Cervical cytology: Difference between revisions
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{{Top | <noinclude>{{Top | ||
|author1=[[User:Mikael Häggström|Mikael Häggström]] | |author1=[[User:Mikael Häggström|Mikael Häggström]] | ||
|author2= | |author2= | ||
}} | }} | ||
'''[[Cytology]]''' of the '''[[cervix]]''':</noinclude> | |||
==Clinical information== | ==Clinical information== | ||
It is not necessary to look through more than readily available reports from previous cervical cytologies. | It is not necessary to look through more than readily available reports from previous cervical cytologies. | ||
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Eventually you will be able to tell when most cases are adequate or inadequate without performing a detailed calculation. | Eventually you will be able to tell when most cases are adequate or inadequate without performing a detailed calculation. | ||
=== | ===Transformation zone presence=== | ||
[[File:Cytology of cervical squamous metaplasia.png|thumb|290px|'''Squamous metaplasia''' also counts as endocervix. Typical features are annotated. Pap stain.]] | [[File:Cytology of cervical squamous metaplasia.png|thumb|290px|'''Squamous metaplasia''' also counts as endocervix. Typical features are annotated. Pap stain.]] | ||
State whether the endocervical/transformation zone is present or absent. Count an endocervical component as present if there are 10 or more endocervical or squamous metaplastic cells.<ref name="CibasDucatman">{{cite book | last=Cibas | first=Edmund S. | last2=Ducatman | first2=Barbara S. | title=Cytology : diagnostic principles and clinical correlates | publication-place=Philadelphia, PA | date=2021 | isbn=978-0-323-63637-7 | oclc=1138033641 | page=9}}</ref> | State whether the endocervical/transformation zone is present or absent. Count an endocervical component as present if there are 10 or more endocervical or squamous metaplastic cells.<ref name="CibasDucatman">{{cite book | last=Cibas | first=Edmund S. | last2=Ducatman | first2=Barbara S. | title=Cytology : diagnostic principles and clinical correlates | publication-place=Philadelphia, PA | date=2021 | isbn=978-0-323-63637-7 | oclc=1138033641 | page=9}}</ref> | ||
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==Main conditions to exclude or confirm== | ==Main conditions to exclude or confirm== | ||
'''Squamous atypia''', seen mainly as cells with increased nucleus/cytoplasm ratio, nuclear hyperchromasia and irregular nuclear outline. | '''Squamous atypia''', seen mainly as cells with increased nucleus/cytoplasm ratio, nuclear hyperchromasia and irregular nuclear outline. | ||
If the slide has been previously marked by a cytotechnologist or other previewer, grade the marked cells first. Then, you only need to look for worse findings on the rest of the slide. | |||
<gallery mode=packed heights=220> | <gallery mode=packed heights=220> | ||
File:Atipia de células escamosas (ASCUS, ASC) (9392112063).jpg|'''Atypical squamous cells of undetermined significance (ASCUS)''', with only few slightly atypical cells | File:Atipia de células escamosas (ASCUS, ASC) (9392112063).jpg|'''Atypical squamous cells of undetermined significance (ASCUS)''', with only few slightly atypical cells | ||
File:Cytopathology of low-grade squamous intraepithelial lesion (LSIL).png|'''Low-grade squamous intraepithelial lesion (LSIL)''', here compared to an unremarkable intermediate squamous cell. | File:Cytopathology of low-grade squamous intraepithelial lesion (LSIL).png|'''Low-grade squamous intraepithelial lesion (LSIL)''', here compared to an unremarkable intermediate squamous cell. | ||
File:Cytology of High-Grade SIL, ThinPrep.jpg|'''High-grade squamous intraepithelial lesion (HSIL)''', showing even more prominent features, and decreased cytoplasm, causing a high nuclear/cytoplasmic ratio. | File:Cytology of High-Grade SIL, ThinPrep.jpg|'''High-grade squamous intraepithelial lesion (HSIL)''', showing even more prominent features, and decreased cytoplasm, causing a high nuclear/cytoplasmic ratio. | ||
File:ThinPrep Pap smear HPV.jpeg|''' | File:Cytopathology of keratinizing squamous cell carcinoma.png|Cytopathology of '''squamous cell carcinoma, keratinizing variant''', with typical features.<ref>- Image annotated by Mikael Häggström<br>- Reference for entries: {{cite web|url=https://www.pathologyoutlines.com/topic/cervixSCC.html|title=Cervix - Squamous cell carcinoma and variants|author=Gulisa Turashvili, M.D., Ph.D.|website=Pathology Outlines}} Last author update: 24 September 2020. Last staff update: 4 April 2022.<br>- Source image from National Cancer Institute (Public Domain)</ref> Pap stain. | ||
File:ThinPrep Pap smear HPV.jpeg|LSIL and '''changes consistent with human papillomavirus''' (HPV), which is the presence of koilocytes, which show perinuclear cavitation, binucleation, nuclear hyperchromasia, and nuclear enlargement. | |||
</gallery> | |||
[[File:Cytopathology of nonkeratinizing squamous cell carcinoma.png|thumb|350px|Cytopathology of squamous cell carcinoma, nonkeratinizing variant, with typical features.<ref>- Image annotated by Mikael Häggström<br>- Reference for entries: {{cite web|url=https://www.pathologyoutlines.com/topic/cervixSCC.html|title=Cervix - Squamous cell carcinoma and variants|author=Gulisa Turashvili, M.D., Ph.D.|website=Pathology Outlines}} Last author update: 24 September 2020. Last staff update: 4 April 2022.<br>- Source image by Ravi Mehrotra, Anurag Gupta, Mamta Singh and Rahela Ibrahim (Creative Commons Attribution 2.0 Generic license.)</ref> Pap stain. Necrotic debris (dirty background) is a feature that generally makes a HSIL case "suspicious for invasive squamous cell carcinoma".<ref name="pmid34345247">{{cite journal| author=Alrajjal A, Pansare V, Choudhury MSR, Khan MYA, Shidham VB| title=Squamous intraepithelial lesions (SIL: LSIL, HSIL, ASCUS, ASC-H, LSIL-H) of Uterine Cervix and Bethesda System. | journal=Cytojournal | year= 2021 | volume= 18 | issue= | pages= 16 | pmid=34345247 | doi=10.25259/Cytojournal_24_2021 | pmc=8326095 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34345247 }} </ref> In contrast to the more distinct keratinizing variant, these findings are overall less specific, and most can be seen in other cancers such as [[adenocarcinoma]] as well (which, however, tends to have fine chromatin)<ref>{{cite web|url=https://www.pathologyoutlines.com/topic/lungtumoradenocarcinoma.html|title=Adenocarcinoma overview|website=Pathology Outlines|author=Authors: Caroline I.M. Underwood, M.D., Alexis Musick, B.S., Carolyn Glass, M.D., Ph.D.}} Last staff update: 19 July 2022</ref>]] | |||
<gallery mode=packed heights=220> | |||
File:Glycogenated cervical squamous cells.tif|Distinguish HPV-changes from '''glycogenated''' squamous cells. Glycogen confers a yellowish color to the cytoplasm. It can look like the perinuclear cavitation of koilocytes, but has more rounded edges. | |||
</gallery> | </gallery> | ||
===Clinical implication=== | |||
If you are uncertain of the degree of dysplasia, it can be useful to look up how much difference it will likely make for the management of the patient. You may make an Internet search for the management of abnormal cervical screening in your region (such as [https://app.asccp.org/ The ASCCP tool] for management in the US). A change from close follow-up to colposcopy is not that big of a deal, but if one of the alternatives will lead to a diagnostic excision, make sure that the case is looked upon by commensurate expertise. | |||
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:Negative for intraepithelial lesion or malignancy (NILM). | :Negative for intraepithelial lesion or malignancy (NILM). | ||
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