Pap smear

PAP SMEAR PATHOLOGY Various slide ABOUTE many candition can see in popanicula smear test short disscution about epidemiology and screening hpv bethesda reporting and how to pop smearing when to pop smear and organism metaplasia and other condition lsil hsil cin1 cin2 cin3 ascus asch

1. بسم الله الرحمن الرحیم in the name of GOD the compassionate the merciful

2. Pop smear M.A.Nourani MEDICAL STUDENT

3. What is pop smear? Is obtaining sample of exfoliated cervical cell The test was invented by Dr. Georgios Pap anikolaou (1928)

4. purpose . to detect potentially precancerous changes ( called cervical intraepithelial neoplasia (CIN ) or squamous intraepithelial lesion system (SIL )) caused by human papillomavirus .detect infections and abnormalities in the endocervix and endometrium

5. How to do Time : tow week after LMP Don’t intercourse for 3 day Don’t use vaginal cream Empty bladder before In speculum insertion Don’t use lubricant gel (if need use sterile water)

6. Conventional(slide) or liquid base

7. No problem

8. When to do pop smear Start: 21 y o or 3 year after first sexual activity 21-30:every 3 years 30-65: if last 3 test is normal repeat every 3 year With normal HPV test every 5 year After 65:if last 3 test normal not necessary annual screening should not be done

9. In case of total hysterectomy pop smear not necessary if it due to benign cause other than positive HPV In case that don’t have cervix sample from vigina cuff In case supera cervical hysterectomy follow guide line 5 year co-test If person don’t : Use DES(Diethylstilbestrol is an estrogen ) History of CIN3 Immune deficiency (HIV , transplant)

10. Epidemiology : cervical cancer the fourth most common cancer in women in world The second most common cancer in woman in iran Two HPV types (16 and 18) cause 70% of cervical cancers and pre-cancerous cervical lesions (WHO) Other source say hpv exist 99% of cervical cancer About 660 million persons infected by HPV

11. hpv is the most common sexually transmitted infection in the world Cause of cervical cancer and wart Has 200 type Tow vaccine exist Cervarix = for type 18,16 Gardasil = for type 18,16,11,6 Vaccine can’t alternative to pop smear Mechanism: attach to p53 and retinoplastoma (tumor suppressor pro)

12. Transformation zone Endocervix =columnar Ectocervix =squamous Between them = squamocolomnar junctio n A dynamic zone affected by puberty pregnancy menopause …

13. Cervix NORMAL Histology

14. Normal Squamous Epithelium

15. Basal cell PMN

16. Parabasal cell

17. Intermediate cell

18. Superficial cell: Dark and picknotic nucleus

19. Normal pop smear

20. glandular cells from endocervix Always in cluster(group) Normal columnar

21. Columnar cell from fallopian tube have cillia

22. Endometrial cell (exodus ball) Seen in 6-10 day menstural cycle it is group of endometrial cell like ball Last remnant of endometrial shedding and the cells show degenerative changes After 40 yo must be reported and can phathologic

23. lymphocyte

24. Polymorphs

25. sperm

26. Metaplastic Cells A cell that was endocervical are changing to squamous cell

27. Satisfactory Squamous Cellularity In past: Presence or absence endocervical cell is important Now: Enough number of squamous cell In conventional 8000 In liquid base 5000 Presence of endocervical cell Confirm taking sample from transformation zone

28. Satisfactory: Borderline adequate squamous cellularity

29. Unsatisfactory due to scant squamous cellularity

30. Unsatisfactory: Obscuring RBCs and WBCs

31. Unsatisfactory- obscuring RBCs and WBCs

32. Trichomonas Vaginalis

33. Candida : characteristic hyphes

34. bacterial vaginosis the presence of multiple microorganisms, which are attached to a single squamous epithelial cell .

35. Chlamydia : target inclusion

36. herpes simplex virus Multnuclated – molding 1 – „milk glass“ nuclei; 2 – multinucleated cells; fused nuclei; 3 – nuclear chromatin is present only close to the nuclear membrane.

37. Atrophy : all similar to parabasal and basal

38. radiation Cellular changes induced by radiation therapy / exposure: vacuolization; cytomegaly ; multinucleated cells; signs of cellular repair / reparation.’

39. IUD 1 – prominent large cytoplasmic vacuole; 2 – small cells can mimic HSIL.

40. CIN VS SIL

41. CIN VS SIL

42. Atypical Squamous Cells-Undetermined Significance(ASC-US)

43. LSIL koilocyte LSIL 1 – enlarged nuclei (approximately 5 x intermediate cell nucleus); 2 – multinucleated cells; 3 – irregular nuclear margins; 4 – presence of rough chromatin deposits; 5 – presence of koilocytes

44. HSIL HSIL 1 – increased number of parabasal cells, enlarged nuclei, irregular nuclear margins, expressed hyperchromia and the presence of rough chromatin deposits.

45. Squamus cell carcinoma Squamous cell carcinoma 1 – signs of HSIL; 2 – large nuclei and irregular chromatin deposits; 3 – tumor diathesis; 4 – cellular polymorphism.

46. Atypical Glandular Cell . Atypical glandular cells: AGC-NOS 1 – endocervical (glandular) cells arranged in piles, hyperchromasia . Not Otherwise Specified (AGC-NOS) (can be classified as endocervical , endometrial or non classified)

47. Atypical Glandular Cells . Atypical glandular cells, which are more neoplastic: AGC-FN 1 – nuclear hyperchromia , nuclei can almost not be visualized . – Favor Neoplasia (AGC-FN) Atypical glandular cells, which are more neoplastic.

48. Adenocarcinoma in situ AIS Adenocarcinoma in situ – AIS A characteristic arrangement of cells in a “rosette-shaped-pattern” is common; increased N and C ratio; nuclei appear oval-shaped; irreglar chromatin deposits “Salt-Pepper”; mucosal cells are diversified.

49. Adenocarcinoma Fig. 19. Adenocarcinoma 1 – round and large nuclei; increased cellular cytoplasma ; 2 – macronucleoli are common; 3 – tumor diathesis.

50. The Bethesda System for Reporting PAP Smear Results

51. The Bethesda System for Reporting PAP Smear Results

52. Thank you