CYTO CHAP 2

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

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