PART TWO
Diagnostic Cytology
Fig. 7.32
E n ta m o e b a g in g iv a lis .
(A) Vaginopancervical smear (Papanicolaou x HP). (B) LBGS (Papanicolaou x HP).
Fig. 7.33 "Bubble-gum" cells
occurring in a patient with an IUD. (A) Vaginopancervical smear (Papanicolaou x HP). (B) IUD-associated glandular cells LBGS
(Papanicolaou x MP).
Table 7.5
Comparison of IUD-associated columnar-type cells
and adenocarcinoma cells
Feature
IUD columnar cells
Tumor cells
Tumor diathesis
Absent
Present
Distribution
Endocervical
Random
Inflammation
Present
Variable
Cellular
degeneration
Present
Absent
"Bubble gum" cyto-
plasm
Present
Absent
Bare nuclei
Absent
Present
Cellular preservation
Poor
Good
Atypical histiocytic
cells
Absent
Present
fungal or BV infection. Nearly half (47%) of the 1,000 patients
studied were oral contraceptive users. Pregnancy and menopause
were other physiologic features, followed by the postpartum
state, that were often associated with the presence of
L. buccalis
in cervical smears. Sometimes acute inflammatory changes may
be observed in the presence of
Leptotrichia.
Mycoplasma
These are the smallest known organisms capable of growing in cell-
free media. Jones and Davson documented a correlation between
the occurrence of a "dirty" smear and mycoplasma,61 and Mardh
and co-workers confirmed these findings and reported the occur-
rence of coccoid organisms both on the surface and in between the
squamous epithelial cells in dirty smears in cases of
Mycoplasma
.49
Such features appear to have limited practical value.483,49
Follicular Cervicitis
Also referred to as lymphocytic cervicitis, this is a specific type
of cervical, and sometimes vaginal, lesion in which the pre-
dominant feature is the occurrence of lymphoid follicles in the
subepithelial areas. When examined cytologically, numerous
mature and reactive lymphoid cells and germinal macrophages
(tingible bodies) are seen (Fig. 7.36A).50 Cellular changes are
uncommonly recognized in LBGS (Fig. 7.36B) and are often
more problematic to interpret. Small lymphoid cells appear in
aggregates especially in LBGS and do not clearly reveal tingi-
ble bodies.51 Lack of mucus and small size of the lymphocytes
appear to contribute to these morphologic changes. At times,
a capillary from the germinal center of the lymphoid follicle
may be scraped and observed in the smear (Fig. 7.37). There is
evidence that nearly 50% of the cases of follicular cervicitis are
104
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