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CYTOLOGY-Educational Notes

Invasive endocervical adenocarcinoma

Columnar cells possess cytoplasmic vacuoles, nuclear enlargement, eccentric nuclei, large eosinophilic nucleoli, multiple nucleoli and papillary spherical clusters. There is overlapping of nuclei and clusters may  have a lumen (rosette or glands). Such cells are seen in adenocarcinoma, squamous cell carcinoma and HGSIL.

It is difficult to differentiate between dysplastic and malignant endocervical cells. However, in adenocar- cinoma,

CYTOLOGY-Bethesda System


establish an effective communication with the referring Bethesda system (Table 16.2) considered cervico- vaginal smear as a medical consultation and stressed it to be reported in clear, unambiguous language so as to consultant and facilitate cyto-histologic correlation.

Table 16.2: The 2001 Bethesda system for reporting cervical cytologic diagnosis

I.    Specimen type

Indicate conventional smear (Pap smear) vs. liquid-based

I3. Specimen adequacy

        Satisfactory for evaluation

(presence/absence of endocervical/transformation zone component and any other

CYTOLOGY- Normal Pap Smear

Normal Pap Smear
In child bearing age, predominantly superficial cells and intermediate cells are seen (Fig. 16.13). Parabasal cells are seen only occasionally in normal smears but are seen in certain situations which will be described later. Basal cells are seen rarely. Endocervical cells form an important constituent of the Pap smear. Neutrophils may be present.

In menopausal women, cytology findings are affected by withdrawal of estrogenic activity. In early meno-pause, 

Cytology- Interpretation Result

Interpretation/ Result

Negative for Intraepithelial Lesion/Malignancy
In TBS 2001, cervical cytologic specimens that contain no epithelial abnormalities are listed under the category “negative for intraepitheliallesion or malignancy.” This includes the previous categories of “within normal limits” and “benign cellular changes”. The presence of organisms and other non-neoplastic findings are

Cytology- High Grade Intraepithelial Lesion

Koilocytes, if present, signify LGSIL. A few dyskaryotic parabasal cells may be seen. Background is generally clear, and there is no inflammation.

High Grade Intraepithelial Lesion (HSIL)

The category of HSIL includes moderate dysplasia, severe dysplasia, and carcinoma in situ, or CIN 2, 3. HSIL lesions are characterized by the presence of marked nuclear abnormalities. Cells may lie as streaks- trapped in mucus (Fig. 16.30). Abnormal shapes like cancer cells

Cytology- Cervical Cytology Reporting

Abnormal Findings

The term” dyskaryosis” meaning’ abnormal nucleus’ is used to describe cells with nuclear abnormalities and maturity of cytoplasm and is still used in UK. The term” dysplasia” is also used to describe the same, mainly in USA. Both these terms can be used interchangeably.

Dysplastic (Dyskoryotic) Cells

Dysplastic (dyskaryotic) cells show slight to moderate nuclear abnormalities (enlargement and hyperchro- masia) in well differentiated

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