Body fluids, cervical pap

fluid cytology

1. Diagnostic cytology… contd Dr. R upinder Kaur

2. Gastrointestinal tract cytology

3. GIT cytology Lesions from the oral cavity can be sampled by scrapping(abrasive cytology) the surface with wooden or metallic spatula Samples from oesophagus , stomach, small and large intestine can be obtained either by brushing or lavage during endoscopy

4. Endoscopic oesophageal Viral brushings candidiasis inclusions

5. Urinary tract

6. Urine cytology 3 consecutive samples necessary to rule out any pathology especially malignancy Early morning freshly voided sample required To be sent to the cytology lab immediately for processing Centrifugation of 10-20 ml of sample at 3000rpm for 5-10 min and smears made from the sediment Fix the smeared slide and stain

7. Urine cytology Paucicellular normally Only very few cells should be seen- squamous and transitional epithelial cells Difficult to interpret reactive vs atypical cells Malignancy based on irregularity of nuclear margins and hyperchromatism ( Transitional epithelial cells)

8. Malignant urine cytology

9. Buccal smear Smears prepared from the oral cavity after cleaning the area For determination of sex chromatin One barr body/nucleus in 20-80% of the cells in a normal female In males count is in <2% nuclei In XXX female 2 barr bodies are seen whereas in XO no barr body is visualized

10. Female genital tract

11. This project on pap smears started during dinner at Il Mulino , a well known Italian restaurant in Manhattan’s West Village

12. Female genital tract Prepared by different methods depending upon the purpose for which they are intended Cervix ( ayres spatula/brush )- Pap smear Vagina ( lateral vaginal wall)- hormonal status Endocervix Combined ecto and endocervix endometrial Study of the cells on smears for screening of premalignant , malignant and other non malignant lesions Cost effective and easy screening method

13. Age Screening < 21 No Screening 21-29 Cytology alone every 3 years 30-65 Preferred: Cytology + HPV every 5 years* OR   Acceptable: Cytology alone every 3 years* > 65 No screening, following adequate neg prior screens After total hysterectomy No screening, if no history of CIN2+ in the past 20 years of cervical cancer ever Triple A Guideline: ACS, ASCCP, American Society for Clinical Pathology CA Cancer J CLIN March 2012 *If cytology result is negative or ASCUS + HPV negative

14. Ayers Spatula Concave end to fit the cervix Convex end for vaginal wall and vaginal pool scrapings

15. Squamo-Columnar Junction Junction of pink cervical skin and red endocervical canal Inherently unstable Key portion of the cervix to sample Most likely site of dysplasia

16. Sample Cervix - Use concave end - Rotate 360 degrees - Don’t use too much force (bleeding, pain) - Don’t use too little force ( inadequate sample)

17. Cytobrush Insert ~ 2 cm (until brush is fully inside canal) Rotate only 180 degrees (otherwise will cause bleeding)

18. Make Pap Smear As thin as possible Properly labeled Put wet slide in fixative 95% alcohol / cytofix

19. Spray with Fixative Within 10-15 seconds Allow to fully dry before packaging Cytologic Fixative (hairspray works acceptably also ) Stain and visualize under microscope

20. Pap smear: reporting Sample adequacy Maximum 10-15,000 squamous epithelial cells in conventional smears Endocervical / transformation zone component(metaplastic cells) may/may not be present Reporting by Bethesda method Sample adequacy, B enign cellular changes, E pithelial cell abnormalities, O ther malignant neoplasms

21. IMPROVEMENTS TO THE PAP TEST New collection devices (brooms and brushes rather than spatulas) Liquid-based Pap Tests rather than smears Ancillary tests such as HPV detection Computerized screening devices.(PAPNET)

22. Liquid Based Cytology – lab processing  

23. conventional Liquid Based Cytology

24. Squamous epithelial cells

25. Endocervical Endometrial Cells cells

26. Normal smear

27. Metaplastic Cells

28. Candida Albicans –Yeast Infection

29. Herpes Simplex-HSV

30. Human Papillomavirus - HPV

31. Cervical intraepithelial lesions

32. Squamous intraepithelial lesion

33. Low grade squamous intraepithelial lesion(LSIL)

34. HSIL- High grade squamous intraepithelial lesion