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Difference between revisions of "Gynecologic cytopathology"
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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. | ||
=Preparation= | |||
The standard for Pap test is the Papanicolaou stain. It is described in the ''[[staining]]'' article and discussed in the context of cytopathology in the ''[[cytopathology]]'' article. | The standard for Pap test is the Papanicolaou stain. It is described in the ''[[staining]]'' article and discussed in the context of cytopathology in the ''[[cytopathology]]'' article. | ||
=Slide marking conventions= | |||
Conventions are important for facilitating communication between various team members. They are discussed in the ''[[cytopathology]]'' article. | Conventions are important for facilitating communication between various team members. They are discussed in the ''[[cytopathology]]'' article. | ||
=Normal cells= | |||
Squamous cell types:<ref>Half-day. 10 November 2008.</ref> | Squamous cell types:<ref>Half-day. 10 November 2008.</ref> | ||
#Intermediate cells: | #Intermediate cells: | ||
| Line 35: | Line 35: | ||
*Nucleus approximately the size of an intermediate cell nucleus. | *Nucleus approximately the size of an intermediate cell nucleus. | ||
==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> | ||
*Progesterone - makes the Pap test blue... more intermediate cells. | *Progesterone - makes the Pap test blue... more intermediate cells. | ||
| Line 42: | Line 42: | ||
*Older patients... more estrogen, glycogen. | *Older patients... more estrogen, glycogen. | ||
==Unusual non-malignant cells== | |||
#Clue cells: | #Clue cells: | ||
#*Purple squamous cell; squamous cell covered with bacteria. | #*Purple squamous cell; squamous cell covered with bacteria. | ||
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|} | |} | ||
=Gynecologic pathology in tables= | |||
==Normal cells== | |||
{| class="wikitable" | {| class="wikitable" | ||
! Cell | ! Cell | ||
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*If ''only'' normal cells are present the diagnosis is ''negative for intraepithelial lesion and malignancy'' (NILM). | *If ''only'' normal cells are present the diagnosis is ''negative for intraepithelial lesion and malignancy'' (NILM). | ||
==Abnormal cells== | |||
{| class="wikitable" | {| class="wikitable" | ||
! Cell | ! Cell | ||
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*By definition, it is not possible to diagnose [[squamous cell carcinoma]] (SCC) on a pap test as one cannot demonstrate stromal invasion. | *By definition, it is not possible to diagnose [[squamous cell carcinoma]] (SCC) on a pap test as one cannot demonstrate stromal invasion. | ||
===HSIL versus LSIL=== | |||
{| class="wikitable" | {| class="wikitable" | ||
! | ! | ||
| Line 292: | Line 292: | ||
**LSIL cells: classically the size of IC. | **LSIL cells: classically the size of IC. | ||
==Infectious organisms== | |||
{| class="wikitable" | {| class="wikitable" | ||
! Disease | ! Disease | ||
| Line 352: | Line 352: | ||
*Usually not reported. | *Usually not reported. | ||
=Adequacy of specimens= | |||
There is a generally accepted standard for cervical (liquid-based) cytology specimens:<ref>UHN PCY50001.08 P.10.</ref> | There is a generally accepted standard for cervical (liquid-based) cytology specimens:<ref>UHN PCY50001.08 P.10.</ref> | ||
*>5000 squamous cells/slide, if no abnormality is present. | *>5000 squamous cells/slide, if no abnormality is present. | ||
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*Young nulliparous. | *Young nulliparous. | ||
=Specific entities - infectious= | |||
==Candida== | ==Candida== | ||
{{Main|Candidiasis}} | {{Main|Candidiasis}} | ||
| Line 455: | Line 456: | ||
*''Mycete'' = fungus.<ref>URL: [http://en.wiktionary.org/wiki/-mycete#English http://en.wiktionary.org/wiki/-mycete#English]. Accessed on: 14 September 2011.</ref> | *''Mycete'' = fungus.<ref>URL: [http://en.wiktionary.org/wiki/-mycete#English http://en.wiktionary.org/wiki/-mycete#English]. Accessed on: 14 September 2011.</ref> | ||
=Squamous intraepithelial lesion= | |||
*Abbreviated ''SIL''. | |||
General: | General: | ||
*The nucleus makes it SIL. | *The nucleus makes it SIL. | ||
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Image: | Image: | ||
*[http://commons.wikimedia.org/wiki/File:Squamous_cell_carcinoma_in_the_cervix,_pap_stain.jpg HSIL with features suggestive of invasion (WC)] | *[http://commons.wikimedia.org/wiki/File:Squamous_cell_carcinoma_in_the_cervix,_pap_stain.jpg HSIL with features suggestive of invasion (WC)] | ||
=Glandular lesions= | |||
==Adenocarcinoma in situ== | |||
*Abbreviated ''AIS''. | |||
''Adenocarcinoma in situ'' on Pap test is classically divided into: | |||
*Endocervical. | |||
*Uterine. | |||
*Extra-uterine. | |||
===Adenocarcinoma vs. squamous carcinoma=== | |||
*"Feathering" - seen in adenocarcinoma<ref>URL: [http://www.cytology-asc.com/cec/endocx/ http://www.cytology-asc.com/cec/endocx/]. Accessed on: 13 September 2011.</ref> more commonly on smears.<ref name=pmid18335553>{{Cite journal | last1 = Belsley | first1 = NA. | last2 = Tambouret | first2 = RH. | last3 = Misdraji | first3 = J. | last4 = Muzikansky | first4 = A. | last5 = Russell | first5 = DK. | last6 = Wilbur | first6 = DC. | title = Cytologic features of endocervical glandular lesions: comparison of SurePath, ThinPrep, and conventional smear specimen preparations. | journal = Diagn Cytopathol | volume = 36 | issue = 4 | pages = 232-7 | month = Apr | year = 2008 | doi = 10.1002/dc.20782 | PMID = 18335553 | URL=http://onlinelibrary.wiley.com/doi/10.1002/dc.20782/pdf }}</ref> | |||
*"Birdtails" - seen on liquid preparations. | |||
Images: | |||
*[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)]. | |||
==Adenocarcinoma of the endocervix== | |||
===General=== | |||
*Associated with [[HPV]]. | |||
===Cytopathology=== | |||
Features: | |||
*Cluster of small cells. | |||
**Cells approximately the size of a lymphocyte ~ 10 micrometres. | |||
*Nucleoli - '''key feature''' (may be subtle). | |||
Negatives: | |||
*Lack cilia. | |||
**Cilia on cells is a feature of benignancy and should sway the pathologist away from adenocarcinoma. | |||
Image: | |||
*[http://commons.wikimedia.org/wiki/File:Cervical_AIS,_ThinPrep.jpg AIS endocervix (wikimedia.org)]. | |||
=Waffle categories= | |||
*Like all [[waffle diagnosis|waffle diagnoses]], these should be used sparingly. | |||
==Atypical squamous cells of undetermined significance== | ==Atypical squamous cells of undetermined significance== | ||
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*Adenocarcinoma in situ. | *Adenocarcinoma in situ. | ||
== | =Weird stuff= | ||
==Carpet beetle larval parts== | ==Carpet beetle larval parts== | ||
===General=== | ===General=== | ||
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*[http://screening.iarc.fr/atlascyto_detail.php?flag=0&lang=1&Id=cyt17099&cat=E2f1 Radiation changes (iarc.fr)]. | *[http://screening.iarc.fr/atlascyto_detail.php?flag=0&lang=1&Id=cyt17099&cat=E2f1 Radiation changes (iarc.fr)]. | ||
=See also= | |||
*[[Cytopathology]]. | *[[Cytopathology]]. | ||
*[[Basics]]. | *[[Basics]]. | ||
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*[[Uterus]]. | *[[Uterus]]. | ||
=References= | |||
{{reflist|2}} | {{reflist|2}} | ||
=External links= | |||
*[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)]. | ||
[[Category:Cytopathology]] | [[Category:Cytopathology]] | ||