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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
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Thick smear,
Obscured by heavy inflammatory cells and/or blood
Severe drying artefact, contaminated by lubricant jelly
Low cellularity
Conventional: >10% of coverage (Minimum 8000 to 12000)
LBP: >5000 (Autocyte: 8/hpf; ThinPrep: 4/hpf)
(II) Non-specific Reactive Changes
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Common causes:
Infection
Trauma
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Cellular changes
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Peri-nuclear halo
Karyorrhexis
Karyolysis
Karyopyknosis
Polychromasia
Cytoplasmic vacuole
Polymorphs increase
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Infective agents
Normal flora: a mixture of bacteria including lactobacillus
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Bacterial infection
Need culture to confirm
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Trichomonas Vaginalis
Vaginal discharge
Usually assoicated with mixed bacterial infection
Pear-shaped
Cyanophilic
Eccentric elongated small nuclei
Eosinophilic cytoplasmic granules
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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
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Shift in flora suggestive of bacterial vaginoisis
Clue cells
Gardnerella vaginalis
Absence of lactobacilli
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Actinomyces
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IUCD
Pelvic pain, irregular bleeding
Clumps of filamentous organisms (cotton ball)
Radial distribution or woolly appearance
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(III) Specific cellular changes
Virus (Herpes Simplex infection)
Radiotherapy
Cytotoxic drugs
Herpes Simplex Infection
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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
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Cell size increase, bizzare shape
Enlarged nuclei with degeneration (nuclear vacuolization)
Cytoplasmic vacuolization
Polychromatic staining
Follicular cervicitis
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Lymphocytic reaction
More common in postmenopausal woman
Lympho follicle: mature and immature lymphocyte
Tingible-body macrophages
Atrophic vaginitis
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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
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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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