Difference between revisions of "Gynecologic cytopathology"

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Gynecologic cytopathology (view source)

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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.


Image:
===Images===
*[http://commons.wikimedia.org/wiki/File:Low-grade_sil_and_endocx.jpg Endocervical cells and LSIL (WC)].
<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>
Image:Low-grade_sil_and_endocx.jpg | Endocervical cells and LSIL. (WC)
</gallery>


==Mix of cells==
==Mix of cells==
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===Clue cells===
===Clue cells===
Features:
Features:
*Purple squamous cell; squamous cell covered with bacteria.
*Purple squamous cell covered with rod-shaped bacteria.
*Associated with ''bacterial vaginosis'' - which is caused by ''Gardnerella vaginalis''.<ref name="pmid3493202">{{cite journal |author=Scott TG, Smyth CJ, Keane CT |title=In vitro adhesiveness and biotype of Gardnerella vaginalis strains in relation to the occurrence of clue cells in vaginal discharges |journal=Genitourinary medicine |volume=63 |issue=1 |pages=47–53 |year=1987 |month=February |pmid=3493202 |pmc=1194007 |doi= |url=}}</ref>
 
**''Gardnerella vaginalis'' is a rod gram variable.<ref>{{cite journal |author=Taylor-Robinson D |title=The bacteriology of Gardnerella vaginalis |journal=Scand J Urol Nephrol Suppl |volume=86 |issue= |pages=41–55 |year=1984 |pmid=6399409 |doi= |url=}}</ref>
Notes:
*The cytologic finding of ''[[bacterial vaginosis]]''.


Image:
Image:
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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 - '''key feature'''.
**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.
**In my humble opinion, reporting benign endometrial cells in premenopausal women is ''not'' evidence-based practise; the practise is driven by lawsuit-paranoia in the USA.
**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.


Notes:  
====Images====
*Cells often described as ''boat-shaped''.
<gallery>
*May resemble the lenses of ''coke bottle glasses''.
Image: Navicular cell -- very high mag.jpg | NC - very high mag.
*Associated with: [[pregnancy]], contraception with medroxyprogesterone acetate (Depo-provera).<ref name=pmid10945902>{{Cite journal  | last1 = Volk | first1 = EE. | last2 = Jax | first2 = JM. | last3 = Kuntzman | first3 = TJ. | title = Cytologic findings in cervical smears in patients using intramuscular medroxyprogesterone acetate (Depo-provera) for contraception. | journal = Diagn Cytopathol | volume = 23 | issue = 3 | pages = 161-4 | month = Sep | year = 2000 | doi =  | PMID = 10945902 }}</ref>
Image: Navicular cell - alt -- very high mag.jpg | NC - very high mag.
Image: Navicular cell -- extremely high mag.jpg | NC - extremely high mag.


Images:
Image: Navicular cells -- extremely high mag.jpg | NCs - extremely high mag.
*[http://www.flickr.com/photos/28287204@N02/3083659626/ Navicular cells (flickr.com)].
</gallery>
*[http://www.flickr.com/photos/28287204@N02/3112533994/ Cluster of navicular cells (flickr.com)].


==Glycogen halos versus HPV effect==
==Glycogen halos versus HPV effect==
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| Irregular
| Irregular
| '''Blue, abundant'''
| '''Blue, abundant'''
| Small nucleus (~ size of PMN), no [[nucleolus]]
| Small nucleus (~ size of [[PMN]]), no [[nucleolus]]
| -
| -
|-  
|-  
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| Dense, dark blue
| Dense, dark blue
| 2X IC nucleus, '''nucleolus''', no membrane irreg., no chromatin changes
| 2X IC nucleus, '''nucleolus''', no membrane irreg., no chromatin changes
| DDx: HSIL, basal cell
| DDx: [[HSIL]], basal cell
|-
|-
| Endometrial cell
| Endometrial cell
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| vacuolated, usu. abundant
| vacuolated, usu. abundant
| '''Normal NC ratio''', enlarged nucleus, no nuclear membrane irregularies, +/-multinucleation
| '''Normal NC ratio''', enlarged nucleus, no nuclear membrane irregularies, +/-multinucleation
| DDx: LSIL, vitamin B12 def.
| DDx: [[LSIL]], vitamin B12 def.
|}
|}
Note:
Note:
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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
|
|-
|-
| [[Adenocarinoma in situ]] (AIS)
| [[Adenocarcinoma in situ]] (AIS)
| groups; '''rosette formation'''
| groups; '''rosette formation'''
| Usually well-circumscribed
| Usually well-circumscribed
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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)
|-
|-
| Image (example)
| Images (example)
| [http://commons.wikimedia.org/w/index.php?title=File:High-grade_squamous_intraepithelial_lesion.jpg HSIL (WC)]
| [[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)]]
| [http://commons.wikimedia.org/w/index.php?title=File:Low-grade_squamous_intraepithelial_lesion.jpg LSIL (WC)], [http://commons.wikimedia.org/wiki/File:Low-grade_sil_and_endocx.jpg LSIL & endoCx (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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==Infectious organisms==
==Infectious organisms==
{| class="wikitable"
{| class="wikitable sortable"
! Disease
! Disease
! Organism
! Organism
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| Sexually transmitted
| Sexually transmitted
| <ref name=Ref_WMSP446>{{Ref WMSP|446}}</ref>
| <ref name=Ref_WMSP446>{{Ref WMSP|446}}</ref>
| [http://commons.wikimedia.org/wiki/File:Trichomonas_pap_test.jpg T. vaginalis - Pap stain (WC)], [http://commons.wikimedia.org/wiki/File:Pap_test_trichomonas.JPG Trichomonas - Pap stain (WC)]
| [[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)]]
|-
|-
| Candidiasis
| [[Gynecologic_cytopathology#Candida|Candidiasis]]
| Candida albicans
| Candida albicans
| [[Fungi]]
| [[Fungi]]
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| ?
| ?
| ?
| ?
| [http://commons.wikimedia.org/w/index.php?title=File:Candida_pap_1.jpg Candida on Pap test (WC)]
| [[Image:Candida_pap_1.jpg|thumb|150px|center| Candida on Pap test (WC)]]
|-
|-
| Herpes
| [[Gynecologic_cytopathology#Herpes simplex virus|Herpes]]
| [[Herpes simplex virus]] (HSV 1 - less commonly, HSV 2 - more commonly)
| [[Herpes simplex virus]] (HSV 1 - less commonly, HSV 2 - more commonly)
| [[Virus]]
| [[Virus]]
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| Sexually transmitted
| Sexually transmitted
| ?
| ?
| [http://commons.wikimedia.org/wiki/File:Herpes_simplex_virus_pap_test.jpg HSV (WC)],[http://commons.wikimedia.org/wiki/File:Herpes_simplex_virus_pap_test_2.jpg HSV (WC)], [http://www.virology.org/sbpgphoto2.html Herpes simplex virus - surgical (virology.org)]
| [[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)]]
|-
|-
| Actinomycetes
| [[Gynecologic_cytopathology#Actinomycetes|Actinomycetes]]
| Actinomycetes
| Actinomycetes
| Gram-positive bacteria  
| Gram-positive bacteria  
| '''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)]
|-
|-
| Bacterial vaginosis (see ''Note 1'')
| [[Bacterial vaginosis]] (see ''Note 1'')
| Gardnerella vaginalis
| Gardnerella vaginalis
| Gram-variable rod
| Gram-variable rod
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| Fishy smell
| Fishy smell
| ?
| ?
| [http://commons.wikimedia.org/wiki/File:Vaginose-G15.jpg Bacterial vaginosis (WC)], [http://www.atsu.edu/faculty/chamberlain/Website/lectures/lecture/image/clue2.jpg Clue cell (atsu.edu)]
| [[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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*Presence should be noted in the pathology report.
*Presence should be noted in the pathology report.


Images:
====Images====
<gallery>
Image:Candida_pap_1.jpg | Candida on Pap test - example 1. (WC)
Image:Candida_pap_2.jpg | Candida on Pap test - example 2. (WC)
</gallery>
<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)].
*[http://commons.wikimedia.org/w/index.php?title=File:Candida_pap_1.jpg Candida on Pap test - example 1 (WC)].
*[http://commons.wikimedia.org/w/index.php?title=File:Candida_pap_2.jpg Candida on Pap test - example 2 (WC)].


==Trichomoniasis==
==Trichomoniasis==
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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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**Size: ~0.5 x 20 micrometres.
**Size: ~0.5 x 20 micrometres.


Images:
====Images====
*[http://commons.wikimedia.org/wiki/File:Trichomonas_pap_test.jpg T. vaginalis - Pap stain (WC)].
<gallery>
*[http://commons.wikimedia.org/wiki/File:Pap_test_trichomonas.JPG T. vaginalis - Pap stain (WC)].
Image:Trichomonas_pap_test.jpg | T. vaginalis - Pap stain. (WC)
*[http://commons.wikimedia.org/wiki/File:Trichomonas_vaginalis_01.jpg Trichomonas vaginalis - Giemsa stain (WC)].
Image:Pap_test_trichomonas.JPG | T. vaginalis - Pap stain. (WC)
Image:Trichomonas_vaginalis_01.jpg | Trichomonas vaginalis - Giemsa stain. (WC)
</gallery>
<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)].
Line 472: Line 533:
#Early: Large "ground-glass" nuclei - nuclei with hazy & uniformly dull appearance.
#Early: Large "ground-glass" nuclei - nuclei with hazy & uniformly dull appearance.
#Late: multi-nucleation with moulding of nuclei and nuclear inclusions surrounded by a clear halo.
#Late: multi-nucleation with moulding of nuclei and nuclear inclusions surrounded by a clear halo.
DDx:
*[[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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DDx - sulfur granule:<ref name=asc_cockle>URL: [http://www.cytology-asc.com/cec/normal/index.htm#cockle http://www.cytology-asc.com/cec/normal/index.htm#cockle]. Accessed on: 10 April 2012.</ref>
DDx - sulfur granule:<ref name=asc_cockle>URL: [http://www.cytology-asc.com/cec/normal/index.htm#cockle http://www.cytology-asc.com/cec/normal/index.htm#cockle]. Accessed on: 10 April 2012.</ref>
*Hematoidin (cockleburr) crystal - radiating crystal, refractile, classically golden-brown.
*Hematoidin (cockleburr) crystal - radiating crystal, refractile, classically golden-brown.
==Bacterial vaginosis==
===General===
*Benign.
*Very common.
*Classically associated with ''Gardnerella vaginalis''.<ref name=pmid3493202>{{cite journal |author=Scott TG, Smyth CJ, Keane CT |title=In vitro adhesiveness and biotype of Gardnerella vaginalis strains in relation to the occurrence of clue cells in vaginal discharges |journal=Genitourinary medicine |volume=63 |issue=1 |pages=47–53 |year=1987 |month=February |pmid=3493202 |pmc=1194007 |doi= |url=}}</ref><ref name=pmid22082330>{{Cite journal  | last1 = Polatti | first1 = F. | title = Bacterial vaginosis, Atopobium vaginae and nifuratel. | journal = Curr Clin Pharmacol | volume = 7 | issue = 1 | pages = 36-40 | month = Feb | year = 2012 | doi =  | PMID = 22082330 }}</ref>
Clinical:
*Fishy odor.
Treatment:
*Antibiotics (metronidazole or clindamycin).<ref name=pmid22082330/>
===Cytopathology===
Features:
*Purple squamous cell covered with rod-shaped micro-organisms.
Image:
*[http://www.atsu.edu/faculty/chamberlain/Website/lectures/lecture/image/clue2.jpg Clue cell (atsu.edu)].
===Stains===
*Gram stain +ve/-ve.
**''Gardnerella vaginalis'' is a gram variable rod.<ref name=pmid6399409>{{cite journal |author=Taylor-Robinson D |title=The bacteriology of Gardnerella vaginalis |journal=Scand J Urol Nephrol Suppl |volume=86 |issue= |pages=41–55 |year=1984 |pmid=6399409 |doi= |url=}}</ref>
===Sign out===
*Usually not reported.


=Squamous intraepithelial lesions=
=Squamous intraepithelial lesions=
Line 504: Line 599:
==Low-grade squamous intraepithelial lesion==
==Low-grade squamous intraepithelial lesion==
*Abbreviated '''LSIL'''.
*Abbreviated '''LSIL'''.
{{Main|Low-grade squamous intraepithelial lesion}}
===General===
===General===
*Usually regress, i.e. will disappear on their own.
*Usually regress, i.e. will disappear on their own.
*Low inter-rater concordance.<ref name=pmid22007754>{{Cite journal  | last1 = Bigras | first1 = G. | last2 = Wilson | first2 = J. | last3 = Russell | first3 = L. | last4 = Johnson | first4 = G. | last5 = Morel | first5 = D. | last6 = Saddik | first6 = M. | title = Interobserver concordance in the assessment of features used for the diagnosis of cervical atypical squamous cells and squamous intraepithelial lesions (ASC-US, ASC-H, LSIL and HSIL). | journal = Cytopathology | volume = 24 | issue = 1 | pages = 44-51 | month = Feb | year = 2013 | doi = 10.1111/j.1365-2303.2011.00930.x | PMID = 22007754 }}</ref>


===Cytopathology===
===Cytopathology===
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* In the context of exams: 2 of criteria 1-3 is enough to call LSIL.<ref>Chan, S. 26 April 2012.</ref>
* In the context of exams: 2 of criteria 1-3 is enough to call LSIL.<ref>Chan, S. 26 April 2012.</ref>


Images:
====Images====
<gallery>
Image:Low-Grade_SIL_with_HPV_Effect.jpg | LSIL with HPV effect. (WC)
Image:Low_grade_squamous_intraepithelial_lesion.jpg | LSIL. (WC)
Image:ThinPrep_Pap_smear_HPV.jpeg | LSIL. (WC)
</gallery>
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)].
*[http://commons.wikimedia.org/wiki/File:Low-Grade_SIL_with_HPV_Effect.jpg LSIL with HPV effect (WC)].
 
===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==
*Abbreviated '''HSIL'''.
*Abbreviated '''HSIL'''.
{{Main|Squamous intraepithelial lesion of the uterine cervix}}
===General===
===General===
*Often progress to cervical cancer.
*Often progress to [[cervical cancer]].


===Cytopathology===
===Cytopathology===
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*[[Squamous carcinoma]].
*[[Squamous carcinoma]].


Image:
====Images====
*[http://commons.wikimedia.org/wiki/File:High-Grade_SIL.jpg HSIL (WC)].
<gallery>
*[http://commons.wikimedia.org/wiki/File:ThinPrep_Pap_smear_HPV.jpeg HSIL (WC)].
Image:High-Grade_SIL.jpg | HSIL. (WC)
Image:High-grade_squamous_intraepithelial_lesion.jpg | HSIL. (WC/Nephron)
</gallery>


===Squamous cell carcinoma===
===Squamous cell carcinoma===
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Note:
Note:
*Nucleoli DDx:
*Nucleoli DDx:
**Reactive changes.
**[[Reactive squamous epithelium of the uterine cervix|Reactive changes]].
**Glandular lesions (adenocarcinoma in situ, atypical glandular cells).
**Glandular lesions ([[adenocarcinoma in situ]], atypical glandular cells).


Image:
Image:
Line 592: Line 707:
**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)].


==Endocervical adenocarcinoma in situ==
==Endocervical adenocarcinoma in situ==
{{Main|Endocervical adenocarcinoma in situ}}
*[[AKA]] ''adenocarcinoma in situ of the endocervix''.
*[[AKA]] ''adenocarcinoma in situ of the endocervix''.
===General===
===General===
Line 621: Line 738:
*[[Endometrial adenocarcinoma in situ]].
*[[Endometrial adenocarcinoma in situ]].
*Metastatic [[colorectal adenocarcinoma]].
*Metastatic [[colorectal adenocarcinoma]].
*Lower uterine segment epithelium<ref name=Ref_GP167>{{Ref GP|167}}</ref> - esp. [[proliferative phase endometrium]] - mitoses rare, NC ratio normal.


Image:  
===Image===
*[http://commons.wikimedia.org/wiki/File:Cervical_AIS,_ThinPrep.jpg AIS endocervix (wikimedia.org)].
<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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*Abbreviated ''ASC-US'' or ''ASCUS''.
*Abbreviated ''ASC-US'' or ''ASCUS''.
===General===
===General===
*This is a [[waffle diagnosis|waffle category]] that should be used very rarely.
*This is a [[waffle diagnosis|waffle category]] that should be used sparingly.
*May be an indication for HPV testing.
**The ASCUS/LSIL rate is used as a [[quality]] measure<ref name=pmid10757336>{{Cite journal  | last1 = Duggan | first1 = MA. | title = Cytologic and histologic diagnosis and significance of controversial squamous lesions of the uterine cervix. | journal = Mod Pathol | volume = 13 | issue = 3 | pages = 252-60 | month = Mar | year = 2000 | doi = 10.1038/modpathol.3880046 | PMID = 10757336 | URL = http://www.nature.com/modpathol/journal/v13/n3/full/3880046a.html }}</ref> - the specific ratios are dependent on how they specimens are processed.<ref>URL: [http://www.cap.org/apps/docs/proficiency_testing/CYP07600.pdf http://www.cap.org/apps/docs/proficiency_testing/CYP07600.pdf]. Accessed on: 2 May 2012.</ref>
*Diagnosis may be an indication for HPV testing.


===Cytology===
===Cytology===
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Note:
Note:
*One should '''not''' see [[nucleoli]].
*One should '''not''' see [[nucleoli]].
**Nucleoli are seen in [[reactive changes]] and [[squamous cell carcinoma of the uterine cervix]].
*The IC nucleus is ~ 8 μm.<ref>URL: [http://www.curran.pwp.blueyonder.co.uk/cytology.htm http://www.curran.pwp.blueyonder.co.uk/cytology.htm]. Accessed on: 5 November 2012.</ref>


DDx:
DDx:
*[[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==
Line 684: Line 829:
*Architecture: cell clusters or rare single cells.
*Architecture: cell clusters or rare single cells.


DDx:
DDx:<ref name=pmid16686950>{{Cite journal  | last1 = Chivukula | first1 = M. | last2 = Shidham | first2 = VB. | title = ASC-H in Pap test--definitive categorization of cytomorphological spectrum. | journal = Cytojournal | volume = 3 | issue =  | pages = 14 | month =  | year = 2006 | doi = 10.1186/1742-6413-3-14 | PMID = 16686950 | PMC = 1524979 | URL = http://www.ncbi.nlm.nih.gov/pmc/articles/pmid/16686950/?tool=pubmed }}</ref>
*[[HSIL]].
*[[HSIL]].
*[[NILM]].
*[[NILM]] - atrophy, parabasal cells.
*[[LSIL]].


==Atypical glandular cells==
==Atypical glandular cells==
Line 771: Line 917:


==Radiation changes in cervical cytology==
==Radiation changes in cervical cytology==
{{Main|Radiation changes}}
===General===
===General===
*Radiation is used to treat cervical cancer.
*Radiation is used to treat cervical cancer.
Line 850: Line 997:
*[[Cervix]].
*[[Cervix]].
*[[Uterus]].
*[[Uterus]].
*[[Gynecologic pathology]].


=References=
=References=
Line 857: Line 1,005:
*[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]]
Michael
48,470

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