histopath - exfoliative cytology

Cytology

Focuses on individual cells or a small group of cells

Biopsy

Tissue specimen

Exfoliative Cytology

-Examination of cells shed from the body or organ surfaces

-Examination of cells desquamated from epithelial surfaces

-Examines cells spontaneously shed/physically removed from epithelial and mucous membranes

Gynecologic Specimens

-Commonly used

-Usuallyobtained from a cervicovaginal smear

-Procedure: “PAP Smear” or “PAP Test”

Non-Gynecologic Specimens

-Sometimes used

-Other tissues

Pros of Cytology

-Less invasive with little to no recovery time

-Faster turnaround time (TAT)

-High specificity and sensitivity – varies depending on the case

-Useful for screening programs

-Readily performed in lowresource settings

Cons of Cytology

-Limited tissue architectural info

-Potential false negatives

-Less accurate in detecting cancer

-Sampling limitations

-Limited material for comprehensive tests

-Limited info on tumor grade and stage

Gregorios Papanicolaou

-He discovered cellular changes (cancer) in the cervix

-Developed the PAP TEST/SMEAR

-Cervical cancer is the 2nd leading cancer in the Philippines

Pap Test/Smear

Examines cells from cervical tissue smear

Human Papillomavirus (HPV) infection

#1 cause of cervical cancer

specificity of 90-95%

determines the chance that lesion is cancerous

sensitivity of 50-70%

determines the chance that diagnosis is missed

Cervical Cancer

-Irregular maturation of cells

-Compromised basement membrane

Low-Grade Squamous Intraepithelial Lesion

-2/3 of epithelium is affected, nuclear irregularities

-Infected with HPV

High-Grade Squamous Intraepithelial Lesion

-Similar to cervical cancer

-Infected with HPV

-Intact basement membrane

-More irregular nuclei, scant cytoplasm

Superficial Cells

 Most mature (topmost layer)

 Small, pyknotic nucleus

 Keratin and cytoplasm is stained pink

 Large, polygonal cells

Intermediate Cells

 Mostly found in smears from pregnant women

 Larger cells

 Not pyknotic

Parabasal Cells

 Immature squamous cells

 Common at the transformation zone

 Round/oval shape

 Smaller than the superficial and intermediate cells, less cytoplasm

 Mostly present in specimens from women with low estrogen levels, very thin tissue, and in post-menopausal women

 Rarely seen

Squamous Metaplastic Cell

 Many (if not most) begin at the transformation zone

 Sampled from the transformation zone

 Aka transformation zone

 Midway of parabasal and squamous cells

Endocervical cells

 Endocervical lining

 Mucin in cytoplasm

 Picket fence/honeycomb appearance

Endometrial cells

 Found during day 6 to day 10 of the menstrual cycle

 Commonly found in specimens from menstruating women

 If this is present in the smear beyond menopause, it must be reported

Low-Grade Squamous Intraepithelial Lesion

 Has enlarged, irregular nuclei

 Pale halo around nuclei

Squamous Cell Carcinoma

 Dirty background

 Highly pleomorphic, atypical nuclei

 “tadpole” cells

 Abnormal keratinization

Atypical Squamous Cells of Undetermined Significance

 Not normal, not abnormal (cancer) cells

 May be due to other causes

3 M’s detecting infection

 Multinucleation

 Molding of Nuclear

 Margination of Nucleus

Candidiasis

 Pseudohyphae, budding yeast forms

 “shish kebab” appearance

 Cheese-like exudate on cervix

 Yeast infection

Trichomoniasis

 Pear-shaped, oval/round

 Cyanophilic

 Pale, vesicular, and eccentric nucleus

 Sometimes have flagella

 Strawberry cervix, itching/burning sensation

True

T/F

 Acceptance/Rejection Criteria

• Patient ID must be accurate

True

T/F

Smeared slides immediately immersed in 95% Ethanol as fixative

Spay Fixatives

What is the alternative for 95% Alcohol as Fixative

Papanicolaou Staining

95% Ethanol → Deionized Water → Hematoxylin (nuclear stain) → Blueing Bath → Orange G→ Eosin G5 (Polychromatic stain) → 100% Ethanol → Xylene

Modified Papanicolaou Staining

95% Ethanol → Deionized Water → Hematoxylin (nuclear stain) → Neoclear Solution → Acid Alcohol → Propanol → Orange G → Polychrome Stain

Papanicolaou Stain

 Provides/stains clearer details

 Stains Gynecologic/Non-gynecologic specimens

 Cannot stain unfixed smear

Romanowsky Stain

 Stains unfixed smears

 Less detailed cells

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