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Cervix-Cytology

Atypia / premalignant / preinvasive lesions

Squamous cell carcinoma of cervix


Reviewer: Marilin Rosa, M.D., University of Florida (see Reviewers page)
Revised: 9 June 2011, last major update June 2011
Copyright: (c) 2006-2010, PathologyOutlines.com, Inc.

Definition
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● Malignant invasive tumor showing squamous cell differentiation
● Diagnosis in conventional smears is more likely to be missed if few malignant cells and not keratinized (Arch Pathol Lab Med 2005;129:1097); also if Trichomonas present (Arch Pathol Lab Med 2004;128:403)

Epidemiology
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● Invasive squamous cell carcinoma is the most common malignant neoplasm of the uterine cervix
● Reduced prevalence due to Papanicolaou smear testing to detect premalignant lesions (currently 1 million cases of SIL detected per year in US, 13,000 new invasive carcinomas)

Etiology
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● Associated with high risk human papillomavirus (HPV) infection

Cytology description
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● Highly irregular shaped cells (tadpole, caudate)
● Keratinized cells are orange, often with squamous pearls
● Nonkeratinized cells have dense, hard, basophilic cytoplasm
● Also cannibalism (tumor cells surround other cells)
● Prominent nucleoli may be seen
● Compared to adenocarcinoma, have more irregular cellular and nuclear shapes, more cytoplasmic density, more chromatin granularity, more hyperchromasia
● Tumor diathesis in background (necrosis, hemorrhage, inflammatory cells) is suggestive of malignancy
● Tumor diathesis in liquid based cytology is more subtle than with with conventional smears; consists of necrotic material at peripheral of cell groups (“clinging diathesis”) and not in the background
● Other features in liquid based cytology are mild to moderate inflammation, coexistent dysplasia, keratinization, decreased cell coverage (Diagn Cytopathol 2002;26:1)
Papillary squamotransitional carcinoma of cervix: liquid based cytology specimens are moderately to highly cellular with three dimensional, arborizing, papillary clusters of basal or parabasal cells; occasional fibrovascular cores; cells vary from bland to SIL; frequent mitotic figures; occasional tumor diathesis and dyskeratotic cells; no koilocytosis (Acta Cytol 2003;47:141)

Cytology images
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Keratinizing and nonkeratinizing tumors

               
Hyperchromatic spindle-like cells with heavy keratinized cytoplasm
SurePath (liquid based cytology) images contributed by Frank Melgoza MD and Mai Gu MD PhD, UC Irvine, California (USA):

Differential Diagnosis
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Keratinizing dysplasia involving endocervical glands: (Diagn Cytopathol 2003;28:23)
Atrophic vaginitis with Thin-Prep: similar background, but no malignant squamous epithelial cells, (Diagn Cytopathol 2002;27:362)
HPV related changes: no irregular shapes, not heavy keratinization, no tumor diatheses
Radiation related changes:

End of Cervix-cytology > Atypia / premalignant / preinvasive lesions > Squamous cell carcinoma of cervix


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