CSI 255

CYTOLOGY
BOOK?
(based on bethesda form)
 NORMAL CELL

Parabasal cells

 15-25 µm.
 Round to oval shape.
 Cyanophilic cytoplasm.
 Large nuclei, high N:C ratio.

Intermediate cells

 Polyhedral.
 Pale cyanophilic cytoplasm, flattened.
 Cell border teends to fold.
 Glycogen-golden or pale brown.
 Nuclei vesicular, reticular chromatin, chromocentre.
 NORMAL CELL

Superficial cells

 Similar in size to intermediate cells.

 Small nuclei, dark, pyknotic appearance.
 No chromatin pattern.
 Cytoplasm thin semi-translucent, eosiniphilic.
 Cell borders not folded.
 Keratohyalin granules, nuclear debris.

Endocervical cells
 Honeycomb pattern.
 Naked nuclei with mucus.
 Most tall columnar cells.
 Well-defined cell borders.
 Abundant clear cytoplasm,
distended, vacuoles.
 Oval to round nucleus.

Endometrial cells
 Ball like clusters, rarely as
single cells.
 Nuclei small,round,
approximate size of
intermediate cell nucleus.
 Scanty cytoplasm, may be
vacuolated.
NEGATIVE INTRAEPITHELIAL FOR LESION OR
MALIGNANCY (NILM)

Trichomonas vaginalis (TV)

 Pear-shaped / kite-shaped.
 Oval / round cynophilic.
 Range about 15 - 30 micrometer.
 Nucleus is pale and eccentric.
 Leptothrix may be seen while flagella rarely seen.
 Eosinopilic cytoplasmic granules may be seen.

Candida spp

 Round budding yeast , small and uniform.

 Range about 3 - 7 micrometer.
 Fragmented leukocyte nuclei.
 Rouleau formation of squamous cell 'speared' by hyphae may be seen.
 Have pseudohyphae formed by elongated budding.
 Pseudohyphae are eosinophilic and gray-brown in colour.
 May also seen inflammatory background.
 NILM

Gardnerella vaginalis (GV) / Bacterial vaginosis (BV)

 Small cocobacilli.
 Covered on an individual squamous cell.
 Also known as "clue cell".
 Conspicuous absence of lactobacilli.

Actinomyces spp

 Can be seen as "cotton-ball" cluster.

 Irregular "wooly-body" appearance.
 Presence of neutrophils.
 Often associated with IUD device.
 NILM

Herpes simplex virus (HSV)

 Nuclei look like "ground-glass".

 Multinucleation and nuclear moulding.
 Dense eosinophilic intranuclear inclusions surrounded by a halo are
variably present.

Reactive cellular changes – inflammation

 Nuclear enlargement.
 Endocervical cells maybe larger.
 binucleation or multinucleation.
 Nuclei maybe vesicular or hypochromatic.
 Nuclear outline is smooth, round, uniform.
 Mild hyperchromasia.
 NILM

Reactive cellular changes – radiation

 Cell size markedly increased in size.

 Bizarre cell shape.
 Binucleation and multinucleation.
 Mild nuclear hyperchromasia.
 Nuclear pallor and nuclear vacuolization.

Reactive cellular changes – IUCD

 Glandular cells singly or clusters, clean background.

 Occasional single epithelial cells with large nucleus.
 High N: C ratio.
 Nucleoli maybe prominent.
 Large vacuole displacing nucleus ‘signet-ring’ cell.
 NILM

Atrophy

 Flat, monolayer sheet of parabasal-like cells with preserved nuclear

polarity.
 Abundant inflammatory exudate.
 Enlarge nuclei. Slight increase N:C ratio.
 Mild nuclear hyperchromasia with elongation.
 Uniform chromatin and autolysis with naked nuclei.

Glandular cells status post hysterectomy

 Benign-appearing endocervical-type glandular cells that cannot be

differentiated from those sampled from endocervix.
 Goblet cell or mucinous metaplasia may be seen.
 Round to cuboidal cells may resemble endometrial-type cells.
 Goblet cell metaplasia and bland cellular features.
 NILM

Keratotic cellular changes – typical parakeratosis

 Miniature superficial squamous cells with dense orangeophilic

cytoplasm.
 Cells seen in isolation, sheet, whorls.
 Round, oval, polygonal or spindle cells.
 Pyknotic nuclei.

Keratotic cellular changes –

hyperkeratosis

 Anucleate but otherwise

unremarkable mature
polygonal squamous cells.
 Empty spaces or ‘ghost nuclei’
may be seen.

Lymphocytic (Follicular) cervicitis

 Lymphocytes +/- tingible body

macrophages are seen in clusters or
streaming out in mucus.
 Abundant lymphoid cells with a
tingible body macrophage located
centrally.
 SQUAMOUS CELL ABNORMALITIES
ATYPICAL SQUAMOUS CELL (ASC)

Atypical Squamous Cells of Undetermined Signifance (ASC-US)

 In superficial & intermediate squamous cell.

 Nucleus enlargement.
 Hyperchromatic nucleus.
 Pale chromatin.
 Nucleus enlargement.
 Chromatin slightly denser.
 N:C ratio slightly increase.
 Irregular nucleus.
 21/2x to 3x (nuclei enlargement).
 Smooth nuclear membrane - mildly irregular.
 Orangeophilic cytoplasm (parakeratosis).
 ASC

Atypical Squamous Cells Cannot Exclude HGSIL (ASC-H)

 1/2 to 21/2x (nucleus enlargement.)

 In cluster (immature metaplastic cells).
 Hyperchromasia.
 High N:C ratio.
 Metaplastic cell size.
 Crowded sheet ‘pattern’.
 Difficult to visualize.
 Dense cytoplasm.
 Polygonal cell shape.
 SQUAMOUS INTRAEPITHELIAL LESION (SIL)

Low Grade Squamous Intraepithelial Lesion (LGSIL)

 3x nucleus enlargement.
 Abundant cytoplasm.
 N:C ratio slightly increase.
 Singly in sheet pattern.
 Usually in Superficial & Immediate squamous cell.
 Variation of nucleus size and shape.
 Binucleation and multinucleation.
 Nucleus membrane smooth/slightly irregular.
 Nucleoli inconspicuous.
 Distinct cytoplasmic border of the cells.
 Vacuolated cytoplasm.
 Koilocytes.
 Orangeophilic.
 SIL

High Grade Squamous Intraepithelial Lesion (HGSIL)

 Cell occurs in single or syncytical like aggregates.

 Pleomorphic cell shape.
 Increase in N:C ratio due to dysplasia.
 Thickened nuclear membrane, prominent and grooves.
 Cytoplasm is immature or metaplastic densely keratinised.
 Presence of naked nuclei.
 SQUAMOUS CELL CARCINOMA (SCC)

Keratinising Squamous Cell Carcinoma (KSCC)

 Predominantly single cell with few group.

 Bizarre cell shape.
 Macronuclei.
 Pleomorphic appearances.
 Inflammation and necrosis.

Non Keratinising Squamous Cell Carcinoma (NKSCC)

 Cytoplasm seen cyanophilic and slightly vacuolated.

 Flatter sheet with less distinct cytoplasmic borders.
 Inflammatory and necrosis background.
 Nuclei shows coarsely clumped chromatin and irregular distribution.
 Some abnormal keratinized cell.
 GLANDULAR CELL ABNORMALITIES
REACTIVE CELLS

Reactive Endocervical Cells

• Minimal crowding, cells lay flat.

• Nuclear enlargement, hyperchromasia.
• Smooth nuclear membranes.
• Prominent nucleoli.
• N:C ratio maintained.

ATYPICAL GLANDULAR CELL (AGC)

Atypical Glandular Cells Not Otherwise Specified (AGC-NOS) –

Endocervical
• Sheet of cell.
• Enlarged, variable- sized nuclei.
• Some nuclear crowding & overlap.
• 3D group, pseudo- stratification,crowding, cilia.
 AGC

Atypical Glandular Cells Not Otherwise Specified (AGC-NOS) – Endometrial

 Cells in small groups.

 5-10 cells per group.
 Nuclei slightly enlarged.
 Mild hyperchromasia.
 Small nucleoli.
 Scanty cytoplasm, vacuolated.
 Ill-defined cell borders.

AGC FAVOUR NEOPLASTIC

Atypical Glandular Cells Favour Neoplastic - Endocervical

 Sheet of cells, crowded.

 Increase N:C ratio.
 Elongated nuclei.
 Feathering, pseudostratified strip.
ENDOCERVICAL ADENOCARCINOMA IN SITU (AIS)

Feathering Nucleus Gland Opening

Rosette Pseudostratification

 Crowded and overlapping hyperchromatic groupings.

 Elongated nuclei.
 Cells showing a definitive columnar appearance.
 Pallisading cells within the group.
 Nuclear enlargement compared to normal endocervical cells.
 Evenly dispersed, but coursely granular chromatin pattern with
hyperchromasia.
 Micronucleoli usually present.
 Architectural group features of pseudostratification in strips, rosette
formation, nuclear protrusion at the group margins (feathering).
 No tumour diathesis.
 ADENOCARCINOMA

Adenocarcinoma – Endocervical

 Abundant cellularity.
 2 dimensional sheets; large thick groups.
 Many features of AIS.
 Dyscohesion more common.
 Macronucleoli.
 Increasing N:C ratio.
 Increasing nuclear size.
 Chromatin clearing.
 Tumour diathesis present.
 ADENOCARCINOMA

Adenocarcinoma – Endometrial

 Cells occur singly or in small tight clusters.

 Nuclei enlargement.
 Nuclear size vary; loss of nuclear polarity.
 Moderate hyperchromasia of nuclei; irregular chromatin distribution;
parachromatin clearing.
 Small to prominent nucleoli.
 Scanty cytoplasm, often vacuolated.
 Tumour diathesis.
 Engulfed polymorphs.
 ADENOCARCINOMA

Adenocarcinoma - Extrauterine

DIFFERENTIATION BETWEEN REACTIVE ENDOCERVICAL AND ATYPICAL GLANDULAR ENDOCERVICAL

REACTIVE ENDOCERVICAL ATYPICAL ENDOCERVICAL

ARCHITECTURE Cells lie flat,minimal HGCs, rosettes, feathering
crowding/overlap
CELL BORDERS Well defined Indistinct
CYTOPLASM Adequate, mucinous Scant,mucin depleted
N/C RATIO WNL/slightly increased High
NUCLEI Round, can be large Oval/elongated to irregular
CHROMATIN Usually fine, can be dark Usually dark and coarse
NUCLEOLI Often prominent Absent or small
 Atypical Squamous Cells (ASC) Low-Grade Squamous Intraepithelial High-Grade Squamous Intraepithelial Squamous Cell Carcinoma
Lesions Lesions (HSIL) (SCC)
(LSIL)
Characterictics of undetermined significance cannot exclude HSIL (ASC-H) Keratinising SCC Non keratinising SCC
(ASC-US)

Diagram

 Cells present predominantly  Singly or in small fragments.  Cells occur singly and in sheets  Cells occur in singles, in sheets  Isolated and cluster  Singly or in syncytial aggregates
Cell arrangement
singly and in few sheets.  crowded sheet pattern or in syncytial-like aggregates. with poorly defined cell borders.
 Polygonal cell shape.  Cells size is large.  Pleomorphic cell shapes  Pleomorphic malignant  Pleomorphic malignant cells.
 Metaplastic cell  Cells have distinct cytoplasmic cells
Cell configuration NONE
 Small cohesive clusters of border.  Bizarre cell shapes
atypical cell.
 Minimal nuclear  Enlargement  Binucleation and multinucleation.  Hyperchromasia  Nuclear membrane may  Inflammatory and necrotic
hyperchromasia  Hyperchromasia  Variable degrees of hyperchromasia  Irregular nuclear membrane , be irregular. background.
 Smooth nuclear membrane /  Variation of nuclear size and shape prominent and grooves.  Hyperkeratosis may be  Some abnormal keratinised cells.
Nuclear morphology
midly irregular.  Smooth or slightly irregular and present  Blood and necrosis.
thickened  Inflammation and
necrosis.
 Nuclei approximately 2 ½ to 3x  Nuclei about 1 ½ to 2 1/2x  Enlarged nucleus > 3x nucleus of a  Naked nuclei.  Numerous dense opaque  Naked and coarsely clumped
size of intermediate cell larger than normal. normal intermediate cell.  Enlarged nuclei nuclei chromatin
Nuclei nucleus.  Enlarged nuclei.  Hyperchromatic nucleus.  Have nucleolus  Vary markedly in size  irregular distribution
 Hyperchromatic nucleus.
 Enlarged nucleus
 Finely granular, evenly  Finely granular , evenly distributed  Fine or coarsely granular  Coarsely granular and
Chromatin NONE NONE
distributed irregularly distributed
Cytoplasm  Dense orangeophilic  Dense cytoplasm  Vacuolated (koilocytes), dense or  Variable, can be immature, lacy, NONE NONE
(parakeratosis) orangeophilic densely metaplastic, densely
keratinised.

 Inconspicuous or absent.  Present  Inconspicous  Absent  Macronucleoli may be  Absent

Nucleoli
present but not common.
N:C Ratio  Slight increase  High  Slight increase  Marked increase NONE NONE