PART TWO
Diagnostic Cytology
Fig. 7.65
Chlamydia trachomatis
infections.
Intracytoplasmic organisms
seen by monoclonal antibodies, elementary bodies. (A) Various intermediate
forms and (B) 60, 50a, FITC, 1/p with AEC changes; (C) monoclonal antibodies
with immunoperoxidase and AEC Chromogen (Cervicovaginal Smear 60
(A) x OI, (B) x HP, (C) x MP).
using appropriate antigen detection techniques in most of the
infected cells (Fig. 7.65). When properly done, the cytodiagnosis
of
Chlamydia
has a high degree of specificity and sensitivity. The
cytomorphologic features are summarized in Table 7.12.
Cellular degeneration with intracytoplasmic inclusion forma-
tion as commonly observed after radiation and chemotherapy,
Table 7.12
Cytologic features of
C hlam ydia trachom atis
infection
Background
Acute inflammation with
numerous polymorphonuclear
leukocytes and macrophages
Infected cells
Metaplastic columnar cells, and
possibly parabasal cells either
singly or in tissue fragments
Morphology
Intracytoplasmic elementary
bodies; faint, acidophilic coccoid
structures occurring diffusely
or focally; moth-eaten appear-
ance; reticulate and intermediate
bodies occurring intracellularly as
thin-walled target forms
Nebular forms occurring as dense
intracytoplasmic structures;
multinucleation and cellular
reactive changes
secretions, and coccoid organisms all can be mistaken for
Chlamydia.
The value of obtaining a proper medical history
and a high-quality representative smear and staining cannot be
overemphasized. Cytomorphological recognition of
Chlamydia
in genital smears is not recommended in routine practice. The
detection is made using more specific and sensitive molecular
techniques.
Fungal infections
Candida albicans
and
Torulopsis glabrata
are now grouped
together, the latter being called
Candida glabrata
.
Candida
infec-
tion generally involves the vulva, the vagina, and sometimes
the cervix. A large proportion (about 40%) of women with
detectable
Candida
organisms may be asymptomatic. Clini-
cally, the infection produces a white, cheesy, thick discharge
with a burning sensation and intense itching. Pruritus is a
common symptom of
Candida
infection involving the vulvar
region. Sometimes there may be minimal vaginal discharge. In
Papanicolaou stained smears, numerous filamentous organisms
may occur, revealing pseudo- and true hyphal and yeast forms
(Fig. 7.66A). Only yeast-budding forms may be observed, espe-
cially among asymptomatic women (Fig. 7.66B). Sometimes
the organisms cause a peculiar fern-like (herringbone/shish
kabob) arrangement of epithelial cells. Fungal organisms can
be suspected in such cases also when the background contains
numerous fragmented leukocytic nuclei (polydust) (Fig. 7.67).
Although the organisms can be conveniently seen in potas-
sium hydroxide (KOH) preparations, a high degree of correla-
tion between the Papanicolaou detection of
Candida
and fungal
cultures exists. With
Candida
infections, squamous cells often
show increased evidence of maturation, with parakeratosis and
hyperkeratosis. Occasional groups of mature squamous cells
can show prominent perinuclear degenerative vacuolar change
which can be mistaken for koilocytosis. In addition, some intact
squamous cells may show nuclear enlargement that can prompt
an interpretation of atypical squamous cells of undetermined
significance.
Rare cases of blastomycosis have been observed in vaginal
smears.
Alternaria, Aspergillus,
and other fungi seen in the vaginal
specimens are most often contaminants.
122
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