1. Ayre's spatula, carcinoma cervix.pptx

FGT

1. Female genital tract- I Topics to be covered Ayre’s spatula Carcinoma cervix

2. Case 1

3. Clinical details A 35 year old female visited the gynecology OPD for routine clinical check up She had no specific complaints Cervical cytology examination done 5 years back did not reveal any abnormality A pap smear was performed

4. Ayre’s spatula The long end is inserted into the cervical canal and rotated 360 degree to circumferentially scrape the transformation zone Made of wood so that cells can adhere to porous surface Use of taking pap smear for screening carcinoma of cervix

5. Transformation zone : Hormonally responsive zone of metaplasia between ectocervix and endocervix It is the site of infection with HPV The transformation zone cells are scraped and examined cytologically for epithelial abnormality

6. The transformation zone is circumferentially scraped with the Ayre’s spatula The exfoliated cells obtained are smeared on the glass slide The slide is dipped into a coplin’s jar which contains equal amount of ether and alcohol for fixation The slide is stained by Papanicolaou method The cervical cytology is interpreted by microscopic examination PROCEDURE

7. Normal cervical cells seen on pap smear

8. Abnormal cervical cytology- spectrum of changes and progression of lesion

9. ACOG guidelines for screening ACOG- American College of Obstetricians and Gynecologists

10. Case 2

11. Clinical details A 52 year old female presented with complaints of mild per vaginal bleeding which she noticed for the past three months She was married, had four children and was post menopausal for the past 1.5 years Per speculum examination findings : There was an ulceroproliferative growth in the cervix which bleeds on touch

12. Gross There is an irregular, fungating, tan coloured , ulceroproliferative growth replacing the cervix

13. Gross features There is a fungating (exophytic) mass replacing the cervix Infiltrative masses can also be seen

14. Microscopy SQUAMOUS CELL CARCINOMA- KERATINIZING SQUAMOUS CELL CARCINOMA- NON KERATINIZING

15. Histology features Keratinizing squamous cell carcinoma - composed of nests and tongues of malignant squamous cells with keratin pearl formation Non keratinizing squamous cell carcinoma - Lacks keratinization Adenocarcinoma of cervix is characterized by proliferation of glandular epithelium and arises from endocervix

16. IMPRESSION: CARCINOMA CERVIX

17. Questions to ponder.. What are the risk factors for developing carcinoma cervix? Name the premalignant lesions of carcinoma cervix. Which virus is responsible for development of cervical cancer? Name the high risk strains. What is the mechanism by which this virus causes cervical cancer? How can we screen for cervical cancer? What do we look for while screening? What is the system of reporting cervical smears called? How to prevent the development of cervical cancer?

18. Squamous cervical precursor lesions

19. Can you identify the person shown below? Dr. GEORGE PAPANICOLOAOU Father of Modern Cytology Credited for inventing ‘Pap smears”