right|250px|A cytology specimen with LSIL. [[Pap stain]]. (WC/Nephron)]] | |||
'''Gynecologic cytopathology''' is a subset of [[cytopathology]]. ''Gynecologic'' usually refers to Pap test specimens, i.e. uterine cervix, vaginal vault; other gynecologic specimens are considered ''non-gynecologic''. | '''Gynecologic cytopathology''' is a subset of [[cytopathology]]. ''Gynecologic'' usually refers to Pap test specimens, i.e. uterine cervix, vaginal vault; other gynecologic specimens are considered ''non-gynecologic''. | ||
This article deals only with cervical cytopathology. An introduction to cytopathology is in the ''[[cytopathology]]'' article. | This article deals only with cervical cytopathology. An introduction to cytopathology is in the ''[[cytopathology]]'' article. | ||
'''Cervical cytology''' redirects to this article. | |||
=Preparation= | =Preparation= | ||
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*Nucleus approximately the size of an intermediate cell nucleus. | *Nucleus approximately the size of an intermediate cell nucleus. | ||
=== | ===Images=== | ||
<gallery> | |||
Image: Benign endocervical epithelium -- high mag.jpg | Endocervical epithelium - high mag. (WC) | |||
Image: Benign endocervical epithelium -- very high mag.jpg | Endocervical epithelium - very high mag. (WC) | |||
Image: Benign endocervical epithelium - 2 -- high mag.jpg | Endocervical epithelium - high mag. (WC) | |||
Image: Benign endocervical epithelium - 2 -- very high mag.jpg | Endocervical epithelium - very high mag. (WC) | |||
Image: Benign endocervical epithelium - 3 -- high mag.jpg | Endocervical epithelium - high mag. (WC) | |||
Image: Benign endocervical epithelium - 3 -- very high mag.jpg | Endocervical epithelium - very high mag. (WC) | |||
</gallery> | |||
<gallery> | <gallery> | ||
Image:Low-grade_sil_and_endocx.jpg | Endocervical cells and LSIL. (WC) | Image:Low-grade_sil_and_endocx.jpg | Endocervical cells and LSIL. (WC) | ||
</gallery> | </gallery> | ||
==Mix of cells== | ==Mix of cells== | ||
The mix of cells is dependent on age and hormones:<ref>GR. 4 February 2010.</ref> | The mix of cells is dependent on age and hormones:<ref>GR. 4 February 2010.</ref> | ||
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*"Dense" cytoplasm. | *"Dense" cytoplasm. | ||
*Nucleus ~2X the size of an intermediate cell nucleus. | *Nucleus ~2X the size of an intermediate cell nucleus. | ||
**Nucleolus - ''' | **Nucleolus (small) - '''important'''. | ||
**Regular/smooth nuclear membrane. | **Regular/smooth nuclear membrane. | ||
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*Squamous metaplastic cells have a high NC ratio - they are differentiated from HSIL via nuclear features (dark staining + irregular nuclear contour = HSIL). | *Squamous metaplastic cells have a high NC ratio - they are differentiated from HSIL via nuclear features (dark staining + irregular nuclear contour = HSIL). | ||
**Slight nuc. contour irregularies are accepted, may be darker staining. | **Slight nuc. contour irregularies are accepted, may be darker staining. | ||
====Images==== | |||
<gallery> | |||
Image: Squamous metaplasia - Pap test -- high mag.jpg | SM - high mag. (WC) | |||
Image: Squamous metaplasia - Pap test -- very high mag.jpg | SM - very high mag. (WC) | |||
Image: Squamous metaplasia - Pap test - alt -- very high mag.jpg | SM - very high mag. (WC) | |||
</gallery> | |||
===Endometrial cells=== | ===Endometrial cells=== | ||
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Notes: | Notes: | ||
*Endometrial cells may appear irregular in the context of an intrauterine device (IUD); abnormalities in the context of an IUD are often ignored. | *Endometrial cells may appear irregular in the context of an [[intrauterine device]] (IUD); abnormalities in the context of an IUD are often ignored. | ||
**Cytology: cytoplasmic vacuolization, +/-multinucleation. | **Cytology: cytoplasmic vacuolization, +/-multinucleation. | ||
***May be [[signet ring cell carcinoma|signet ring cell]]-like. | ***May be [[signet ring cell carcinoma|signet ring cell]]-like. | ||
*The presence of endometrial cells on a Pap test on a woman >=40 years old (per Bethesda guidelines) should be noted in the pathology report<ref name=pmid15900572>{{cite journal |author=Thrall MJ, Kjeldahl KS, Savik K, Gulbahce HE, Pambuccian SE |title=Significance of benign endometrial cells in papanicolaou tests from women aged >=40 years |journal=Cancer |volume=105 |issue=4 |pages=207-16 |year=2005 |month=August |pmid=15900572 |doi=10.1002/cncr.21156 |url=}}</ref> - this prompts an endometrial biopsy. | *The presence of endometrial cells on a Pap test on a woman >=40 years old (per Bethesda guidelines) should be noted in the pathology report<ref name=pmid15900572>{{cite journal |author=Thrall MJ, Kjeldahl KS, Savik K, Gulbahce HE, Pambuccian SE |title=Significance of benign endometrial cells in papanicolaou tests from women aged >=40 years |journal=Cancer |volume=105 |issue=4 |pages=207-16 |year=2005 |month=August |pmid=15900572 |doi=10.1002/cncr.21156 |url=}}</ref> - this prompts an endometrial biopsy. | ||
** | **The practise of reporting ''benign'' endometrial cells in premenopausal women is ''not'' backed by evidence that demonstrates a significant benefit. | ||
Images: | ====Images==== | ||
<gallery> | |||
Image: Endometrial cells on Pap - 2 -- very high mag.jpg | Endometrial cells - very high mag. | |||
Image: Endometrial cells on Pap - 2 -- very high mag.gif | Endometrial cells - very high mag. | |||
Image: Endometrial cells on Pap - 2a -- very high mag.jpg | Endometrial cells - very high mag. | |||
Image: Endometrial cells on Pap - 2a -- very high mag.gif | Endometrial cells - very high mag. | |||
</gallery> | |||
<gallery> | |||
Image: Endometrial cells on Pap -- high mag.jpg | Endometrial cells - high mag. | |||
Image: Endometrial cells on Pap -- very high mag.jpg | Endometrial cells - very high mag. | |||
Image: Endometrial cells on Pap - alt -- very high mag.jpg | Endometrial cells - very high mag. | |||
</gallery> | |||
www: | |||
*[http://rapids001.techriver.net/nih/patientImages/1826.jpg Endometrial cells - double contour (techriver.net)]. | *[http://rapids001.techriver.net/nih/patientImages/1826.jpg Endometrial cells - double contour (techriver.net)]. | ||
*[http://nih.techriver.net/view.php?patientId=221 Endometrial cells with "exodus" pattern (techriver.net)]. | *[http://nih.techriver.net/view.php?patientId=221 Endometrial cells with "exodus" pattern (techriver.net)]. | ||
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===Navicular cells=== | ===Navicular cells=== | ||
{{Main|Navicular cell}} | |||
Features: | Features: | ||
*Intermediate cells with: | *Intermediate cells with: | ||
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*#Abundant cytoplasmic glycogen - central yellow. | *#Abundant cytoplasmic glycogen - central yellow. | ||
====Images==== | |||
<gallery> | |||
Image: Navicular cell -- very high mag.jpg | NC - very high mag. | |||
Image: Navicular cell - alt -- very high mag.jpg | NC - very high mag. | |||
Image: Navicular cell -- extremely high mag.jpg | NC - extremely high mag. | |||
Image: Navicular cells -- extremely high mag.jpg | NCs - extremely high mag. | |||
</gallery> | |||
==Glycogen halos versus HPV effect== | ==Glycogen halos versus HPV effect== | ||
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! DNA | ! DNA | ||
! Other | ! Other | ||
! Image | |||
|- | |- | ||
| [[Low-grade squamous intraepithelial lesion]] (LSIL) | | [[Low-grade squamous intraepithelial lesion]] (LSIL) | ||
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| Large nucleus (3-4X IC nuc. - see ''Note 1''), perinuclear clearing, nuc. membrane irregularities, chromatin clumping | | Large nucleus (3-4X IC nuc. - see ''Note 1''), perinuclear clearing, nuc. membrane irregularities, chromatin clumping | ||
| DDx: HSIL, reactive changes | | DDx: HSIL, reactive changes | ||
| [[Image:Low-grade squamous intraepithelial lesion - 3 -- very high mag.jpg| thumb|center|150px|LSIL (WC)]] | |||
|- | |- | ||
| [[High-grade squamous intraepithelial lesion]] (HSIL) | | [[High-grade squamous intraepithelial lesion]] (HSIL) | ||
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| Large nucleus (3-4X IC nuc. - see ''Note 1''), '''nuc. membrane irregularities, clumping of coarse chromatin, dark nuc. staining''', +/- small nucleoli | | Large nucleus (3-4X IC nuc. - see ''Note 1''), '''nuc. membrane irregularities, clumping of coarse chromatin, dark nuc. staining''', +/- small nucleoli | ||
| DDx: squamous metaplasia, atrophy with atypia, superficial endometrial cells | | DDx: squamous metaplasia, atrophy with atypia, superficial endometrial cells | ||
| [[Image:High-grade squamous intraepithelial lesion - 2 -- very high mag.jpg |thumb|center|150px|HSIL (WC)]] | |||
|- | |- | ||
| [[Atypical squamous cells of undetermined significance]] (ASC-US) | | [[Atypical squamous cells of undetermined significance]] (ASC-US) | ||
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| '''Moderately enlarged nucleus''' (~2.5-3.0X IC nuc.), minimal changes in nuclear membrane and chromatin | | '''Moderately enlarged nucleus''' (~2.5-3.0X IC nuc.), minimal changes in nuclear membrane and chromatin | ||
| DDx: LSIL, reactive changes | | DDx: LSIL, reactive changes | ||
| | |||
|- | |- | ||
| [[Atypical squamous cells, cannot exclude HSIL]] (ASC-H) | | [[Atypical squamous cells, cannot exclude HSIL]] (ASC-H) | ||
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| '''Moderately enlarged nucleus''' (~1.5-2.0X IC nuc.), minimal changes in nuclear membrane and chromatin | | '''Moderately enlarged nucleus''' (~1.5-2.0X IC nuc.), minimal changes in nuclear membrane and chromatin | ||
| DDx: HSIL, AIS | | DDx: HSIL, AIS | ||
| | |||
|- | |- | ||
| [[Atypical glandular cells]] (AGC) | | [[Atypical glandular cells]] (AGC) | ||
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| Moderately enlarged nucleus (~2X IC nuc.), '''nuc. membrane irregularities, chromatin clumping, dark nuc. staining''', nucleoli | | Moderately enlarged nucleus (~2X IC nuc.), '''nuc. membrane irregularities, chromatin clumping, dark nuc. staining''', nucleoli | ||
| DDx: AIS, HSIL | | DDx: AIS, HSIL | ||
| | |||
|- | |- | ||
| [[Adenocarcinoma in situ]] (AIS) | | [[Adenocarcinoma in situ]] (AIS) | ||
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| Large nucleus (>=2X IC nuc.), '''nuc. membrane irregularities, chromatin clumping, dark nuc. staining''', nucleoli (very common), pseudostratification (as in endocervical AIS) | | Large nucleus (>=2X IC nuc.), '''nuc. membrane irregularities, chromatin clumping, dark nuc. staining''', nucleoli (very common), pseudostratification (as in endocervical AIS) | ||
| DDx: AGC, HSIL | | DDx: AGC, HSIL | ||
| [[Image:Endocervical adenocarcinoma in situ - cyto -- very high mag.jpg|thumb|center|150px|Endocervical AIS (WC)]] | |||
|- | |- | ||
| Features of SCC (see ''Note 2'') | | Features of SCC (see ''Note 2'') | ||
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| Large NC ratio, '''nucleolus''', nuc. membrane irregularities, chromatin clumping | | Large NC ratio, '''nucleolus''', nuc. membrane irregularities, chromatin clumping | ||
| DDx: HSIL | | DDx: HSIL | ||
| | |||
|} | |} | ||
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| Hypermature (orangeophilic cell present) | | Hypermature (orangeophilic cell present) | ||
|- | |- | ||
| | | Images (example) | ||
| [ | | [[Image:High-grade_squamous_intraepithelial_lesion.jpg |thumb|center|150px| HSIL (WC)]] [[Image:High-grade squamous intraepithelial lesion - 4 -- very high mag.jpg| thumb|center|150px| HSIL (WC)]] | ||
| [ | | [[Image:Low-grade_squamous_intraepithelial_lesion.jpg |thumb|center|150px| LSIL (WC)]] [[Image:Low-grade_sil_and_endocx.jpg |thumb|center|150px| LSIL & endoCx (WC)]] | ||
|} | |} | ||
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| Sexually transmitted | | Sexually transmitted | ||
| <ref name=Ref_WMSP446>{{Ref WMSP|446}}</ref> | | <ref name=Ref_WMSP446>{{Ref WMSP|446}}</ref> | ||
| [ | | [[Image:Trichomonas_pap_test.jpg |thumb|150px|center|T. vaginalis - Pap stain (WC)]] [[Image:Trichomonas - Pap - 3 -- very high mag.jpg |thumb|150px|center|Trichomonas - Pap stain (WC)]] | ||
|- | |- | ||
| [[Gynecologic_cytopathology#Candida|Candidiasis]] | | [[Gynecologic_cytopathology#Candida|Candidiasis]] | ||
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| ? | | ? | ||
| ? | | ? | ||
| [ | | [[Image:Candida_pap_1.jpg|thumb|150px|center| Candida on Pap test (WC)]] | ||
|- | |- | ||
| [[Gynecologic_cytopathology#Herpes simplex virus|Herpes]] | | [[Gynecologic_cytopathology#Herpes simplex virus|Herpes]] | ||
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| Sexually transmitted | | Sexually transmitted | ||
| ? | | ? | ||
| [ | | [[Image:Herpes_simplex_virus_pap_test.jpg |thumb|center|150px| HSV (WC)]] [[Image:Herpes_simplex_virus_pap_test_2.jpg |thumb|center|150px| HSV (WC)]] | ||
|- | |- | ||
| [[Gynecologic_cytopathology#Actinomycetes|Actinomycetes]] | | [[Gynecologic_cytopathology#Actinomycetes|Actinomycetes]] | ||
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| '''Clusters of cocci in chains - hyphae-like appearance''' | | '''Clusters of cocci in chains - hyphae-like appearance''' | ||
| low power: pom-pom ''or'' fuzzy ball-like appearance | | low power: pom-pom ''or'' fuzzy ball-like appearance | ||
| Should prompt removal of IUD, if present. | | Should prompt removal of [[IUD]], if present. | ||
| <ref name=Ref_WMSP446>{{Ref WMSP|446}}</ref> | | <ref name=Ref_WMSP446>{{Ref WMSP|446}}</ref> | ||
| [http://www.gfmer.ch/selected_images_v2/detail_list.php?cat1=4&cat2=23&cat3=552&cat4=6&stype=n Actinomycetes (gfmer.ch)], [http://o.quizlet.com/Swjzk-aC7Ah8aYQmYzQ8Kg_m.jpg Actinomycetes (quizlet.com)] | | [http://www.gfmer.ch/selected_images_v2/detail_list.php?cat1=4&cat2=23&cat3=552&cat4=6&stype=n Actinomycetes (gfmer.ch)], [http://o.quizlet.com/Swjzk-aC7Ah8aYQmYzQ8Kg_m.jpg Actinomycetes (quizlet.com)] | ||
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| Fishy smell | | Fishy smell | ||
| ? | | ? | ||
| [ | | [[File:Vaginose-G15.jpg|thumb|center|150px|Bacterial vaginosis (WC)]] [http://www.atsu.edu/faculty/chamberlain/Website/lectures/lecture/image/clue2.jpg Clue cell (atsu.edu)] | ||
|} | |} | ||
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Image:Candida_pap_2.jpg | Candida on Pap test - example 2. (WC) | Image:Candida_pap_2.jpg | Candida on Pap test - example 2. (WC) | ||
</gallery> | </gallery> | ||
www | <gallery> | ||
Image: Candida - Pap test -- high mag.jpg | Candida - high mag. (WC) | |||
Image: Candida - Pap test -- very high mag.jpg | Candida - very high mag. (WC) | |||
</gallery> | |||
=====www===== | |||
*[http://www.flickr.com/photos/moorepix4u2c/1425271033/in/set-72157602113534479/ Candida on Pap test (flickr.com)]. | *[http://www.flickr.com/photos/moorepix4u2c/1425271033/in/set-72157602113534479/ Candida on Pap test (flickr.com)]. | ||
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*Sexually transmitted. | *Sexually transmitted. | ||
*Common. | *Common. | ||
*Occasionally found in [[urine cytology]] specimens.<ref>{{cite journal |authors=Doxtader EE, Elsheikh TM |title=Diagnosis of trichomoniasis in men by urine cytology |journal=Cancer Cytopathol |volume=125 |issue=1 |pages=55–59 |date=January 2017 |pmid=27636204 |doi=10.1002/cncy.21778 |url=}}</ref> | |||
===Cytopathology=== | ===Cytopathology=== | ||
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Image:Trichomonas_vaginalis_01.jpg | Trichomonas vaginalis - Giemsa stain. (WC) | Image:Trichomonas_vaginalis_01.jpg | Trichomonas vaginalis - Giemsa stain. (WC) | ||
</gallery> | </gallery> | ||
www | <gallery> | ||
Image: Trichomonas - Pap - 2 -- high mag.jpg | Trichomonas - high mag. | |||
Image: Trichomonas - Pap - 2 -- very high mag.jpg | Trichomonas - very high mag. | |||
</gallery> | |||
<gallery> | |||
Image: Trichomonas - Pap - 3 -- high mag.jpg | Trichomonas - high mag. | |||
Image: Trichomonas - Pap - 3 -- very high mag.jpg | Trichomonas - very high mag. | |||
</gallery> | |||
=====www===== | |||
*[http://nih.techriver.net/view.php?patientId=305 Trichomonas and Leptothrix (nih.techriver.net)]. | *[http://nih.techriver.net/view.php?patientId=305 Trichomonas and Leptothrix (nih.techriver.net)]. | ||
*[http://nih.techriver.net/view.php?patientId=325 Trichomonas and Leptothrix (nih.techriver.net)]. | *[http://nih.techriver.net/view.php?patientId=325 Trichomonas and Leptothrix (nih.techriver.net)]. | ||
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DDx: | DDx: | ||
*[[Reactive endocervical cells]] - may be multinucleated. | *[[Reactive endocervical cells]] - may be multinucleated. | ||
====Image==== | |||
<gallery> | |||
Image:Herpes simplex virus pap test.jpg | HSV on pap test. (WC) | |||
</gallery> | |||
==Actinomycetes== | ==Actinomycetes== | ||
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Image:Low-Grade_SIL_with_HPV_Effect.jpg | LSIL with HPV effect. (WC) | Image:Low-Grade_SIL_with_HPV_Effect.jpg | LSIL with HPV effect. (WC) | ||
Image:Low_grade_squamous_intraepithelial_lesion.jpg | LSIL. (WC) | Image:Low_grade_squamous_intraepithelial_lesion.jpg | LSIL. (WC) | ||
Image:ThinPrep_Pap_smear_HPV.jpeg | LSIL. (WC) | |||
</gallery> | </gallery> | ||
www: | www: | ||
*[http://www.flickr.com/photos/moorepix4u2c/1440144102/in/set-72157602113534479/ Possible LSIL (flickr.com)]. | *[http://www.flickr.com/photos/moorepix4u2c/1440144102/in/set-72157602113534479/ Possible LSIL (flickr.com)]. | ||
===Sign out=== | |||
<pre> | |||
Low grade squamous intraepithelial lesion (LSIL). | |||
</pre> | |||
====Cannot exclude HSIL==== | |||
<pre> | |||
At least low grade squamous intraepithelial lesion; CANNOT EXCLUDE high-grade squamous intraepithelial lesion. | |||
</pre> | |||
==High-grade squamous intraepithelial lesion== | ==High-grade squamous intraepithelial lesion== | ||
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<gallery> | <gallery> | ||
Image:High-Grade_SIL.jpg | HSIL. (WC) | Image:High-Grade_SIL.jpg | HSIL. (WC) | ||
Image:High-grade_squamous_intraepithelial_lesion.jpg | HSIL. (WC/Nephron) | Image:High-grade_squamous_intraepithelial_lesion.jpg | HSIL. (WC/Nephron) | ||
</gallery> | </gallery> | ||
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**Central nucleus. | **Central nucleus. | ||
Images: | ===Images=== | ||
www: | |||
*[http://www.cytology-asc.com/cec/endocx/endo4.html Feathering in adenocarcinoma (cytology-asc.com)]. | *[http://www.cytology-asc.com/cec/endocx/endo4.html Feathering in adenocarcinoma (cytology-asc.com)]. | ||
*[http://www.edupathonline.com/apps/blog/show/3692069-endocervical-ais AIS (edupathonline.com)]. | *[http://www.edupathonline.com/apps/blog/show/3692069-endocervical-ais AIS (edupathonline.com)]. | ||
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*Lower uterine segment epithelium<ref name=Ref_GP167>{{Ref GP|167}}</ref> - esp. [[proliferative phase endometrium]] - mitoses rare, NC ratio normal. | *Lower uterine segment epithelium<ref name=Ref_GP167>{{Ref GP|167}}</ref> - esp. [[proliferative phase endometrium]] - mitoses rare, NC ratio normal. | ||
Image: | ===Image=== | ||
<gallery> | |||
Image: Endocervical adenocarcinoma in situ - cyto -- high mag.jpg | ECAIS - high mag. (WC) | |||
Image: Endocervical adenocarcinoma in situ - cyto -- very high mag.jpg | ECAIS - very high mag. (WC) | |||
Image: Endocervical adenocarcinoma in situ - cyto -- very high mag.gif | ECAIS - very high mag. (WC) | |||
Image: Endocervical adenocarcinoma in situ - cyto - alt -- high mag.jpg | ECAIS - high mag. (WC) | |||
Image: Endocervical adenocarcinoma in situ - cyto - alt -- very high mag.jpg | ECAIS - very high mag. (WC) | |||
</gallery> | |||
<gallery> | |||
Image:Cervical_AIS,_ThinPrep.jpg | Endocervical AIS. (WC/euthman) | |||
</gallery> | |||
==Endometrial adenocarcinoma in situ== | ==Endometrial adenocarcinoma in situ== | ||
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*[[NILM]]. | *[[NILM]]. | ||
*[[LSIL]]. | *[[LSIL]]. | ||
===Images=== | |||
<gallery> | |||
Image: Atypical squamous cell of undetermined significance - 1 -- high mag.jpg | ASCUS - high mag. (WC) | |||
Image: Atypical squamous cell of undetermined significance - 1 -- very high mag.jpg | ASCUS - very high mag. (WC) | |||
Image: Atypical squamous cell of undetermined significance - 1a -- high mag.jpg | ASCUS - high mag. (WC) | |||
Image: Atypical squamous cell of undetermined significance - 1a -- very high mag.jpg | ASCUS - very high mag. (WC) | |||
Image: Atypical squamous cell of undetermined significance - 1b -- very high mag.jpg | ASCUS - very high mag. (WC) | |||
</gallery> | |||
===Sign out=== | |||
<pre> | |||
Atypical squamous cells of undetermined significance (ASC-US). | |||
</pre> | |||
==Atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion== | ==Atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion== | ||
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*[http://www.cytology-asc.com/cec/normal/index.htm Collection of usual benign findings on pap tests (cytology-asc.com)]. | *[http://www.cytology-asc.com/cec/normal/index.htm Collection of usual benign findings on pap tests (cytology-asc.com)]. | ||
*[http://nih.techriver.net/ Bethesda system atlas (techriver.net)]. | *[http://nih.techriver.net/ Bethesda system atlas (techriver.net)]. | ||
*[http://www.i2k.com/~suzanne/normalpap.htm Normal pap test - drawing (i2k.com)]. | |||
[[Category:Cytopathology]] | [[Category:Cytopathology]] |
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