CYTO CHAP 2
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Questions and Answers

What is the characteristic appearance of Candida in vivo or culture?

  • Pseudohyphae with constrictions along their length
  • Small, uniform, round budding yeast surrounded by clear halos (correct)
  • Tangled clumps of filamentous organisms
  • Large multinucleated epithelial cells with moulded nuclei

    • What is a characteristic feature of bacterial vaginosis?

  • Absence of lactobacilli (correct)
  • Presence of lactobacilli
  • Presence of neutrophils
  • Tangled clumps of filamentous organisms

    • What is the recommendation for a sample with satisfactory adequacy, endocervical/transformation zone component absent, and negative for intraepithelial lesion or malignancy?

  • Repeat smear in 3 months
  • Repeat smear in 6 months
  • Refer for colposcopy
  • Repeat as scheduled (correct)

    • What is the characteristic morphology of Actinomyces spp.?

    <p>Tangled clumps of filamentous organisms</p> Signup and view all the answers

    What is the characteristic feature of herpes simplex virus infection?

    <p>Ground-glass appearance of nuclei</p> Signup and view all the answers

    What is the management for a sample with unsatisfactory adequacy and atrophic changes?

    <p>Give a course of estrogen</p> Signup and view all the answers

    What is the characteristic morphology of Trichomonas vaginalis?

    <p>Pear-shaped, oval, round cyanophilic organism</p> Signup and view all the answers

    What is the interpretation of a sample with satisfactory adequacy, endocervical/transformation zone component present, and Trichomonas vaginalis identified?

    <p>Negative for intraepithelial lesion or malignancy</p> Signup and view all the answers

    What is the next step for a sample with unsatisfactory adequacy and a 2nd smear that is still unsatisfactory?

    <p>Refer to Flowchart for Management of ‘Negative For Malignant Cells’ Smear</p> Signup and view all the answers

    What is the association of bacterial vaginosis with?

    <p>PID and preterm birth</p> Signup and view all the answers

    What is the recommendation for a sample with satisfactory adequacy, endocervical/transformation zone component present, and Trichomonas vaginalis identified?

    <p>Repeat smear in 6 months after treatment</p> Signup and view all the answers

    What is the management for a sample with unsatisfactory adequacy and no atrophic changes?

    <p>Repeat smear in 3 months</p> Signup and view all the answers

    What is the recommended course of action for atrophic changes with inflammation in a cervical smear?

    <p>Clear inflammation/estrogen therapy and repeat in 3-6 months</p> Signup and view all the answers

    What should be done if no endocervical cells are seen in a cervical smear?

    <p>Repeat in 1 year</p> Signup and view all the answers

    What should be done if a specific organism is identified in a cervical smear?

    <p>Treat the infection and repeat in 3-6 months</p> Signup and view all the answers

    What should be done if endometrial cells are seen in a cervical smear?

    <p>Correlate with history and refer to a gynaecologist if abnormal</p> Signup and view all the answers

    What is the recommended course of action for atrophic changes without inflammation in a cervical smear?

    <p>Repeat in 1 year</p> Signup and view all the answers

    What should be done if inflammatory changes are seen in a cervical smear?

    <p>Clear inflammation and repeat in 3-6 months</p> Signup and view all the answers

    What is the postulate of development of adenosis after traumatic stimulation?

    <p>Stromal mesenchymal cells</p> Signup and view all the answers

    What is the category under which 'cytologically benign appearing endometrial cells' were reported in postmenopausal women in the 1991 Bethesda System?

    <p>Epithelial cell abnormality</p> Signup and view all the answers

    In which age group is the presence of normal endometrial cells reported under NILM?

    <p>Women &gt; 40 years</p> Signup and view all the answers

    What is the characteristic of the cytoplasm of endometrial cells?

    <p>Scanty and may be vacuolated</p> Signup and view all the answers

    What is the recommended educational comment when reporting exfoliated endometrial cells in a woman 40 years or older?

    <p>Exfoliated endometrial cells are usually derived from a benign process and only a small proportion of women with this finding have endometrial abnormalities</p> Signup and view all the answers

    What is the characteristic of the nuclei of endometrial cells?

    <p>Small and round</p> Signup and view all the answers

    What is the category of epithelial cell abnormality that encompasses HPV?

    <p>Low grade squamous intraepithelial lesion</p> Signup and view all the answers

    What is the significance of the presence of benign endometrial cells in a smear?

    <p>It does not affect the adequacy of the smear</p> Signup and view all the answers

    What is the recommended course of action for a patient with atypical glandular cells favour neoplastic?

    <p>Refer to a gynaecologist</p> Signup and view all the answers

    What is the category that combines the previous categories of 'within normal limits' and 'benign cellular changes'?

    <p>Negative for intraepithelial lesion or malignancy (NILM)</p> Signup and view all the answers

    What is the term that replaces 'infection' in the 2001 Bethesda System?

    <p>Organism</p> Signup and view all the answers

    What is the recommended course of action for a patient with adenocarcinoma?

    <p>Refer to a gynae oncologist</p> Signup and view all the answers

    What is the category that replaces 'ASCUS' in the 2001 Bethesda System?

    <p>ASC</p> Signup and view all the answers

    What is the significance of the presence of endometrial cells in a woman over 40 years of age?

    <p>It requires further evaluation</p> Signup and view all the answers

    Study Notes

    Morphological Characteristics of Microorganisms

    • Budding yeasts: 3-7µm in size
    • Pseudohyphae: formed by elongated budding, show constrictions along their length
    • Candida (Torulopsis glabrata): does not form pseudohyphae in vivo or culture, consists of small, uniform, round budding yeast surrounded by clear halos

    Bacterial Vaginosis

    • Filmy background of small coccobacilli
    • Individual squamous cells may be covered by a layer of bacteria, obscuring cell membrane – clue cells
    • Examples of coccobacilli: Gardnerella vaginalis, Mobiluncus spp.
    • Absence of lactobacilli (normal vaginal flora)
    • Associated with PID, preterm birth, operative gynae infections

    Actinomyces spp.

    • Tangled clumps of filamentous organisms
    • Radial distribution, wooly body appearance
    • Acute inflammatory response with presence of neutrophils
    • Associated with intrauterine contraceptive device (IUD) usage

    Herpes Simplex Virus

    • Nuclei have ground-glass appearance due to accumulation of viral particles, leading to peripheral margination of chromatin
    • Dense eosinophilic intranuclear inclusions surrounded by a halo or clear zone
    • Large multinucleated epithelial cells with moulded nuclei

    Trichomonas Vaginalis

    • Pear-shaped, oval, or round cyanophilic organism

    Cellular Changes

    • Postulates:
      • Development of adenosis after traumatic stimulation of stromal mesenchymal cells
      • Mucinous/goblet cell metaplasia in response to atrophy
      • Prolapse of fallopian tube after simple hysterectomy

    Normal Endometrial Cells

    • 1991 Bethesda System: reported under General categorization ‘Epithelial cell abnormality’
    • 2001 Bethesda System: reported under interpretation/result NILM
    • Presence of normal endometrial cells in women > 40 years old is reported under NILM
    • Optional educational comment is recommended when reporting exfoliated endometrial cells in a woman 40 years or older
    • If date of LMP is provided, and specimen is obtained in first half of cycle, may comment that the finding of endometrial cells correlates with menstrual history

    Morphological Characteristics of Normal Endometrial Cells

    • Ball-like clusters, rarely as single cells
    • Nuclei small, round, approximate size of intermediate cell nucleus
    • Scanty cytoplasm, may be vacuolated
    • Ill-defined cell borders

    Epithelial Cell Abnormalities

    • Atypical squamous cells: of undetermined significance (ASC-US), cannot exclude HSIL (ASC-H)
    • Low-grade squamous intraepithelial lesion (LSIL): encompassing HPV
    • Sample adequacy: Satisfactory for evaluation, endocervical/transformation zone component present or absent

    Management Guidelines and Algorithm for Pap Smear Results

    • Flowchart for Management of Unsatisfactory Smear
    • Flowchart for Management of Abnormal Smear

    Changes in 2001 Bethesda System

    • Specimen adequacy: Satisfactory for evaluation, Unsatisfactory for evaluation
    • Interpretation/result: replaced ‘result’
    • Term “Within normal limits” eliminated
    • Categories of ‘within normal limits’ and ‘benign cellular changes’ combined into a single category ‘negative for intraepithelial lesion or malignancy (NILM)’
    • Term ‘organism’ replaced ‘infection’
    • Presence of glandular cells post-hysterectomy
    • Presence of endometrial cells (in woman > 40 yrs of age)
    • ‘ASCUS’ changed to ‘ASC’, either ASC-US or ASC-H
    • ‘AGUS’ changed to ‘AGC’
    • ‘AIS’ as separate entity
    • 4 elements to 7 elements

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    Related Documents

    The 2001 Bethesda System: Gynae Cytology Reporting PDF

    Description

    This quiz covers the characteristics of budding yeasts, Candida, and bacterial vaginosis, including their morphology and identifying features in microscopy.

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