Cervix Cytology

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Cervix-Cytology

Normal cells / non-neoplastic findings

Repair

Reviewer: Farnaz Hasteh, M.D., UCSD Medical Center (see Reviewers page)
Revised: 14 June 2011, last major update June 2011
Copyright: (c) 2006-2010, PathologyOutlines.com, Inc.

Definition
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● Changes seen with inflammation, radiation, chemotherapy or trauma
● Common source of diagnostic error (Arch Pathol Lab Med 2001;125:134)

Epidemiology
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● Common in postpartum women and after radiation therapy (Diagn Cytopathol 1995;13:107)

Etiology
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● When mucosa is denuded or damaged, the underlying or peripheral epithelial cells rapidly proliferate with increased protein synthesis to fill the defect; these cells have cytologic features described below, which may mimic malignancy

Clinical features
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● Differentiating repair from dysplasia is very important

Cytology description
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● Cohesive monolayers of cells with well defined or indistinct borders, abundant cytoplasm (usually blue but no organgophilia/keratinization), uniform enlarged nuclei, finely granular and evenly distributed chromatin; nuclei may be hypo- to hyperchromatic, but almost all have prominent round nucleoli and normal N/C ratio
● Cells still keep their order and do not overlap, although they may fold on themselves, giving the impression of a syncytium
● Almost all cases have a chronic inflammatory infiltrate
● May see multinucleation
● Normal mitotic figures may be seen
● Single cells are rare
● If atypia present, must include diagnosis of ASCUS in cytology report, although this has been questioned (Diagn Cytopathol 2005;33:214)
● In liquid based cytology, repair groups are more rounded because of preparation

Cytology images
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Reparative changes - various images

HSIL not repair

Liquid based cytology

Positive stains
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● Ki-67 present in both reactive and atypical lesions (Mod Pathol 2003;16:665)

Negative stains
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● p16

Differential diagnosis
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● SIL: pleomorphic nuclei in all cases, usually coarse chromatin and mitotic figures, usually no inflamed stroma
● Metaplastic epithelium: usually small nucleoli and no inflamed stroma, occasional nuclear pleomorphism or mitotic figures (Int J Gynecol Pathol 1996; 15:338)

End of Cervix-cytology > Normal cells / non-neoplastic findings > Repair

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