Cervical Cytology Morphology Flashcards
(134 cards)
1
Q
In cytology what is the main stain used to identify and visualise cells?
A
The Papanicolaou stain.
2
Q
Describe the Papanicolaou stain including its constituents.
A
The Papanicolaou stain is a combination of cytoplasmic and nuclear stains which allows the identification of various types of epithelial cells.
The cytoplasmic stains are eosin, light green and orange G.
Eosin stains superficial cells pink, light green stains less mature cells blue/green, orange G stains keratinised cells orange.
The nuclear stain is haematoxylin and this stains the nuclei blue/black.
3
Q
What are the cytoplasmic stains contained in the Papanicolaou stain?
A
Eosin, light green and orange G.
4
Q
What are the nuclear stains contained in the Papanicolaou stain?
A
Haematoxylin.
5
Q
What does eosin stain?
A
Eosin stains superficial cells pink.
6
Q
What does light green stain?
A
Light green stains less mature cells blue/green.
7
Q
What does orange G stain?
A
Orange G stains keratinised cells orange.
8
Q
What does haematoxylin stain?
A
Haematoxylin stains nuclei blue/black.
9
Q
How can epithelial cells be identified? How do we distinguish normal and abnormal epithelial cells?
A
Epithelial cells can be identified by their morphology and staining properties.
The distinction between normal and abnormal epithelial cells is based primarily on nuclear morphology.
The following features may be used to distinguish normal from abnormal cells:
Nuclear size, Nucleocytoplasmic ratio, Chromatin pattern (granular/smooth), Nuclear shape (round/oval/irregular), Intensity of nuclear staining (in abnormal cells you tend to get darker staining).
10
Q
Name the 4 layers of the squamous epithelium.
A
1) . Basal layer (1 cell thick)
2) . Parabasal layer (4-5 cells thick)
3) . Intermediate layer (stain blue)
4) . Superficial layer ( oldest cells, stain pink)
11
Q
What hormone are superficial cells under the influence of?
A
Oestrogen. Increased oestrogen leads to increased superficial cell production.
12
Q
What hormone are intermediate cells under the influence of?
A
Progesterone. Increased progesterone leads to increased levels of intermediate cells.
13
Q
Describe superficial cells.
A
Superficial cells are angular polygonal cells that have an eosinophilic (pink) cytoplasm and a low N/C ratio (small nuclei).
14
Q
Describe intermediate cells.
A
Polygonal cells with a cyanophilic (blue/green) cytoplasm.
Have a round/oval nucleus with a low N/C ratio and fine vesicular chromatin. The nucleus tends to be slightly longer than in superficial cells.
15
Q
Describe parabasal cells.
A
Parabasal cells are round/oval cells that tend to be 12-30um in diameter.
They have a dense green/blue cytoplasm and a round/oval nucleus occupying half the cell.
They have evenly distributed vesicular chromatin.
16
Q
What 2 types of cells is the glandular epithelium made up of?
A
Endocervical epithelium and endometrial epithelium.
17
Q
Describe the glandular endocervical epithelium.
A
It is a simple columnar epithelium. A single layer of endocervical epithelial cells with all the nuclei at the basement membrane.
It secretes mucin which acts as a lubricant and a protective barrier.
Movement of mucin is assisted by ciliated cells.
18
Q
Describe the endocervical cells of the endocervical epithelium.
A
Endocervical cells are columnar cells with cilia occasionally visible at one end.
They have a finely vacuolated cyanophilic cytoplasm and an oval nucleus with fine chromatin.
Occasionally they may have more than one nucleus.
They may be seen arranged in a honeycomb shape or in palisades.
19
Q
Describe the glandular endometrial epithelium.
A
The epithelial lining of the uterus is called the endometrium. It consists of a single layer of cuboidal cells called endometrial cells.
20
Q
Describe endometrial cells.
A
Endometrial cells are normally present up to day 12 of the cycle.
They are round/oval cells that are 8-10um in diameter and have little cytoplasm. They have crumpled, hyperchromatic nuclei.
They are seen as dense tight blue clusters. They may be observed as a dense core of stromal cells and a periphery of larger epithelial cells often referred to as a top hat formation or a wreath. They are tight groups of disorganised cells.
21
Q
What is metaplasia?
A
Metaplasia is the transformation of one cell type to another.
22
Q
Give an example of where metaplasia takes place in the cervical canal.
A
In the cervix the endocervical glandular epithelium transforms into squamous epithelium when it is exposed to the acidic pH of the vagina.
This is the region of the cervix that is most susceptible to metaplastic change and it is termed the transformation zone (TZ).
The transformation zone is the area where precancerous and cancerous lesions of the cervix usually arise. Cervical samples must be taken from this area.
Metaplastic cells have cyanophilic cytoplasm. They have cytoplasmic projections giving rise to the term spider cells. Their nuclei are vesicular, and variable in size with small nucleoli. Morphology can depend on the degree of maturation.
23
Q
What influence do hormone levels have on the cervical epithelium after menopause?
A
After the menopause oestrogen levels decrease. This induces atrophy of the cervical epithelium which leads to a drop in the number of superficial cells and an increase in the numbers of parabasal cells. This is known as the post menopausal atrophic pattern.
24
Q
What hormonally influenced changes take place in the cervical epithelium after birth?
A
The changes that take place after birth depend on the levels of oestrogen and progesterone which depend on whether or not the mother breast feeds.
During breast feeding the lack of oestrogen causes atrophy and the sample consists mainly of parabasal and intermediate cells. This is known as the lactating pattern.
25
What non-epithelial elements may be found at the cervical epithelium?
Macrophages,
Giant histiocytes,
Neutrophils,
Red Blood Cells.
26
Describe the appearance of macrophages.
They vary in size. The cytoplasm may contain vacuoles or is lace-like. The nucleus is often kidney bean shaped and located off centre.
27
Describe the appearance of giant histiocytes.
They are multinucleated large cells. They are often present in post menopausal women.
28
Describe the appearance of polymorphs (neutrophils).
They group together in bunches, indicate infection and can be observed in the blood.
29
How might red blood cells appear on a slide?
Not singular, they get bunched together by sample processing.
30
What two types of cells is the cervical epithelium comprised of?
Squamous epithelium and glandular epithelium cells.
31
What kinds of injury may inflammation be a response to?
Physical (heat, cold, irradiation)
Chemical (acids, alkalis, drugs)
Microbiological (bacteria, fungi, viruses, protazoa)
32
What four things may make up an inflammatory response?
Redness, swelling, pain, heat.
33
You would likely see an increase in polymorphonuclear neutrophils in what stage of cervicitis?
Acute phase
34
You would likely see an increase of lymphocytes and plasma cells in what stage of cervicitis?
Chronic phase.
35
Describe degenerative inflammatory changes that may occur in epithelial cells in response to inflammation.
Degenerative changes will affect the nucleus and the cytoplasm.
The nucleus may show enlargement, multinucleation, vacuolation, condensation of chromatin at nuclear membrane, fragmentation, shrinkage and nuclear lysis.
The cytoplasm may display vacuolation, ingestion of leukocytes, cytolysis, peri nuclear halo and eosinophila.
36
Describe regenerative inflammatory changes that may occur in epithelial cells in response to inflammation.
The nucleus may show enlargement, multinucleation and unlike in degenerative changes - hyperchromasia, evenly distributed chromatin clumping and enlarged nucleoli.
The cytoplasm may display vacuolation and unlike in degenerative changes - increase in the N:C, sheet formation of repair cells, hyper/para-keratosis.
37
List the six most common infections associated with cervical inflammatory changes.
```
Candida albicans,
Trachomonas vaginalis,
Bacterial vaginosis,
Actinomyces,
Herpes,
HPV
```
38
Why can it be difficult to distinguish inflammation from neoplasia cytologically?
The morphological features overlap.
39
List some feature of inflammatory changes to cervical cells.
```
Nuclear enlargement,
Peri-nuclear halos,
Increased amount and injestion of polymorphs,
Vacuolation of cytoplasm,
Cell degeneration,
Cell death
```
40
Describe the appearance of candida on smears.
Candida is a fungi. It appears as tangled filaments, often with hyphae. Cells can form a kebab skewer shape. It can also exist in a population of red spores (dormant stage).
41
What are the symptoms of Candida albicans infection?
Thick white discharge,
Itching and redness of the vagina,
Pain during intercourse,
May have no symptoms.
42
What is the treatment for Candida albicans infection?
Anti fungal treatments including medications and creams.
If no symptoms are apparent then no treatment may be necessary.
43
Describe the cytologically appearance of herpes simplex virus.
In cytology shows smooth chromatin and ground glass appeared.
May see multinucleated cells which often appear moulded together.
44
What are the symptoms of Herpes?
None in the latent phase.
In active state 90% of patients experience cold sores, blistering, pain, itching, dysuria, discharge, enlarged lymph nodes, fever, headache and muscle pains.
45
What is the treatment for heroes simplex virus?
HSV cannot be completely cleared up but can be inhibited by antivirals that interfere with viral replication.
Painkillers and anaesthetic ointments ease symptoms.
46
How does HPV appear cytologically?
There are more than 100 different subtypes of HPV. Some low risk and associated with warts and low grade CIN, others high risk and associated with high grade CIN.
On a cervical sample HPV can cause multinucleation, enlarged nuclei, coarse chromatin an dyskeratosis.
For HPV to be reported in a smear koilocytes must be present. Koilocytes are squamous cells with a large clearing around the nuclei and a thick, irregular rim of cytoplasm around the edge.
47
What are the symptoms of HPV?
There may be none or genital warts may be present that cause bleeding during intercourse.
48
What are the treatments for HPV?
There are currently none.
It is often cleared up by the immune system.
Vaccination against high risk subtypes is available.
49
What is actinomyces?
A bacteria that colonises IUCD's.
50
How does actinomyces present cytologically?
They can show up as blue clusters of bacteria that have a dense centre with filaments radiating out.
Occasionally have a bottle brush appearance.
Generally cause no problems.
51
What are the symptoms of actinomyces?
On rare occasions can cause PID causing intramenstual bleeding, pain in the lower abdomen and discharge.
52
What are the treatments for actinomyces?
For PID caused by actinomyces may advice antibiotics or removal of IUCD.
53
What is the cytologically appearance of trachomonas vaginalis?
Trachomonas vaginalis is a protazoa.
It appears pear shaped with flagella and a faintly visible nucleus.
It stains a blue/grey colour.
Sometimes red granules can be seen in the cytoplasm.
It is difficult to see in cervical samples because it blends in with cervical material. An inflamed appearance of the rest of the slide including peri nuclear halos and two-toned colours of squamous cells could indicate that trachomonas is present.
Sometimes trachomonas can be seen clustered around squamous in a nursery or marina effect.
54
What are the symptoms of trachomonas vaginalis?
May be none.
May be green frothy discharge, soreness, inflammation and pain during intercourse.
55
What are the treatments for trachomonas vaginalis?
Appropriate antibiotics given.
56
What is bacterial vaginosis?
It is an inflammatory condition of the vagina caused by a mix of coccobacilli including gardnerella and several other organisms.
57
How can bacterial vaginosis be identified cytologically?
Clue cells can be found in the sample.
These can be intermediate or squamous cells that are heavily coated in coccobacilli. The bacteria peppers the surface giving them a hazy blue appearance.
58
What are the symptoms of bacteria vaginosis?
Milky white discharge with a fishy odour.
59
What is the treatment for bacterial vaginosis?
A course of antibiotics.
60
What two groups can cervical abnormalities be split into?
Low grade and high grade.
61
What do low grade cervical abnormalities include?
Borderline changes and mild dyskaryosis.
62
What usually causes low grade cervical abnormalities?
Low grade abnormalities are usually caused by low and high risk HPV subtypes.
63
What percentage of low grade cervical abnormalities progress to high grade?
11%
64
What percentage of low grade cervical abnormalities progress to invasive cancer if left untreated?
1%
65
Describe the cytologically appearance of borderline changes.
```
Nuclear enlargement,
Variation in nuclear size,
Hyperchromasia,
Koilocytes may be present,
Keratinisation (formation of keratin within the squamous cells. Orange cytoplasm and pyknotic nucleus),
Increased N:C ratio,
Smooth nuclear outline.
```
66
Which high risk subtypes of HPV are responsible for 70% of all cervical squamous cell cancers?
Types 16 and 18.
67
Which HPV genes are responsible for their carcinogenic effects?
HPV gene E6 which binds p53.
HPV gene E7 which binds Rb.
Inactivates their function in the cell cycle and can cause cells to transform.
68
What cells are marker cells of HPV infection?
Koilocytes. These are cells in which the cytoplasm is pushed to the edge this creating a clear zone around the nucleus. The nuclei are usually enlarged and they are sometimes binucleate.
69
Describe the cytologically appearance of mild dyskaryosis.
Occurs in both superficial and intermediate squamous cells.
Abnormal, coarse (speckled) chromatin pattern,
Irregular nuclear membrane,
May show associated koilocytes,
Hyperchromasia,
Enlarged nucleus accounts for up to half the cell.
70
What does CIN stand for?
Cervical Intraepithelial Neoplasia.
71
What classification does mild dyskaryosis correspond to histologically?
CIN1.
72
What section of the cervical epithelium is involved in CIN1?
The lower third of the cervical epithelium is involved in CIN1.
73
Will low grade cervical abnormalities always progress?
No. Given time may regress back to normal.
74
What is the main cytologically difference between borderline changes and mild dyskaryosis?
In mild dyskaryosis an irregular nuclear outline can be observed whereas the nuclear outline is smooth in when only borderline changes are present.
75
What types of dyskaryosis are classified as high grade?
Moderate dyskaryosis and severe dyskaryosis.
76
How is moderate dyskaryosis usually classified histologically?
CIN II
77
How is severe dyskaryosis usually classified histologically?
CIN III
78
Describe the cytological appearance of moderate dyskaryosis.
Nuclear enlargement which occupies 1/2 - 1/3 of the cell diameter. Nuclear cytoplasmic ratio or 0.5-0.67.
Uneven chromatin which is more striking than in mild dyskaryosis.
Greater irregularity in nuclear membrane.
Greater degree of hyperchromasia.
Multinucleation.
Cytoplasm is reduced and borders may be angular or rounded.
79
Describe the cytological appearance of severe dyskaryosis.
Nuclear enlargement greater than 2/3 of the cell diameter occurs (nuclear cytoplasmic ratio is greater than 0.67).
Uneven chromatin.
Greater irregularity in nuclear membrane.
Multinucleation.
Abnormal cell maturation including keratinisation may me seen.
Dyskaryosis cells can present as small single cells and dense cell groups (hyperchromatic crowded cell groups).
80
What is most common malignant carcinoma of the cervix?
Squamous cell carcinoma.
81
Where do most cervical invasive squamous cell carcinomas arise from?
Most arise from a focus of CIN.
Progression from CIN to cancer takes several years.
82
What does the term 'invasive' refer to in invasive squamous cell carcinoma?
The fact that the neoplastic cells have breached the basement membrane of the epithelium and extended into the underlying cervical stroma.
83
Is cervical cytology the best way to diagnose invasive squamous cell carcinoma?
No, it cannot be reliably diagnosed from cervical cytology. Histological examination is required for reliable diagnosis.
84
What might the cells of an invasive squamous cell carcinoma look like cytologically?
They may look indistinguishable from severe dyskaryosis.
The surface of the tumour is often covered with debris and no or very few abnormal cells.
85
What would you recommend for a woman with an unhealthy looking cervix?
Referral to colposcopy.
86
Does cervical cytology test for cancer?
No. It detects precancerous abnormalities on cells.
87
What morphological features may be associated with the diagnosis of invasive squamous cell carcinoma?
Numerous dyskaryotic cells.
Cellular pleomorphism (fibre/tadpole shaped cells).
Very coarse aggregates of nuclear chromatin.
Large, irregular, sometimes multiple nucleoli.
Cytoplasmic keratinisation, including the presence of thick anucleate fragments of keratinised cytoplasm.
Tissue fragments or microbiopsies composed of dyskaryotic cells.
Tumour diathesis (mixture of necrotic cell debris, inflammatory exudate and blood).
88
What might be the cause of obtaining a false positive in a cytological screening test?
Three cell types are most commonly associated with false positives: squamous metaplastic cells, endometrial cells and histiocytes.
Squamous metaplastic cells can mimic moderate or severe dyskaryosis.
Endometrial cells can mimic sheets of severe dyskaryosis.
Histiocytes can mimic single cell high grade dyskaryosis.
This is why identifying cell types is very important. You can then adjust the criteria for dyskaryosis to account for cell characteristics.
89
What factors may lead to false negatives in cytological screening?
Small cell severe dyskaryosis may be hard to identify as the cells are no more than twice the size of a polymorph.
In pale cell dyskaryosis the chromatin of the dyskaryotic cells stains less intensely than adjacent polymorphs.
Hyperchromatic crowded cell groups (microbiopsies) may occur. These cell groups are often 3D and can be virtually opaque to light thus inhibiting their microscopic interpretation.
90
What cell types do glandular lesions of the cervical epithelium consist of?
Glandular lesions are either made up of endocervical or endometrial cells.
91
What are the two main risk factors in women who have glandular lesions?
Numerous sexual partners.
Sex at an early age.
92
Who is typically affected by endocervical lesions?
CGIN occurs at an average age of 37 years with invasive endocervical adenocarcinoma occurring at an average age of approximately 56 years of age.
93
Who is typically affected by endometrial glandular lesions?
Occurs more commonly in women more than 40 years of age.
94
The _________________ is line with columnar epithelium forming a single layer. It is terminated by the internal OS (leading to the uterus) and the internal OS (leading to the vagina).
The endocervical canal is line with columnar epithelium forming a single layer. It is terminated by the internal OS (leading to the uterus) and the internal OS (leading to the vagina).
95
What are the two types of columnar endocervical epithelial cells?
Columnar cells are either mucous secreting or ciliated.
96
Where do the majority of endocervical abnormalities occur?
In the endocervical canal.
97
Two stages of endocervical adenocarcinoma can be identified. What are these two stages?
1) . Premalignant stage known as Glandular Inraepithelial Neoplasia (CGIN).
2) . Malignant invasive endocervical adenocarcinoma.
98
Describe the histological feature of CGIN.
Abnormal glands are lined with cells that have enlarged hyperchromatic nuclei and course chromatin.
Nuclei lie perpendicular to the basement membrane, they may also lie at various different angles (loss of polarity).
99
Describe the architectural features of CGIN.
Numerous endocervical cells may be seen singularly or in small groups.
Mitotic features are commonly present.
Nuclear crowding and overlapping may be seen.
There is little or no pleomorphism.
Feathering or fraying of the edges of the cell sheets may be seen.
Rosettes may form.
Pseudo stratification (multi layering of abnormal endocervical cells) may occur.
100
What are the nuclear features of CGIN?
Nuclei are oval with smooth membranes.
Nuclear enlargement (bulges) may be seen.
Nuclei are hyperchromatic with a coarse chromatin pattern.
Mitosis can be seen withing sheets of cells.
101
What are the features of Invasive Endocervical Adenocarcinoma?
The main symptom is vaginal bleeding (seen in 75% of cases).
Small groups of crowded endocervical cells may be seen.
Nuclear enlargement and pleomorphism is usually observed.
Enlarged and prominent nuclei.
Higher number of abnormal cells may be present.
Vacuolated cytoplasm.
Tumour diathesis.
102
What kind of formation do normal endometrial cells form?
A top hat formation.
103
What are endometrial cells?
Endometrial cells are a single layer of epithelial cells that line the endometrium.
The presence of endometrial cells in cervical samples from post menopausal women (not present due to menstruation) should always be investigated.
104
What are the architectural features of endometrial abnormalities?
Abnormal endometrial cells may form 3D balls with scalloped edges.
They will display larger nuclei than normal endometrial cells.
Prominent and multiple eosinophilic (pink) nucleoli are seen.
Leucophagocytosis.
Cytoplasmic vacuoles may push the nucleus to the edge of the cell.
Tumour cells with pyknotic nuclei and eosinophilic/orangephilic cytoplasm may be observed.
105
What types of dyskaryosis are classified as high grade?
Moderate dyskaryosis and severe dyskaryosis.
106
How is moderate dyskaryosis usually classified histologically?
CIN II
107
How is severe dyskaryosis usually classified histologically?
CIN III
108
Describe the cytological appearance of moderate dyskaryosis.
Nuclear enlargement which occupies 1/2 - 1/3 of the cell diameter. Nuclear cytoplasmic ratio or 0.5-0.67.
Uneven chromatin which is more striking than in mild dyskaryosis.
Greater irregularity in nuclear membrane.
Greater degree of hyperchromasia.
Multinucleation.
Cytoplasm is reduced and borders may be angular or rounded.
109
Describe the cytological appearance of severe dyskaryosis.
Nuclear enlargement greater than 2/3 of the cell diameter occurs (nuclear cytoplasmic ratio is greater than 0.67).
Uneven chromatin.
Greater irregularity in nuclear membrane.
Multinucleation.
Abnormal cell maturation including keratinisation may me seen.
Dyskaryosis cells can present as small single cells and dense cell groups (hyperchromatic crowded cell groups).
110
What is most common malignant carcinoma of the cervix?
Squamous cell carcinoma.
111
Where do most cervical invasive squamous cell carcinomas arise from?
Most arise from a focus of CIN.
Progression from CIN to cancer takes several years.
112
What does the term 'invasive' refer to in invasive squamous cell carcinoma?
The fact that the neoplastic cells have breached the basement membrane of the epithelium and extended into the underlying cervical stroma.
113
Is cervical cytology the best way to diagnose invasive squamous cell carcinoma?
No, it cannot be reliably diagnosed from cervical cytology. Histological examination is required for reliable diagnosis.
114
What might the cells of an invasive squamous cell carcinoma look like cytologically?
They may look indistinguishable from severe dyskaryosis.
The surface of the tumour is often covered with debris and no or very few abnormal cells.
115
What would you recommend for a woman with an unhealthy looking cervix?
Referral to colposcopy.
116
Does cervical cytology test for cancer?
No. It detects precancerous abnormalities on cells.
117
What morphological features may be associated with the diagnosis of invasive squamous cell carcinoma?
Numerous dyskaryotic cells.
Cellular pleomorphism (fibre/tadpole shaped cells).
Very coarse aggregates of nuclear chromatin.
Large, irregular, sometimes multiple nucleoli.
Cytoplasmic keratinisation, including the presence of thick anucleate fragments of keratinised cytoplasm.
Tissue fragments or microbiopsies composed of dyskaryotic cells.
Tumour diathesis (mixture of necrotic cell debris, inflammatory exudate and blood).
118
What might be the cause of obtaining a false positive in a cytological screening test?
Three cell types are most commonly associated with false positives: squamous metaplastic cells, endometrial cells and histiocytes.
Squamous metaplastic cells can mimic moderate or severe dyskaryosis.
Endometrial cells can mimic sheets of severe dyskaryosis.
Histiocytes can mimic single cell high grade dyskaryosis.
This is why identifying cell types is very important. You can then adjust the criteria for dyskaryosis to account for cell characteristics.
119
What factors may lead to false negatives in cytological screening?
Small cell severe dyskaryosis may be hard to identify as the cells are no more than twice the size of a polymorph.
In pale cell dyskaryosis the chromatin of the dyskaryotic cells stains less intensely than adjacent polymorphs.
Hyperchromatic crowded cell groups (microbiopsies) may occur. These cell groups are often 3D and can be virtually opaque to light thus inhibiting their microscopic interpretation.
120
What cell types do glandular lesions of the cervical epithelium consist of?
Glandular lesions are either made up of endocervical or endometrial cells.
121
What are the two main risk factors in women who have glandular lesions?
Numerous sexual partners.
Sex at an early age.
122
Who is typically affected by endocervical lesions?
CGIN occurs at an average age of 37 years with invasive endocervical adenocarcinoma occurring at an average age of approximately 56 years of age.
123
Who is typically affected by endometrial glandular lesions?
Occurs more commonly in women more than 40 years of age.
124
The _________________ is line with columnar epithelium forming a single layer. It is terminated by the internal OS (leading to the uterus) and the internal OS (leading to the vagina).
The endocervical canal is line with columnar epithelium forming a single layer. It is terminated by the internal OS (leading to the uterus) and the internal OS (leading to the vagina).
125
What are the two types of columnar endocervical epithelial cells?
Columnar cells are either mucous secreting or ciliated.
126
Where do the majority of endocervical abnormalities occur?
In the endocervical canal.
127
Two stages of endocervical adenocarcinoma can be identified. What are these two stages?
1) . Premalignant stage known as Glandular Inraepithelial Neoplasia (CGIN).
2) . Malignant invasive endocervical adenocarcinoma.
128
Describe the histological feature of CGIN.
Abnormal glands are lined with cells that have enlarged hyperchromatic nuclei and course chromatin.
Nuclei lie perpendicular to the basement membrane, they may also lie at various different angles (loss of polarity).
129
Describe the architectural features of CGIN.
Numerous endocervical cells may be seen singularly or in small groups.
Mitotic features are commonly present.
Nuclear crowding and overlapping may be seen.
There is little or no pleomorphism.
Feathering or fraying of the edges of the cell sheets may be seen.
Rosettes may form.
Pseudo stratification (multi layering of abnormal endocervical cells) may occur.
130
What are the nuclear features of CGIN?
Nuclei are oval with smooth membranes.
Nuclear enlargement (bulges) may be seen.
Nuclei are hyperchromatic with a coarse chromatin pattern.
Mitosis can be seen withing sheets of cells.
131
What are the features of Invasive Endocervical Adenocarcinoma?
The main symptom is vaginal bleeding (seen in 75% of cases).
Small groups of crowded endocervical cells may be seen.
Nuclear enlargement and pleomorphism is usually observed.
Enlarged and prominent nuclei.
Higher number of abnormal cells may be present.
Vacuolated cytoplasm.
Tumour diathesis.
132
What kind of formation do normal endometrial cells form?
A top hat formation.
133
What are endometrial cells?
Endometrial cells are a single layer of epithelial cells that line the endometrium.
The presence of endometrial cells in cervical samples from post menopausal women (not present due to menstruation) should always be investigated.
134
What are the architectural features of endometrial abnormalities?
Abnormal endometrial cells may form 3D balls with scalloped edges.
They will display larger nuclei than normal endometrial cells.
Prominent and multiple eosinophilic (pink) nucleoli are seen.
Leucophagocytosis.
Cytoplasmic vacuoles may push the nucleus to the edge of the cell.
Tumour cells with pyknotic nuclei and eosinophilic/orangephilic cytoplasm may be observed.
