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Cervix-Cytology

Benign / non-neoplastic lesions

Atrophy


Reviewer: Farnaz Hasteh, M.D., UCSD Medical Center (see Reviewers page)
Revised: 16 November 2010, last major update November 2010
Copyright: (c) 2006-2010, PathologyOutlines.com, Inc.

Definition
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● Increased number of basal and parabasal cells, associated with diagnosis of ASCUS

Clinical features
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● May cause increased incidence of ASCUS in Pap smears of peri- and post-menopausal women (Cancer 2001;93:100)
● Associated with scanty smears (Cytopathology 1997;8:274), ASCUS in post-menopausal women (Diagn Cytopathol 2001;24:132)
● Changes may disappear after topical estrogen

Prognostic features
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● New guidelines recommend HPV testing as initial triage management of postmenopausal women with cytologic result of LSIL (Arch Pathol Lab Med 2009;133:1276)

Treatment
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● Estrogen - will cause atypical atrophic cells to mature, but dysplastic cells will not respond (Cancer 1998;84:218)

Micro description
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● No atypia in upper epithelial layers, no mitotic figures

Cytology description
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● Increased number of parabasal cells and basal cells, which form sheets and syncytial-like aggregates or hyperchromatic crowded groups
● Naked nuclei (small cells) may be seen
● Cells have high N/C ratio but uniform chromatin
● Pseudokeratinized cells (pink to orangophilic cytoplasm) are due to degeneration
● Severe atrophy can show dirty background with inflammation, debris, old blood, blue blobs and giant cells
● In liquid based cytology, background of atrophic smear is cleaner
● May resemble urothelial metaplasia, but cells have prominent intercellular bridges
● Nuclei are uniform, evenly spaced, often elongated with grooves

Cytology images
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Various images

Negative stains
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● Ki-67 (Gynecol Oncol 2000;79:225, J Pathol 2000;190:545), cyclin E, p16

Videos
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Cervical atrophy

Differential diagnosis
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● SIL: strong Ki-67+ and p16 staining in 75-80%, strong cyclin E+ in 31% (J Low Genit Tract Dis 2005;9:100)
● Dirty background of severe atrophy can mimic tumor diathesis

End of Cervix-cytology > Benign / non-neoplastic lesions > Atrophy


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