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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 1. 2. 3. 4. 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 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 1 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 2 (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 3