Cervix

• 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 N:C ratio
    • Hallmark of atrophy
      • Low estrogen state: premenarche, postpartum, postmenopause, Turner syndrome and postoophorectomy
• 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 stromal cells with a surrounding layer of glandular epithelium

Contributed by Shuyue Ren, M.D., Ph.D.

A 35 year old woman presents for routine gynecological examination and Pap test is performed. What kind of squamous cells are predominantly present?

1. Basal cells
2. Intermediate cells
3. Parabasal cells
4. Superficial layer cells

D. Superficial layer cells. Superficial squamous cells are typically observed in young women and abundant during the ovulatory phase of the menstrual cycle when estrogen levels are high. Answer A is incorrect because basal cells are immature squamous cells typically found in the deepest layer of the cervical epithelium. They are rarely seen in Pap smears, unless there is severe atrophy. Answer B is incorrect because intermediate squamous cells are immature squamous cells. These cells are often seen in response to hormone changes, like during pregnancy or postpartum. Answer C is incorrect because parabasal cells are immature squamous cells, often seen in conditions including atrophy, inflammatory change or hormonal imbalances.

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Reference: Cervix cytology - Normal and nonneoplastic findings

A 40 year old woman presents for routine gynecological examination and Pap test is performed. A tight cluster of bland 3D endometrial cells are noted. By 2015 Bethesda system, how do you report the cluster of cells?

1. Endocervical cells, reported
2. Exfoliated endometrial cells, not reported
3. Exfoliated endometrial cells, reported
4. Exodus ball, reported

B. Exfoliated endometrial cells, not reported. Exfoliated endometrial cells are not reported. By 2015 Bethesda system, exfoliated bland 3D endometrial cells should be reported in a woman ≥ 45 years of age. Answer A is incorrect because benign endocervical cells are not required to report. Answer D is incorrect because an exodus ball is a collection of peripheral glandular and central stromal endometrial cells, typically seen between day 6 and 10 of the menstrual cycle. Exodus is not required to report in a woman < 45 years of age. Answer C is incorrect because exfoliated endometrial cells are not required to report in a woman < 45 years of age.

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Reference: Cervix cytology - Normal and nonneoplastic findings