Basic Cytology Principles

BASIC CYTOLOGY PRINCIPLES

FEATURES TO BE EVALUATED IN A PAP TEST Adequacy Presence of abnormal cells Number and distribution of abnormal cells Relationship between cells Cell size and shape Nuclear size and shape Nuclear changes and nucleoli N/C ratio Cytoplasmic features Background or diathesis

Features of preneoplastic and neoplastic cells Abnormality in shape and size of cells Variation in shape and size of cells Increase in nuclear size Increase in nuclear membrane irregularity Hyperchromasia Prominence of nucleoli and irregularity in shape thereof Thickening of nuclear membrane

Features of preneoplastic and neoplastic cells(2) Increase in N/C ratio Cytoplasm scanty mitosis:increased number and abnormal forms Noncohesiveness Abnormal polarity

Common causes of falsenegative pap test Atypical endocervical cells Crowded cell aggregates Cytolysis Intermediate cells with nuclear enlargement Keratinized cells Metaplastic-like cells Necrotic debris Artifacts (obscuring

Common causes of falsepositive Pap test Atrophic smear Atypical endocervical and endometrial cells Multinucleated cells Parakeratosis Perinuclear halo in nonkoilocytes Pseudoparakeratosis Reactive/repair Squamous metaplasia Tubal metaplasia

Differential diagnosis of cells with “naked” nuclei Aytolysis of cytoplasm in menopause Cytolysis Degeneration,especially of endocervix Reserve cells in tamoxifen treatment

Differential diagnosis of giant multinucleated cells Histiocytes

Radiation

Atrophy

Syncytiotrophoblast

Folic acid deficiency Squamous carcinoma Tissue repair Viral infection

Choriocarcinoma

granuloma

Uterine sarcoma

Cytological features of “dark cell clusters” Crowded with piling up of cells Hyperchromatic overlapping nuclei Anisonucleosis Scant cytoplasm Increased N/C ratio Mitosis present Often difficult to determine whether squamous or glandular

Differential diagnosis of dark cell clusters Reactive endocervical cells Tubal metaplasia

Atypical squamous cells cannot exclude HGSIL

atrophy:smooth nuclear membrane

HGSIL nuclear membrane irregular

Benign endometrial cells

Adenocarcinoma in situ Enocervical or endometrial

Differential diagnosis of small cells Lymphocytes in chronic lymphocytic cervitis Degenerated cells Endometrial cells Histiocytes Reserve cells Tamoxifen cells Squamous cell carcinoma small cell type Small cell anaplastic carcinoma

Differential diagnosis of cells with macronucleoli Repair,regenerative Decidua ,or reactive Adenocarcinoma squamous cells Metastatic tumor Reactive endocervical cells Nonkeratinizing squamous Viral inclusions carcinoma Treatment effect pemphigus

Differential diagnosis of adenocarcinoma Viral infections

Histiocytes

Endocervical cells,benign and atypical

Metaplasia

Endometrial cells,benign and atypical Endometritis

Vaginal adenosis Intrauterine device Microglandular hyperplasia Metastatic tumor

adenocarcinoma