?????(exfoliative cytology) :?????,????????????????????????????????????,????,??????????????,???????????????,???????(clinical cytology) ,?????(cytopathology) - PowerPoint PPT Presentation

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?????(exfoliative cytology) :?????,????????????????????????????????????,????,??????????????,???????????????,???????(clinical cytology) ,?????(cytopathology)

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Title: ?????(exfoliative cytology) :?????,????????????????????????????????????,????,??????????????,???????????????,???????(clinical cytology) ,?????(cytopathology)


1
?????????????
  • ??????????????
  • ? ?

2
??????????
  • ?????(exfoliative cytology) ?????,?????????????
    ???????????????????????,????,??????????????,??????
    ?????????,???????(clinical cytology)
    ,?????(cytopathology)

3
??????????
  • 1928?,Papaniculaou ?????????, ????????.
  • 50??,??????
  • 70??,???????????
  • ???,???????DNA???PCR??????????

4
???????????
  1. ?????(???????????)
  2. ?????(?????????????)
  3. ???????(?????????????????)

5
??? ????????
  • ????????
  • ????????????????????,?????????????.
  • ??? (Basal Cells, Parabasal Cells)
  • ?? (Intermediate Cells)
  • ?? (Superficial Cells)

6
??????Squamous epithelium cells
7
(No Transcript)
8
??? ????????
  • ??????
  • ???????????????????????.
  • ???????????????.

9
????????Ciliated columnar epithelium cell
10
????????Ciliated columnar epithelium cell
  • Ciliated columnar epithelium cell with terminal
    bars and cilia.

11
????????Mucus columnar epithelium cell
  • Mucus columnar epithelium cell
  • Note that the nuclei are uniform, basal, and do
    not stratify

12
??? ????????
  • ?????????????
  • ?????
  • ?????

13
??? ????????
  • ????????????
  • ????????????????????????????????????.
  • ?????????.

14
??? ????????????
  • ???(dyskaryosis) ????????,?????????????????,????,
    ???????,????????????????????????????,?????????????
    ???
  • ????????????????,?????????????????????????

15
??????
16
??? ????????
  • ????????????
  • ??????????,?????,??????,??,???,?????,????,??,????
    ??,??????,??
  • ???????????????????????????
  • ?????????,?????

17
?????Squamous cell carcinoma
  • ???????,??????,?????,??????????????????????,??
    ??????,??????????????????????,??????

18
?????Squamous cell carcinoma
19
?? Adenocarcinoma
  • ??????, ????????,???????????????? ???????,
    ????????,????,??????, ???????,?????,???????

20
?? Adenocarcinoma
21
???? Undifferentiated Carcinoma
  • ?????????????????????,??????????????
  • ????????, ?????,???????????????????,???????,??????
    ??????,???,????.

22
??????? Small cell carcinoma
23
?????????Gynecologic Cytology
  • ??????????????????,??????????????

24
????????? (Gynecology Cytology)
  • (?)??????
  • ????
  • ????
  • ????????????
  • (?)??????
  • ???????
  • ?????????
  • ????????
  • ??????

25
??? ????????
  • ????????
  • ????????????????????,?????????????.
  • ??? (Basal Cells, Parabasal Cells)
  • ?? (Intermediate Cells)
  • ?? (Superficial Cells)

26
??????-??????
27
??????-??????
28
??????-??????
29
????????? (Gynecology Cytology)
  • ??????
  • ?????????????
  • ???????
  • ?????????
  • ????????
  • ??????

30
??????? (Endocervical cells)
  • Endocervical cells.
  • Note uniformity of cells Prominent cell
    borders-a benign feature of endocervical
    cells-results in characteristic "honeycomb"
    appearance.
  • Nuclei are round to oval with smooth outlines.
  • This is the classic cytologic appearance of
    benign glandular epithelium from virtually any
    site.

31
??????? (Endocervical cells)
  • Endocervical cells
  • Note that the nuclei are uniform, basal, and do
    not stratify

32
??????? (Endocervical cells)
  • Ciliated endocervical cells with terminal bars
    and cilia.

33
?????? (Endometrial cells)
  • In contrast with usually flat lying,
    well-preserved endocervical cells, endometrial
    cells tend to be "packed together" and
    degenerated.
  • Note that the normal endometrial cell nucleus is
    approximately the size of the intermediate
    squamous cell nucleus.

34
?????? (Endometrial cells)
  • Classic "double contour" arrangement (stroma in
    center surrounded by epithelium) is associated
    with "exodus" (days 6 to 10).

35
????????
  • Cervix (tissue)
  • Transformation zone, from simple columnar
    epithelium of endocervix into squamous
    metaplasia.
  • This area is of particular interest because it is
    where most neoplastic lesions of the cervix
    arise.

36
????????
  • The presence of endocervical cells is one
    measure of the adequacy of a Pap smear,
    indicating that the transformation zone has been
    sampled.

37
????????
  • ??????
  • ????????
  • ??????
  • ???????????? (??????,???????)

38
?????? Trichomonas vaginalis
39
?????? Atrophic Vaginitis
40
?????????????? Cellular changes associated with
Herpes Simplex Virus
41
??????????????? Cellular changes associated with
Human Papiloma Virus
  • HPV infection (tissue)
  • Note well-defined cytoplasmic vacuoles and
    nuclear atypia of the koilocytes.

42
??????????????? Cellular changes associated with
Human Papiloma Virus
43
??????????????? Cellular changes associated with
Human Papiloma Virus
  • Koilocytes HPV infection, low-grade squamous
    intraepithelial lesion.
  • To be a diagnostic koilocyte, the cytoplasmic
    vacuole must be clear and extremely well defined,
    with condensation of the peripheral cytoplasm.
  • In addition, the nucleus must appear abnormal
    Binucleation is common.

44
????????? (LSIL)
  • Low-grade Squamous Intraepithelial Lesion (LSIL)
  • Note resemblance to normal intermediate cells,
    although the cytoplasm is slightly thick and
    dense.
  • The nuclei are "big and dark" .

45
????????? (HSIL)
  • High-grade Squamous Intraepithelial Lesion (HSIL)
  • This is represented by small cells with high
    nuclear/cytoplasmic ratios and irregular nuclei.
  • Note thin rim of dense cytoplasm

46
????????? (Gynecology Cytology)
  • ???????????????????,?????????????(95)??????????
    ??

47
???????Squamous cell carcinoma
  • ???????,??????,?????,??????????????????????,??
    ??????,??????????????????????,??????

48
???????Squamous cell carcinoma
  • Keratinizing squamous cell carcinoma
  • Markedly pleomorphic or bizarre shaped, heavily
    keratinized tumor cells, and marked
    hyperchromasia are characteristic.
  • Cells tend to occur singly.

49
???????Squamous cell carcinoma
50
???????Squamous cell carcinoma
  • Keratinizing squamous cell carcinoma (tissue).
  • Note squamous pearl (aka squamous eddy) pearls
    are pathognomonic of keratinization.

51
???????Squamous cell carcinoma
  • Nonkeratinized squamous cell carcinoma.
  • Compared with keratinizing SCC, the cells of
    nonkeratinizing SCC are more uniform and more
    often occur in aggregates.
  • Nuclear abnormalities are usually easier to
    appreciate in nonkeratinizing SCC.

52
????????? Gynecology Cytology
  • ????????????5??,??????????????????????????,?????
    ???,????,???????,?????,?????????????,????,????????
    ,??????????????,?????,?????

53
???? (Endocervical Adenocarcinoma)
  • Endocervical adenocarcinoma is represented by a
    rosette-like arrangement of malignant
    endocervical cells.
  • Note prominent nucleoli.

54
???? (Endocervical Adenocarcinoma)
  • Endocervical adenocarcinoma in situ.
  • Crowded rosette, Benign endocervical cells rarely
    form rosettes.

55
???? (Endocervical Adenocarcinoma)
56
????????? Gynecology Cytology
  • ??????
  • ???,????????1,?????????????????,????,?????
    ???????,??????????????????????

57
????????? (Small cell neuroendocrine carcinoma)
  • A rare cause of HCGs, small cell neuroendocrine
    carcinoma is cytologically similar to the far
    more common small "oat" cell carcinoma that
    occurs in the lung.
  • Note high nuclear /cytoplasmic ratios, fine, dark
    chromatin, and inconspicuous nucleoli.
  • There is an attempt at rosette formation by the
    cells in this field.

58
??????
  • Malignant mixed mesodermal (müllerian) tumor or
    carcinosarcoma.
  • Often, only the malignant epithelial component is
    seen in the Pap smear. The adenocarcinoma can
    range from well differentiated to poorly
    differentiated.

59
????????? Gynecology Cytology
  • ???????
  • I ? ??????--????
  • ?? ??????,?????
  • ?? ???????
  • ?? ??????????,???????,?????????,????
  • ?? ????,????????.

60
????????? Gynecology Cytology
  • TBS???????,?????????????????TBS???????????
  • ??????????
  • ?????????????????????

61
?????????????????????????????????????????
???????? (Pap x200 obj).
62
????????? Gynecology Cytology
  • TBS??????????????(????????????????????????????)??
    ????(???????????????)?

63
????????? Gynecology Cytology
  • TBS??????????????????????(ASCUS)????????????HPV??
    ??????????(LSIL)????????????(AGUS)?

64
????????? Gynecology Cytology
  • TBS?????????????????????(HSIL)???????????????????
    ????????

65
???
  • ????????????
  • ??????????????
  • ??????????????
  • ???????????????
  • ???????????????????
  • ????????????????????
  • ???????The Bethesda System (TBS)?????????
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