Gynaecytology: Non-neoplastic findings II
By Lin Wai Fung
Photomicrograhs of the following cases can be found at
http://137.189.150.85/cytopathology/slide/cytotraining_gynae2.asp
(I) Specimen Adequacy
Unsatisfactory smears
1. Thick smear,
2. Obscured by heavy inflammatory cells and/or blood
3. Severe drying artefact, contaminated by lubricant jelly
4. Low cellularity
Ø Conventional: >10% of coverage (Minimum 8000 to 12000)
Ø LBP: >5000 (Autocyte: 8/hpf; ThinPrep: 4/hpf)
(II) Non-specific Reactive Changes
1. Common causes:
Infection
Trauma
2. Cellular changes
· Peri-nuclear halo
· Karyorrhexis
· Karyolysis
· Karyopyknosis
· Polychromasia
· Cytoplasmic vacuole
· Polymorphs increase
3. Infective agents
Normal flora: a mixture of bacteria including lactobacillus
· Bacterial infection
Need culture to confirm
· Trichomonas Vaginalis
Vaginal discharge
Usually assoicated with mixed bacterial infection
Pear-shaped
Cyanophilic
Eccentric elongated small nuclei
Eosinophilic cytoplasmic granules
· Candida species
Fungal infection
Common during pregnancy, taking oral contraceptives
Thick, white chessy discharge
Budding yeasts
Pseudohyphae (eosinophilic or gray brown)
Spearing of squamous cells
· Shift in flora suggestive of bacterial vaginoisis
Clue cells
Gardnerella vaginalis
Absence of lactobacilli
· Actinomyces
· IUCD
· Pelvic pain, irregular bleeding
· Clumps of filamentous organisms (cotton ball)
· Radial distribution or woolly appearance
(III) Specific cellular changes
Virus (Herpes Simplex infection)
Radiotherapy
Cytotoxic drugs
Herpes Simplex Infection
· Ground glass appearance
· Intranuclear viral particles
· Peripheral margination of chromatin
· Eosinophilic intracnuclear inclusion, surrounded by a halo
· Multinucleation (molded nuclei)
Reactive Cellular Changes Associated with Radiation
· Cell size increase, bizzare shape
· Enlarged nuclei with degeneration (nuclear vacuolization)
· Cytoplasmic vacuolization
· Polychromatic staining
Follicular cervicitis
· Lymphocytic reaction
· More common in postmenopausal woman
· Lympho follicle: mature and immature lymphocyte
· Tingible-body macrophages
Atrophic vaginitis
· Postmenopausal, thin epithelium, easily traumatized
· Background debris, inflammatory cells
· Parabasal cells with vary degree of degeneration. Some with eosinophilic cytoplasmic staining (keratin)
(IV) Epithelial Regeneration
· Tissue regenerate at the edge of a ucler
· Monolayer
· Some pleomorphic in nuclear size
· Nucleoli prominent
· Cohesive
· Streaming nuclei polarity
· Can involve mature squamous, metaplastic, and columnar epithelium
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