ASCP - Cytology - GYN

What is the squamous abnormality seen on this Pap smear?

HSIL (with features suspicious for invasion) - dispersed dysplastic cells with high N:C ratio + irregular nuclear membrane seen in background of granular debris suggestive of tumor diathesis

What is the diagnosis and recommended follow-up for this pap smear from a 21F

LSIL; repeat pap in 1 year - hyperchromatic, irregular nuclei, perinuclear halos

Retention period for cytopathology reports

10 years

Retention period for GYN cytopathology glass slides

5 years

Retention period for non-gyn glass cytopathology glass slides (including FNA)

10 years

HPV vaccine (Gardasil) offers protection against which HPV types

HPV 6, 11, 16, 18

Which HPV types cause vulvar condylomas

HPV 6, 11

Which HPV types cause 70% of cervical cancer

HPV 16, 18

Diagnosis from this Pap smear from 58F

Adenocarcinoma - vacuolated cytoplasm (some w PMNs) + enlarged nuclei w granular chromatin distribution + round/slightly irregular nuclear contours + variable prominent nucleoli arranged in small clusters displaying nuclear overlap; background w granular debris + inflammatory cells; degree of cytoplasmic vacuolization favors glandular origin (vs squamous)

45F pap smear - diagnosis

HSIL
Red circle - LSIL koilocytic change
Black circle - HSIL - cells can be smaller than LSIL, higher N:C ratio, nuclear hyperchromasia, nuclear irregularity

50F pap smear - diagnosis

LSIL - squamous cells w nuclear enlargement + nuclear contour irregularity + hyperchromasia + koilocytes (sharply demarcated cytoplasmic cavities, only seen in LSIL)

Which characteristic cell is seen in this pap smear

Pseudo-koilocytes - glycogen in squamous cells can have a yellow refractile/cracked appearance and can mimic koilocytic changes

Bethesda classification recommends reporting presence of endometrial cells in a pap smear starting at what age

45 years or older

35F pap smear - the finding is best classified as what

Atypical endocervical cells - glandular cells with columnar morphology in a “picket fence” arrangement w significant nuclear crowding and overlap; nuclear enlargement + pleomorphism + more hyperchromatic than surrounding intermediate squamous cells

Which cervical cancer type is most likely to arise from an HPV-independent mechanism?

Adenocarcinoma, gastric type

Which HPV strains is each cervical cancer associated with:

SCC

Adenocarcinoma, usual type

Small cell neuroendocrine carcinoma

SCC - HPV16

Adenocarcinoma, usual type - HPV16 and 18

Small cell neuroendocrine carcinoma - HPV18

Which two mutations are associated with cervical adenocarcinoma, gastric type?

STK11 and p53

Pap smear: the cells are most consistent with

HSV

Pap smear: Which HPV subtype is most likely associated with this lesion

HPV18 - HSIL

What is the clinical finding depicted in the image typically associated with?

Diabetes mellitus - Candida infection

ASC guidelines for cervical cancer screening (start, end, methods)

Start: 25 years-old with HPV test

End: 65 years-old with a series of negative prior paps

HPV test q5 years if all tests normal from 25-65

HPV + pap co-test q5 years

Pap alone q3 years

What % of women will develop a persistent infection (>2 years) after an acute high-risk HPV infection?

10%

Pap smear: The lesion on the image is best classified as:

Adenocarcinoma, NOS - 3-dimensional groups with overlapping cells with high N:C ratio, nuclear pleomorphism w 3D structure (specific for adenocarcinoma as SILs don’t show this degree of 3D architecture)

Nucleoli are most commonly seen in squamous cells in which condition?

Reactive changes

A.nal Pap: how would you report?

Negative for intraepithelial lesion or malignancy - bland columnar epithelium with mucinous features (rectal columnar cells). Background shows benign intermediate type squamous cells and anucleate squames.

A patient w no prior abnormal cervical cancer screening undergoes primary HPV testing, which is +HPV16. What is the next step?

Reflex Pap test

Pap test from 55F - what is underlying cause?

Hypoestrogenic state

Cohesive groups of parabasal-type squamous cells > squamous cell atrophy

What is an FDA-approved method for detection of hrHPV?

Hybrid capture assay

How/where is the presence of glandular cells s/p hysterectomy reported?

Reported under “other non-neoplastic findings” - most likely mucinous/goblet cell metaplasia, adenosis of mesenchymal cells, or prolapsed fallopian tube

How/where is the presence of atypical/malignant glandular cells s/p hysterectomy reported?

“Epithelial cell abnormalities, glandular cell”

45F, non-pregnant; what is the recommended f/u for this glandular cell abnormality seen on cervical Pap?

Endometrial sampling in conjunction with colposcopy and endocervical sampling

Crowding, nuclear overlap, increased N:C ratio, mild variation in nuclear size/shape, mild hypochromasia and chromatin irregularity » atypical glandular cells (AGC)

The above is recommended in patients 35+ with AGC or AIS or non-pregnant pts <35 at increased risk of endometrial neoplasia

What condition commonly show intracytoplasmic PMNs on Pap cytology?

Endometrial adenocarcinoma

Vacuolated cytoplasm w “bag of neutrophils”

45F routine Pap test - what is the finding?

Follicular cervicitis

Aggregate of somewhat loose and irregularly shaped lymphoid cells

41F hx exposure to DES in utero vaginal Pap test - what is the diagnosis?

Vaginal adenosis

Sheet of evenly spaced glandular cells w even chromatin, well-defined cell borders in a background of bland squamous cells (vaginal pap should only see squams)

DES exposure increases risk of clear cell adenocarcinoma » regular vaginal pap tests