1. Cytopathology
Feb

2. Forcible removed cytopathology:
Gynecological Cytology
Pap smear, used as screening tool, to detect precancerous cervical lesions.
Vaginal smear
Bronchial wash & Bronchial brush.

3. The Pap Smear

4. PAP smear: named after Dr. George Papanicolaou (1883-1962)
Women (1920)
Hormonal cycles
Pathological conditions (1928)

5. Cervical histology Squamous Epithelium Vagina and outer ectocervix
4 cell layers
Well-glycogenated
Columnar Epithelium
Endo-cervical
Single layer arranged in folds
Mucin producing (not true glands)

6. Vaginal Speculum

7. Squamo-columnar Junction Transformation Zone
Majority of cervical cancers and precursor lesions arise in immature squamous metaplasia, i.e. the leading edge of the squamo-columnar junction

8. Gynecological Cytology – Pap Smear

9. Pap Smear

10. Gynecological cytopathology:
For reporting of cervico- vaginal cytology, Bethesda system (1991) is used.

11. FNA: Ovary and Female Genital Tract
The Bethesda classification system for cervical cytopathology (Pap Smear).
Normal and inflammatory cellular changes
Squamous cell abnormalities
Atypical Squamous Cells of Uncertain Significance (ASC, ASCUS)
Squamous Intraepithelial Lesions (SIL) and Squamous Carcinoma (SCCa), HPV lesion
Glandular abnormalities (AGC, AGUS, Ca)
Atypical Glands of Uncertain Significance (AGUS) and Adenocarcinoma
FNA: Ovary and Female Genital Tract

12. Cytologic screening for cervical cancer
Cervical cancer screening has decreased morbidity and mortality
Deaths from cervical cancer decreased from 26,000 to less than 5,000 between 1941 and 1997

13. Pap smears are not perfect
For a high grade lesion, the sensitivity of a single pap smear is only 60-80%
Estimated false negative rate is 30-50%
Requires adequate specimen collection
Requires adequate cytological review
Requires adequate patient and physician follow-up

14. Who to screen? When to screen
HPV
Risk factors for cervical dysplasia
Early onset of sexual activity
Multiple sexual partners
Tobacco
Oral contraceptives

15. Screening frequency
Yearly until three consecutive normal pap smears, then may decrease frequency to every three years
Annual screening for high-risk women is highly recommend.

16. When to stop routine screening
Age 65 and “adequate recent screening”
Three consecutive normal pap smears
No abnormal pap smears in last 10 years
No history of cervical or uterine cancer
Hysterectomy

17. Normal Cervix

18. Squamous Epithelium

19. Endocervix

20. Normal smear

21. Non-Epithelial Cells
Lymphocytes
Polymorphs
sperms

22. Endometrial Cells

23. Squamous Metaplasia Central ectocervix and proximal endocervical canal
Replacement of columnar cells by squamous epithelium
Progressive and stimulated by
Acidic environment with onset of puberty
Estrogen causing eversion of endocervix
Normal
Squamous metaplasia

24. Ectropion / Erosion
At puberty & pregnancy the endocervical cells are pushed out to lie on the ectocervix
Normal
Ectropion

25. Normal Cervix
Wide Ectropion

26. Metaplastic Cells

27. Normal squamous cells

28. Squamous metaplastic cells

29. Squamous cell carcinoma

30. Koilocytes - HPV