EXFOLIATIVE CYTOLOGY Prt 2 Flashcards by Kyra Catedral

Q

GYNECOLOGIC SPECIMENS

A

Vaginal and
Cervical smears

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

• Screening test for precancerous condition
• Not an identification for cancer
• Recommended for females (35 yrs old and above)

A

VAGINAL AND CERVICAL SMEARS

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

If the female has a child = recommended to undergo______

A

Pap Smear

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

True or False

Vaginal and Cervical Smears are diagnostic

A

False

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

: junction of endocervical mucosa

A

Transformation Zone
• T-zone

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Vaginal and Cervical Smears

Collection:

A

Aspiration of posterior fornix
Swabbing

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Vaginal and Cervical Smear

• Instruments:

A

• 8-inch alass pipette and rubber bulb (for cancer cytology
• Sterile tongue depressor (for hormonal studies)
• Avre’s spatula
• Cervix brush

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Precautions for Vaginal Smear Prep

Patient must avoid vaginal examination or douching_____ before collection

Spread smear thinly in a_____ motion

Glass pipette must be absolutely____

No ____ or ____must be used

A

24-48 hrs

rotary

dry

No lubricant or powder

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

CYTOLOGIC COLLECTION AND PREPARATION

A

Vaginal scrape
Vulvar scrape
Endocervical brush
Lateral vaginal scrape
Four quadrant vaginal scrape

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

CYTOLOGIC COLLECTION AND PREPARATION

• Samples of endocervical canal

A

Endocervical brush

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

CYTOLOGIC COLLECTION AND PREPARATION

• Patients with hysterectomy

A

Vaginal scrape

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

CYTOLOGIC COLLECTION AND PREPARATION

For hormonal evaluation

A

Lateral vaginal scrape

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

CYTOLOGIC COLLECTION AND PREPARATION

For localization of vaginal adenosis

A

Four quadrant vaginal scrape

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

CYTOLOGIC COLLECTION AND PREPARATION

For detection of herpetic lesions or carcinoma

A

Vulvar scrape

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Pap staining

Developed by

A

Dr. George Papanicolau

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Detects human uterine and cervical CA.

A

Pap staining method

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

• Cytologic evaluation of other secretions
• Transparent blue staining of cytoplasm
• Excellent nuclear detail is produced
• Color range is predictable

A

Pap staining method

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

• Valuable in comparing cellular appearances in smears

A

Pap staining

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

3 stains used in pap staining

A

Hematoxylin
OG6 (Orange Green)
Eosin Azure

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Hematoxylin stains..

A

Nuclear structure

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

OG6 (orange green) stains..

A

Cytoplasm of mature cell

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Eosin Azure stains..

A

Cytoplasm of immature cell

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Eosin Azure
Components:

A

• Eosin
• PTA
• Light Green Stain (36, 50, 65)
• Lithium carbonate
• Bismarck brown

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

• It omitted the Bismarck’s brown dye from the EA solution
• Sharpness of color and brilliant staining reactions are improved

A

MODIFIED PAP’S METHOD

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

MODIFIED PAP'S METHOD It omitted the _______from the EA solution • Sharpness of color and brilliant staining reactions are improved

Bismarck's brown dye

• Inexpensive • Not commonly used nowadays • Performed regularly even in pregnant women without undue risk

VAGINAL HORMONAL CYTOLOGY

VAGINAL HORMONAL CYTOLOGY • No prior vaginal examination or douching in the last_____

24 hrs

Wooden Hormonal Cytology _________ of vaginal well • Less contamination and accessible _______is recommended only in vaginal hormonal studies

• Upper lateral 3rd • Wooden spatula

Wooden Hormonal Cytology Assess smear and staining quality Detect RBC and WBC Detect type of exfoliated cells Rough assessment of cell proportion

LPO

Wooden Hormonal Cytology LPO Assess____ and _____ quality Detect___ and ____ Detect type of_______ Rough assessment of______

smear and staining RBC and WBC exfoliated cells cell proportion

Quantitate the cells that were observed under LPO

HPO

CELLS FOUND IN CERVICO-VAGINAL SMEARS

• Mature Superficial Cells • Intermediate Cells • Parabasal Cells • Endometrial Cells • Endocervical Glandular cells • Doderlein Bacilli • Ferning Phenomenon

MATURE SUPERFICIAL CELLS Shape: Color: Nuclei: Abundant during:

• Polygonal • Pale pink cytoplasm • Dark pyknotic nuclei (< 6 u) • Abundant during proliferating phase

• True acidophilia (Due to estrogen)

Mature superficial cells

Vaginal prolapse and drying Drying of smears o Infection Chemicals

Pseudoacidophilia Mature superficial cells

Mature Superficial cells are influenced by

Estrogen

INTERMEDIATE CELLS Size and shape: Color: Abundant during:

Medium sized polyhedral or elongated cells Basophilic cytoplasm with vacuoles Abundant during secretory phase

Intermediate cells are influenced by

Progesterone

Types of intermediate cells

Navicular cells Pregnancy cells

• Boat-shaped • Folds/curls on edges • Estrogen-progesterone effect • Latter half of menstrual cycle, pregnancy, and menopause

NAVICULAR CELLS

Navicular cells Shape: Folds: Effect: During:

• Boat-shaped • Folds/curls on edges • Estrogen-progesterone effect • Latter half of menstrual cycle, pregnancy, and menopause

• Round, oval cells • Translucent basophilic cytoplasm at the center of cell due to central glycogen accumulation • Eccentric nucleus • Double walled boundary with deep blue stain at the cytoplasmic periphery

PREGNANCY CELLS

Pregnancy cells Shape: Color: Nucleus:

• Round, oval cells • Translucent basophilic cytoplasm at the center of cell due to central glycogen accumulation • Eccentric nucleus • Double walled boundary with deep blue stain at the cytoplasmic periphery

• Smaller than intermediate cells • Thick, round to oval

PARABASAL CELLS

• Smaller strongly basophilic cytoplasmic area • Larger vesicular nucleus than intermediate cells

PARABASAL CELLS

• 2 weeks of age to puberty, after childbirth, abortions, and after menopause

PARABASAL BODY

PARABASAL CELLS Shape: Size/ color: Nucleus: Abundant during:

• Thick, round to oval • Smaller strongly basophilic cytoplasmic area • Larger vesicular nucleus than intermediate cells • 2 weeks of age to puberty, after childbirth, abortions, and after menopause

T or F We can identify the age of the patient through vaginal smear

True

• Small, round to slightly oval cells • Large nuclei (> half of cell volume) • Nucleus almost occupies the entire cell • Strongly basophilic cytoplasm • Found before puberty and after menopause

BASAL CELLS

BASAL CELLS Size/ shape: Nuclei: Color: Abundant during:

• Small, round to slightly oval cells • Large nuclei (> half of cell volume) • Nucleus almost occupies the entire cell • Strongly basophilic cytoplasm • Found before puberty and after menopause

• Like parabasal cells; slightly cylindrical • Less basophilic cytoplasm • During and 1-4 days after menstruation

ENDOMETRIAL CELLS

ENDOMETRIAL CELLS Shape: Color: Abundant during:

• Like parabasal cells; slightly cylindrical • Less basophilic cytoplasm • During and 1-4 days after menstruation

Occur in large group or sheets Honeycomb appearance Finely vacuolated pale blue/gray cytoplasm

ENDOCERVICAL GLANDULAR CELLS

ENDOCERVICAL GLANDULAR CELLS Shape/appearance: Color:

Honeycomb appearance Finely vacuolated pale blue/gray cytoplasm

DODERLEIN BACILLI is from the family of

Lactobacillus acidophilus

Most common normal vaginal flora

Doderlein Bacilli

Color of doderlein bacilli

• Blue to lavender with Pap's

T or F • Increased number of Doderlein bacilli indicates healthy vagina

True

Doderlein bacilli Numerous in:

last trimester of pregnancy, infection, estrogen deficiency, DM

Doderlein bacilli Decreased number leads to increase in population of invasive_______ species; comes with the presence of_______.

Lepthothrix Trichomonas vaginalis

if the vagina is not acidic, the number of________ will decrease because of the presence of Trichomonas vaginalis.

Lactobacillus acidophilus

• Seen on dried cervical mucus • Signifies persistent estrogen effect • Basis for diagnosing early pregnancy

Ferning phenomenon

"fern"/palm-leaf pattern of salt crystals

FERNING PHENOMENON

CRITERIA FOR THE CYTOLOGIC DIAGNOSIS OF NORMAL PREGNANCY

• Marked progesterone effect • At least 50% of intermediate cells in cluster • At least some typical pregnancy cells are present • Less than 30% mature superficial cells • Doderlein-filled dirty background

CRITERIA FOR THE CYTOLOGIC DIAGNOSIS OF NORMAL PREGNANCY • Marked______ effect • At least 50% of_____ cells in cluster • At least some typical_____ cells are present • Less than 30% _____cells •______-filled dirty background

progesterone intermediate pregnancy mature superficial Doderlein

REPORT FOR CYTOLOGIC SMEAR FOR DIAGNOSIS OF CANCER o Absence of atypical or abnormal cells

CLASS I

REPORT FOR CYTOLOGIC SMEAR FOR DIAGNOSIS OF CANCER Atypical Cytologic Picture but no evidence of malignancy

• CLASS II

REPORT FOR CYTOLOGIC SMEAR FOR DIAGNOSIS OF CANCER • Cytologic picture suggestive but not conclusive of malignancy

• CLASS III

REPORT FOR CYTOLOGIC SMEAR FOR DIAGNOSIS OF CANCER • Cytologic picture strongly suggestive of malignancy

• CLASS IV

REPORT FOR CYTOLOGIC SMEAR FOR DIAGNOSIS OF CANCER • Cytologic picture conclusive of malignancy

• CLASS V

OTHER MICROSCOPIC EXAMINATION TECHNIQUES OF CYTOLOGIC SMEARS

• Acridine Orange Fluorescent Technique • Phase Contrast Microscopy • Interference Microscopy

Acridine Orange Fluorescent Technique - green/yellow • If increased: malignancy - brick-orange red • If increased: growth

Binds DNA Binds RNA

The second best choice after Pap's staining

Phase Contrast Microscopy

Used for hormonal evaluation of gynecologic specimen and for cancer detection

Phase Contrast Microscopy

Determines the dry weight or individual cells or cellular constituents Very expensive and complex

Interference Microscopy