Pathology

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 squamous or glandular
lesions. More advanced lesions show nuclear enlarge- ment, hyperchromasia, along with high N:C ratio, coarse chromatin and thickened nuclear membrane.

Dysplastic squamous cells are of 3 types:

1. Intermediate dysplastic cells seen in LGSIL.

2. Parabasal dysplastic cells resemble closely parabasal or metaplastic cells in size and shape but have atypical nuclei. Cells lie singly or in clusters or strings or files. These cells are seen in HGSIL or cancer.
3. Small parabasal and basal dysplastic cells. These cells indicate more aggressive lesion. Cells lie scattered loose or in loose clusters or in syncitia.

Dysplastic Endocervical Cells

Dysplastic endocervical cells are uncommon and difficult to recognize. They may be seen in HGSIL or early adenocarcinoma, and are seen as columnar cells with enlarged hyperchromatic or pale nuclei and large nucleoli.

Koilocytes

Koilocytes are mature squamous cells of intermediate type with abnormal enlarged hyperchromatic nuclei that are smudged, homogenous, and are surrounded

by sharply demarcated perinuclear halo. Sometimes binucleation/multinucleation may be seen. Koilocytes are characteristic of HPV infection and are seen with
both low-risk and high-risk types of HPV infection and form the criteria for the diagnosis of LGSIL.

Leukoplakia

White discoloration or abnormal keratinization of cervical surface is called leukoplakia. This is because of keratinization of superficial cells which are seen as anucleate, olygonal, transparent cells with pink or yellow cytoplasm. Brown cytoplasmic granules may be present and ghost nuclei are seen.

Parakeratosis/Pseudoparakeratosis

Also presents as white patch clinically. Small nucleated squmaous cells present in sheets. Cause is not known. But such cells can be seen in HPV infection, low grade and high-grade squamous lesions.

CERVICAL CYTOLOGY REPORTING

Terminologies/Classifications Papanicolaou, the founder of contemporary diagnostic cytology, proposed a classification in 1943 (Table 16.1), but it did not reflect current understanding of cervical neoplasia, classes had no equivalents in histopathologic terminology, and did not reliably communicate clinically relevant information. Over the years, different systems and terminologies evolved to overcome the deficiencies of the previous ones. WHO and CIN classifications had the drawbacks of lack of reproduci- bility in assigning lesions to different categories and the biological behavior of the lesions did not correspond with the cytological categories. Terminology for reporting cervicovaginal smears was further standar- dized by The Bethesda System (TBS) in 1988. Since the goal of any screening program is to detect the precursor lesions and treat them early in order to halt their progress to frank cancer, it is of utmost importance for the clinicians and the pathologists to be familiar with the terminology, morphology and management protocols of the precancerous lesions.

Table 16.1: Evolution of reporting system precancerous
lesions of cervix

Papanicolaou!s classification

Class I: Absence of atypical or abnormal cells

Class II: Atypical cytology but no evidence of malignancy

Class III: Cytology suggestive of but not conclusive for malignancy

Class IV: Cytology strongly suggestive of malignancy

Class V: Cytology conclusive for malignancy

WHO classification proposed by Reagen and Patten in 1962:

Mild dysplasia
Moderate dysplasia
Severe dysplasia
Carcinoma in situ
CIN classification: Proposed by Richart in 1967 to further
improve upon the concept of disease continuum.

CINI
CIN II
CINIII
The Bethesda system: Standardized in 1988, revised twice there
after current system developed in 2001