Cytological changes in abnormal conditions Dr Tarek Atia

Cytological characters of normal The cells are uniform in size and shape. The cells are uniform in nuclear and cytoplasmic ratio. Normal polarity (normal arrangement of cells to the neighbouring cells).

Inflammatory Cellular Changes Inflammation could make some cellular changes. These changes could be Cytoplasmic or Nuclear.

A- Cytoplasmic Changes 1- Loss of cilia of endo-cervical cells; as in Viral infection Mechanical effect (trauma) Metaplastic changes. 2- Variation of the shape and size of cells Small cells: small atrophic cells (postmenopausal cells) Enlarged cells: hyperactive cells secretion.

3- Vaculation of the cytoplasm 3- Vaculation of the cytoplasm. 4- Perinuclear halo: clear spaces around the nucleus. 5- Biphasic cytoplasm: area of eosinophilic cytoplasm with area of basophilic cytoplasm in some cells. 6- Infiltration of the cytoplasm by bacteria, or presence of acute inflammatory cells -------- diagnostic feature of acute inflammation in smear.

B- Nuclear Changes 1- Enlargement of the nucleus 2- Multinucleated cells: - Viral infection - TB; Langhans giant cells 3- Intranuclear vaculation or halo: in viral infection. 4- Disturbance of chromatin distribution: - Rearrangement of chromatin in a circular shape (peripheral) under nuclear membrane; as in viral infection.

5- Post-necrotic nuclear changes - Pyknosis: small dense nucleus. - Karyorrhexis: fragmentation of the nucleus - Karyolysis: lysis and dissolved nucleus 6- Stripped nuclei: rounded or oval blue nuclei without cytoplasm, due to lysis of cytoplasm by proteolytic enzymes. They have well defined sharp nuclear membrane They have fine granular chromatin They are usually occur in endocervical and intermediate squamous vaginal epithelium.

Cytological characters of precancerous cells Loss of stratification: loss of the normal arrangement of epithelial cells into layers. Distorted cells with enlarged, irregular, hyperchromatic nuclei. Increased Nuclear / Cytoplasm (N/C) ratio Nuclear mitosis are present at high level at the top layer more than the basal layers.

Enlarged nuclei with increased N/C ratio Enlarged nuclei with irregular nuclear membrane

Cytological characters of Malignant Cells 1- Nuclear criteria 2- Cytoplasmic criteria 3- Malignant cells intrcellular relationship

1- Nuclear criteria 1. Enlarged hyperchromatic nuclei: deep blue hyperchromatic nuclei due to increase DNA content. 2. Variation of the nuclear shape and size: Variation in size and shape reflecting abnormal cell division and maturation 4. Abnormal chromatin distribution in the nucleus, changes of nuclear membrane 5. Irregular enlarged prominent nucleoli. 6. Multinucleated malignant giant cells 7. Abnormal mitosis.

2- Cytoplasmic criteria Scanty cytoplasm Decreased C/N ratio Tight holding of membrane around nucleus Secretory or inclusion bodies of cytoplasm

3- Malignant cells intrcellular relationship Variation of the size and shape of malignant cells Decreased adhesions between cells Abnormal stratification and polarity