Difference between revisions of "Gynecologic cytopathology"

#Clue cells:

#*Purple squamous cell; squamous cell covered with 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>

#Squamous metaplastic cells:

#*"Dense" cytoplasm.

#*Nucleus ~2X the size of an intermediate cell nucleus.

#*Nucleoli.

#*Note:  

#**Squamous metaplastic cells have a similar appearance to parabasal cells; they cannot be differentiated on morphologic grounds.

#**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.

#Endometrial cells:<ref>SM. 14 January 2010.</ref>

#*Cluster of cells with a well-defined border that is bilayered, i.e. a clump of (epithelioid) stromal cells surrounded by (flatted) glandular cells. Classically described as a cluster with a ''double contour''; known as ''exodus pattern''.<ref>URL: [http://nih.techriver.net/view.php?patientId=78 http://nih.techriver.net/view.php?patientId=78]. Accessed on: 31 March 2012.</ref>

#*Scant cytoplasm.

#*Chromatin clumping.

#*Raisin-like nuclei - approximately the size of an intermediate cell nucleus.

#**Nuclei can be considered normal if nucleus less than 2X the size of an intermediate cell nucleus.

#*Notes:  

#**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.

#****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.

#***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.