Cytopathology

Cytopathology

Feb. 21. 2016


Forcible removed cytopathology: Gynecological Cytology Pap smear, used as screening tool, to detect precancerous cervical lesions. Vaginal smear Bronchial wash & Bronchial brush.

The Pap Smear

PAP smear: named afterDr. George Papanicolaou (1883-1962)
Women (1920) Hormonal cycles Pathological conditions (1928)

Cervical histology

Squamous Epithelium Vagina and outer ectocervix 4 cell layers Well-glycogenated
Columnar Epithelium Endo-cervical Single layer arranged in folds Mucin producing (not true glands)

Vaginal Speculum

Squamo-columnar JunctionTransformation Zone

Majority of cervical cancers and precursor lesions arise in immature squamous metaplasia, i.e. the leading edge of the squamo-columnar junction

Gynecological Cytology – Pap Smear

Pap Smear

Gynecological cytopathology: For reporting of cervico- vaginal cytology, Bethesda system (1991) is used.

The Bethesda classification system for cervical cytopathology (Pap Smear). Normal and inflammatory cellular changes Squamous cell abnormalities Atypical Squamous Cells of Uncertain Significance (ASC, ASCUS) Squamous Intraepithelial Lesions (SIL) and Squamous Carcinoma (SCCa), HPV lesion Glandular abnormalities (AGC, AGUS, Ca) Atypical Glands of Uncertain Significance (AGUS) and Adenocarcinoma FNA: Ovary and Female Genital Tract

Cytologic screening for cervical cancer

Cervical cancer screening has decreased morbidity and mortality Deaths from cervical cancer decreased from 26,000 to less than 5,000 between 1941 and 1997

Pap smears are not perfect

For a high grade lesion, the sensitivity of a single pap smear is only 60-80% Estimated false negative rate is 30-50% Requires adequate specimen collection Requires adequate cytological review Requires adequate patient and physician follow-up

When to screen

HPV Risk factors for cervical dysplasia Early onset of sexual activity Multiple sexual partners Tobacco Oral contraceptives
Who to screen?

Screening frequency

Yearly until three consecutive normal pap smears, then may decrease frequency to every three years Annual screening for high-risk women is highly recommend.

When to stop routine screening

Age 65 and “adequate recent screening” Three consecutive normal pap smears No abnormal pap smears in last 10 yearsNo history of cervical or uterine cancerHysterectomy

Normal Cervix

Squamous Epithelium

Endocervix

Normal smear

Non-Epithelial Cells

sperms
Lymphocytes
Polymorphs

Endometrial Cells

Squamous Metaplasia
Central ectocervix and proximal endocervical canal Replacement of columnar cells by squamous epithelium Progressive and stimulated by Acidic environment with onset of puberty Estrogen causing eversion of endocervix
Squamous metaplasia
Normal

Ectropion / Erosion

At puberty & pregnancy the endocervical cells are pushed out to lie on the ectocervix
Normal
Ectropion

Wide Ectropion

Normal Cervix

Metaplastic Cells

Normal squamous cells

Squamous metaplastic cells

Squamous cell carcinoma

Koilocytes - HPV