Table of Contents
Definition / general | Essential features | Terminology | ICD coding | Cytology - normal | Cytology - nonneoplastic findings | Cytology images | Positive stains | Negative stains | Sample pathology report | Additional references | Board review style question #1 | Board review style answer #1 | Board review style question #2 | Board review style answer #2Cite this page: Ren S. Normal and nonneoplastic findings. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/cervixcytologybenignfeatures.html. Accessed January 17th, 2021.
Definition / general
- Normal and nonneoplastic findings in cervical components of Pap test for routine screening for cervical cancer
- Preparations: conventional and liquid based (ThinPrep and SurePath)
Essential features
- Normal cellular elements:
- Squamous cells:
- Superficial cells
- Intermediate cells
- Parabasal and basal cells
- Endocervical cells, endometrial cells and lower uterine segment cells
- Squamous cells:
- Nonneoplastic findings:
- Variations, reactive changes and inflammatory cells
Terminology
- Pap smear / test
ICD coding
- ICD-10: Z01.419 - encounter for gynecological examination (general) (routine) without abnormal findings
Cytology - normal
- Squamous cells: ectocervical stratified epithelium
- Superficial cells:
- Outermost layer
- Small highly condensed / pyknotic nucleus
- Abundant, usually eosinophilic cytoplasm
- Intermediate cells:
- Middle layer
- Larger nucleus with finely granular chromatin and often longitudinal groove
- Abundant cytoplasm
- Parabasal and basal cells:
- Also called immature squamous metaplastic cells
- Least mature cells
- Deep layer
- Nucleus larger than intermediate cells
- Scant cytoplasm, more granular and dense
- High nuclear to cytoplasmic ratio
- Hallmark of atrophy:
- Low estrogen state: premenarche, postpartum, postmenopause, Turner syndrome and postoophorectomy
- Superficial cells:
- Endocervical cells:
- Picket fence or honeycomb configuration
- Mucin producing glandular cells with polarity, nuclei at one end and mucus at the opposite end
- Nucleus slightly larger than intermediate cell nucleus
- Nucleus with finely granular and even chromatin and small nucleoli
- Vacuolated or granular cytoplasm
- Endometrial cells and lower uterine segment cells:
- Glandular cells, tight clusters or isolated
- Smaller than endocervical cells
- Nucleus equal or slightly smaller than intermediate cell nucleus, dense heterogeneous chromatin
- Scant cytoplasm, dense or vacuolated
- Exodus: exfoliated dense aggregates of endometrial stroma cells with a surrounding layer of glandular epithelium
Cytology - nonneoplastic findings
- Variations:
- Bland nuclear enlargement
- Squamous metaplasia: replacement of endocervical cells
- Stimulated by trauma, infection or inflammation
- Spectrum of morphologic changes
- Immature parabasal-like cells
- Intermediate / superficial cells-like squamous cells
- Hyperkeratosis:
- Anucleate mature polygonal squamous cells
- Empty spaces or ghost nuclei
- Parakeratosis:
- Miniature superficial squamous cells with dense eosinophilic cytoplasm
- Small and dense nuclei
- Tubal metaplasia (Diagn Cytopathol 1993;9:98):
- Replacement of endocervical epithelium by fallopian tube-like epithelium with cilia and terminal bar
- Pregnancy related changes:
- Decidual cells (Diagn Cytopathol 2013;41:886)
- Cytotrophoblast and syncytiotrophoblast
- Arias-Stella reaction (Diagn Cytopathol 1996;14:349)
- Reactive changes:
- Associated with inflammation, radiation therapy and intrauterine contraceptive device
- Glandular cells status post hysterectomy
- Inflammatory cells:
- Present in different conditions
- Neutrophils, lymphocytes, plasma cells and histiocytes
- Artifact:
- Barr body: darkly stained body attached to nuclear membrane
- Inactive X chromosome, present on nuclear margin, formed by telomere association (Proc Natl Acad Sci USA 1991;88:6191)
- Blue blobs: dark blue, rounded, amorphous masses
- Condensed mucus, degenerated bare nuclei or precipitating hematoxylin
- In postmenopausal women, represent parabasal / intermediate squamous cells with various degrees of degeneration (Acta Cytol 2000;44:547)
- May have string of pearls appearance on ThinPrep in postmenopausal atrophy (Diagn Cytopathol 2010;38:233)
- Cornflakes:
- Brown artifact of air bubbles trapped on superficial squamous cells resulting in obscuring of nuclei
- More common on conventional than liquid based preparations
- It can be reversed by returning the slides through xylene and alcohol to water then restaining and recoverslipping
- Degeneration / air drying artifact:
- Degenerative type changes due to delay in transfer of cells to the slide, inflammation or atrophy
- Cytoplasm is lost and moth eaten with vacuolization
- Chromatin is clumped, hazy, smudged or indistinct
- Chromatin rim has variable thickness and irregular contours but no sharp angles of malignancy
- Barr body: darkly stained body attached to nuclear membrane
Cytology images
Contributed by Shuyue Ren, M.D., Ph.D.
Negative stains
- Benign squamous cells: p16
Sample pathology report
- Specimen adequacy:
- Satisfactory for evaluation; endocervical cells / transformation zone component present
- General categorization:
- Negative for intraepithelial lesion or malignancy
Additional references
Board review style question #1
A 35 year old woman presents for routine gynecological examination and Pap test is performed. What kind of squamous cells are predominantly present?
- Basal cells
- Intermediate cells
- Parabasal cells
- Superficial layer cells
Board review style answer #1
Board review style question #2
A 40 year old woman presents for routine gynecological examination and Pap test is performed. A tight cluster of cells is noted. By 2014 Bethesda System, how do you report the cluster of cells?
- Endocervical cells, not reported
- Endocervical cells, reported
- Exfoliated endometrial cells, not reported
- Exfoliated endometrial cells, reported
Board review style answer #2
C. Exfoliated endometrial cells, not reported. By 2014 Bethesda System, exfoliated endometrial cells should be reported in a woman 45 years of age or older.
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Reference: Normal and nonneoplastic findings
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Reference: Normal and nonneoplastic findings