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Cytology Training Program: Gyn Cytology Revision Exercise by Tony Chan

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Title: Cytology Training Program: Gyn Cytology Revision Exercise by Tony Chan


1
Cytology Training ProgramGyn Cytology Revision
Exercise by Tony Chan
  • Reference
  • THE BETHESDA SYSTEM WEBSITE ATLAS
  • American Society of Cytopathology

2
Select Your Interpretation from below
  • NILM Negative for Intraepithelial Lesion or
    Malignancy
  • Endometrial cells in a woman gt 40
  • ASC-US
  • ASC-H
  • LSIL
  • HSIL
  • Invasive Squamous Cell Carcinoma
  • Atypical Endocervical Cells
  • Atypical Endometrial Cells
  • Adenocarcinoma in situ (AIS), Endocervical
  • Adenocarcinoma, Endocervical
  • Adenocarcinoma, Endometrial

3
27 year old woman, colposcopy visit
  • NILM Fungal organisms consistent with Candida
    spp
  • Pseudohyphae and reactive changes in the squamous
    epithelial cells.

4
31 year old
  • HSIL
  • Important features of high grade squamous
    intraepithelial lesions are enlarged and/or high
    N/C ratio, centrally placed nuclei,
    hyperchromasia, and irregular nuclear membranes.

5
40 year old woman, history of squamous cell
carcinoma of the cervix.
  • NILM Reactive cellular changes associated with
    Radiation
  • Enlarged nuclei with abundant polychromatic
    cytoplasm with vacuolization. Mild nuclear
    hyperchromasia without coarse chromatin,
    prominent nucleoli (coexisting repair). Note
    multinucleation (upper right corner insert).

6
What is your interpretation?
  • NILM
  • Pseudokoilocytosis cytoplasmic vacuolization
    without nuclear change of HPV effect.

7
67 year old woman with postmenopausal bleeding
  • Adenocarcinoma, endometrial
  • Three-dimensional papillary cluster of abnormal
    cells with irregular nuclear membranes and
    nucleoli. No evidence of feathering
  • Follow-up adenocarcinoma of the endometrium,
    FIGO Grades I-II

8
Just this cell seen. Whats your interpretation?
  • ASC-US
  • Enlarged nuclei with small perinuclear halo
  • Features are insufficient for an interpretation
    of LSIL.

9
27 year old woman. LMP two weeks ago
  • ASC-H
  • Metaplastic cells with increased NC ratios and
    nuclear contour irregularities.
  • HSIL on repeat Pap CIN3 on LEEP

10
26 year old woman, LMP 2 weeks, mild vaginal
discharge
  • NILM Reactive squamous cellular changes
    associated with Trichomonas vaginalis
  • Trichomonas also seen. Where?

11
What is your interpretation?
  • LSIL
  • Binucleation and koilocytes in mildly dysplastic
    mature cells is consistent with HPV effect.

12
What is your interpretation?
  • HSIL
  • "Keratinizing dysplasia". The dysplastic cells in
    this field display enlarged nuclei with coarsely
    granular chromatin and keratinized cytoplasm.
    Occasional cells have pyknotic or opaque nuclei
    with sharp, angled edges and abnormal cell shapes
    are seen.

13
What is your interpretation?
  • NILM Shift in Flora suggestive of bacterial
    vaginosis
  • Filmy background of small coccobacilli.
    Individual squamous cells covered by a layer of
    bacteria. Conspicuous absence of lactobacilli.

14
58 year old woman, LMP 8 years, postmenopausal
bleeding
  • Adenocarcinoma, Endometrial
  • Large aggregate of small cells with irregular
    chromatin distribution, small nucleoli, poorly
    defined finely vacuolated cytoplasm in a watery
    background.
  • In conventional smears, endometrial
    adenocarcinoma tends to be associated with a thin
    watery diathesis in contrast to the bloody,
    necrotic background often seen with endocervical
    adenocarcinoma.
  • Follow-up Adenocarcinoma of the endometrium

15
What is your interpretation?
  • NILM Cellular changes consistent with Herpes
    simplex virus
  • Note the intranuclear inclusions Vs nucleoli
  • The ground-glass appearance of the nuclei is due
    to accumulation of viral particles leading to
    peripheral margination of chromatin.

16
45 year old
  • Squamous cell carcinoma
  • Dysplastic squamous cells with anisocytosis and
    anisonucleosis including keratinization and
    tadpole cells are diagnostic of invasive squamous
    cell carcinoma.

17
41 yrs old, routine exam
  • NILM Endometrial cells in a woman gt 40
  • Three-dimensional cluster with slightly larger
    nuclei and nucleoli.

18
39 year old woman, routine Pap smear, no LMP
date given
  • Atypical endocervical cells, NOS
  • Sheet of cells with enlarged round or oval nuclei
    with prominent nucleoli. Chromatin is finely
    granular and evenly distributed but occasional
    chromocenters are seen. Cell borders are
    well-defined. Mitotic figures are noted.

19
63 year old woman with postmenopausal bleeding
  • Atypical endometrial cells
  • Aggregate of small cells with slightly enlarged
    round or oval nuclei, small nucleoli and finely
    vacuolated cytoplasm.
  • Follow-up Adenocarcinoma of the endometrium,
    grade I

20
32 years old, mother of 3 children
  • NILM Reactive cellular changes associated with
    IUD
  • Note small cluster of glandular cells with
    cytoplasmic vacuoles displacing nuclei. The
    cytoplasmic vacuoles may displace the nucleus,
    creating a signet-ring appearance.

21
What is your interpretation?
  • Squamous Cell Carcinoma-clinging diathesis
  • Tumor diathesis, variation in cell size and
    shape, evidence of keratinization, and nuclear
    abnormalities are all demonstrated in this image
    from a squamous cell carcinoma.

22
41 year old. No history provided
  • NILM Bacteria morphologically consistent with
    Actinomyces spp.
  • Tangled clumps of filamentous organisms, often
    with acute angle branching, sometimes showing
    irregular wooly appearance. Swollen filaments may
    be seen with clubs at periphery. A cotton ball
    like acute inflammatory response is common.

23
What is your interpretation?
  • NILM Tubal metaplasia
  • Cell group demonstrating crowding,
    pseudostratification and oval or elongated
    nuclei. Note the presence of cilia in some
    cells.

24
What is your interpretation?
  • Endocervical adenocarcinoma in situ (AIS)
  • Cluster of cells with crowded overlapping oval
    nuclei that show hyperchromasia and evenly
    distributed by coarsely granular chromatin. Smear
    background is clean.
  • Nuclear crowding and overlapping, hyperchromasia
    and evenly distributed granular chromatin are
    classic features of AIS.

25
39 year old female, Day 12 of cycle
  • Adenocarcinoma, Endocervical
  • Cluster of cells enlarged nuclei, macronucleoli
    and some nuclear membrane irregularities poorly
    defined, finely vacuolated cytoplasm ghost of
    RBC's and cell debris noted at the edge of the
    cluster ("clinging diathesis").
  • Follow-up Endocervical adenocarcinoma

26
What is your interpretation?
  • HSIL
  • HSIL with extension into gland space. Note that
    in addition to the abnormal cells themselves,
    there is flattening of cells at the edge of the
    cluster, lack of columnar shape and loss of
    polarity.

27
32 year old, LMP now, abnormal cervix on exam
  • Adenocarcinoma, endocervical
  • Large group of abnormal cells with round to
    elongated hyperchromatic nuclei and granular
    chromatin. Note pseudostratified strips with
    feathering at the edges. Nuclear crowding and
    overlap are prominent. Smear background is
    bloody.
  • The cytologic features of endocervical
    adenocarcinoma may overlap with those of
    endocervical adenocarcinoma in situ, but features
    of invasion, such as tumor diathesis, are seen.
  • Follow up Endocervical adenocarcinoma

28
79 year old postmenopausal woman, being
evaluated for possible Squamous cell carcinoma of
vulva
  • NILM Atrophy
  • Sheets of uniform orderly parabasal cells are
    observed representing deep parabasal cells. Some
    nuclei show grooves, but chromatin pattern is
    fine. Atrophic cells may have nucleoli (lower
    right insert).

29
End of Exercise
  • More cases http//nih.techriver.net/atlas.php
  • Self-test
  • http//nih.techriver.net/diagnosis.php
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