Difference between revisions of "Gynecologic cytopathology"

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Gynecologic cytopathology (view source)

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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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Image: Benign endocervical epithelium -- high mag.jpg | Endocervical epithelium - high mag. (WC)
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 -- 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>
<gallery>
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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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***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====
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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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*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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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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**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===
*[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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*[[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==
Michael
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