• Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

Card Range To Study

through

image

Play button

image

Play button

image

Progress

1/50

Click to flip

Use LEFT and RIGHT arrow keys to navigate between flashcards;

Use UP and DOWN arrow keys to flip the card;

H to show hint;

A reads text to speech;

50 Cards in this Set

  • Front
  • Back
  • 3rd side (hint)
ATROPHY

Basal¶basal cells (can mimic HSIL-grooved nuc, crowded, but not chromatin)
Maturation index in atrophy
90/10/10

Predominance of PARABASALS

What is maturation index?
Transitional cell metaplasia
Basal & Parabasal cells
Can mimic HSIL with grooves, irreg membranes. BUT soft pale chromatin
Maturation index at ovulation?

Menses?

Pregnancy?
0/40/60 (Estrogen matures epith)

Left shifted

0/95/5 (PROGESTERONE)
Follicular cervicitis

TINGIBLE BODY MACS

Assoc with chlamydia
When do you see endometrial cells in a pap?
First 12d of cycle

Out-of-phase shedding:
-IUD
-itis
-polyp
reactive

Cohesive flat sheets, “streaming”, lrg nuc with marked size variation, lrg –oli, pale chromatin, mits
Individual abn cells rare
Mimics scc/adenoca
radiation change
Lrg bizarre cells (compare to PMN)
NORMAL N:C ratio
Cyt vacs
polychromasia
multinucleation

mimics HSV, ca, LSIL
cancer?
cancer?
No

IUD!

-Vacuolated cells
- Sm dark cells scant cyt
- Sm grp or isolated
- Lrg nuc, -oli
- Shed endomets throughout cycle
- ACTINOMYCES
What are the risk factors for cervical ca?
What part of the HPV genome binds p53? Rb?
e6 binds p53 & blocks apoptosis

e7 binds Rb & blocks tumor suppression
e6 binds p53 & blocks apoptosis

e7 binds Rb & blocks tumor suppression
Endocervs
honeycomb
endometrial cells
3-D
small dark balls

Mimics: HSIL (flatter), SCC (background diathesis), AIS (mits), small cell ca (darker, nuc smearing)
Caused by?
Caused by?
Shift

Clue cells
background should be CLEAN

Gardnerella vaginalis
Trichomonas
Strawberry cervix

• pear shaped
• pale, eccentrically placed nucleus
• red cytoplasmic granules
Candida

shish kabobs squamous cells
Associated with?
Associated with?
Actinomyces spp.

Assoc with IUDs. no treatment if asymptomatic. IUD can stay in.
HSV

Multinucleated
Margination
Molding
Chlamydia
CMV
usu infects endocervical cells

• mononuclear cells
• markedly enlarged
• basophilic intranuclear inclusion
• small granular cytoplasmic inclusions
Each cell has a large basophilic
intranuclear inclusion that is surrounded by a halo; the cytoplasm contains multiple small
basophilic inclusions as well.
Leptothrix

AND TRICH!

Leptothrix often assoc with trich
Alternaria in pap

water contaminant
Reactive endocervs
Prominent nucleoli
characteristic finding of woman on birth control?
Parakeratosis
Low risk HPV?

High risk HPV?
Low
6, 11, 42, 43, 44, 53, 54, 57, and 66

HIgh
16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 68

Which type most commonly seen in cervical ca?
LSIL

• intermediate-sized cells
• nuclear atypia:
• enlargement
• irregular contour
• hyperchromasia
• slight chromatin coarseness
• cytoplasmic cavities (koilocytes)
LSIL

• intermediate-sized cells
• nuclear atypia:
• enlargement
• irregular contour
• hyperchromasia
• slight chromatin coarseness
• cytoplasmic cavities (koilocytes)
HSIL
• usually parabasal-sized cells
• discrete cells or syncytium-like groups (hyperchromatic
crowded groups)
• nuclear atypia
• enlargement
• marked irregularity in contour
• usually marked hyperchromasia
• marked chromatin coarseness
HSIL / CIS
-syncytial arrangements of high grade cells
-
SCC!

LOOK FOR NUCLEOLI AND IRREGULAR CHROMATIN PATTERN
SCC!

LOOK FOR NUCLEOLI AND IRREGULAR CHROMATIN PATTERN
Features of SCC
Features of SCC
Features of SCC:
HSIL features, plus:
• macronucleolus
• irregular chromatin distribution
• tumor diathesis
• “tadpoles” and “fiber cells” (keratinizing type)
AIS
• hyperchromatic crowded groups
• glandular differentiation
• columnar cells
• strips and rosettes
• “feathering”
• neoplastic nucleus:
• hyperchromasia
• crowding, stratification
• inconspicuous nucleolus
• apoptosis
• mitoses
• no tumor diathesis
Pseudostratification
salt & pepper chromatin
Rosettes are highly characteristic of AIS
Endocervical adenoca

• tumor diathesis (< 50% of cases)
• large, round nucleus
• prominent nucleolus
• abundant cytoplasm
irregular nuclear contours
ROUND cells, vs AIS (columnar)
Endocervical adeno

These malignant cells show variation in nuclear size, with prominent nucleoli and
coarsely granular chromatin.
Minimal deviation adenocarcinoma.

The rare, extremely well-differentiated tumor known
as minimal deviation adenocarcinoma (or adenoma
malignum) is composed of mucinous glands that show
little if any atypia, and yet, if untreated, invade deeply
and metastasize. Patients sometimes present with
vaginal discharge. In most cases, the neoplastic cells
on the Pap test look entirely like normal endocervical
cells
Endometrial adenoca
ENGULFED POLYS
• round cells
• enlarged nucleus
• hyperchromatic
• prominent nucleolus
• scant or abundant vacuolated cytoplasm
• cytoplasmic neutrophils (“bags of polyps”)
3D groups with scalloped borders
LOOKS A LOT LIKE IUD!
Melanoma

Isolated cells
The malignant spindled and epithelioid cells are dyshesive. There is focal finely
granular melanin pigment
# endocervs required in Bethesda?
10 CELLS

Endocervical cells OR squamous met
# cells required?
5000

basically 9 per phf

<5000 is unsat; also if >75% obscured
KNOW THIS
IUD CELLS!

Single cells with increased N/C ratio, slight hyperchromasia and some irregularity to the nuclear membrane represent cellular changes caused by an IUD.
Pap
Pap
Cockleburr cells

radiate arrays of crystalline material often surrounded by macrophages.
Seen in pregnancy.
no significance
pap
pap
ASCUS
Enlarged nuc
smooth contours
even chromatin

MORE REVIEW AT CYTOLOGYSTUFF.COM
What HPV subtype is more common in glandular lesions?
HPV18
What type of cell does lactobacilli target?

what type of bacteria is it?
INTERMEDIATE (eats the glycogen and leads to cytolysis)
Contributes to normal vaginal pH

Unencapsulated GPR
Macrocytosis can occur in radiation and what other condition?
B12 deficiency
Cytologic patterns on Pap during pregnancy
Predominantly intermediate cells (progesterone rich)

Cytolysis may be marked

Fetal distress can cause shift to SUPERFICIAL cells

IUFD can have shift to ATROPHY

Postpartum smears can show atrophic pattern more often with lactating moms
HPV facts
nonencapsulated ds virus
7900 base pairs
early and late genes
Integration of viral genetic material into host genome is critical malignant event (disrupts E1-E2)
INTEGRATION SITES ARE RANDOM
e6-p53; e7-Rb
GYN tumor most frequently associated with "watery discharge"
Fallopian tube tumors
Clues to look for trichomonas
thin perinuclear halos in squamous cells

Leptothrix