BASIC CYTOLOGY PRINCIPLES

FEATURES TO BE EVALUATED IN A PAP TESTAdequacy Presence of abnormal cells Number and distribution of abnormal cells Relationship between cells Cell size and shape Nuclear size and shape Nuclear changes and nucleoli N/C ratio Cytoplasmic features Background or diathesis

Features of preneoplastic and neoplastic cellsAbnormality in shape and size of cells Variation in shape and size of cells Increase in nuclear size Increase in nuclear membrane irregularity Hyperchromasia Prominence of nucleoli and irregularity in shape thereof Thickening of nuclear membrane

Features of preneoplastic and neoplastic cells(2)Increase in N/C ratio Cytoplasm scanty mitosis:increased number and abnormal forms Noncohesiveness Abnormal polarity

Common causes of falsenegative pap testAtypical endocervical cells Crowded cell aggregates Cytolysis Intermediate cells with nuclear enlargement Keratinized cells Metaplastic-like cells Necrotic debris Artifacts (obscuring

Common causes of falsepositive Pap testAtrophic smear Atypical endocervical and endometrial cells Multinucleated cells Parakeratosis Perinuclear halo in nonkoilocytes Pseudoparakeratosis Reactive/repair Squamous metaplasia Tubal metaplasia

Differential diagnosis of cells with naked nucleiAytolysis of cytoplasm in menopause Cytolysis Degeneration,especially of endocervix Reserve cells in tamoxifen treatment

Differential diagnosis of giant multinucleated cellsHistiocytes Atrophy Radiation Syncytiotrophoblast

Folic acid deficiency Squamous carcinoma Tissue repair Viral infection granuloma Choriocarcinoma Uterine sarcoma

Cytological features of dark cell clustersCrowded with piling up of cells Hyperchromatic overlapping nuclei Anisonucleosis Scant cytoplasm Increased N/C ratio Mitosis present Often difficult to determine whether squamous or glandular

Differential diagnosis of dark cell clustersReactive endocervical cells Tubal metaplasia atrophy:smooth nuclear membrane Benign endometrial cells Atypical squamous cells cannot exclude HGSIL HGSIL nuclear membrane irregular Adenocarcinoma in situ Enocervical or endometrial

Differential diagnosis of small cellsLymphocytes in chronic lymphocytic cervitis Degenerated cells Endometrial cells Histiocytes Reserve cells Tamoxifen cells Squamous cell carcinoma small cell type Small cell anaplastic carcinoma

Differential diagnosis of cells with macronucleoliRepair,regenerative Decidua ,or reactive Adenocarcinoma squamous cells Metastatic tumor Reactive endocervical cells Nonkeratinizing squamous Viral inclusions carcinoma Treatment effect pemphigus

Differential diagnosis of adenocarcinomaViral infections Endocervical cells,benign and atypical Endometrial cells,benign and atypical Endometritis Histiocytes Metaplasia Vaginal adenosis Intrauterine device Microglandular hyperplasia Metastatic tumor

adenocarcinoma