PART TWO
Diagnostic Cytology
contain glycogen. Also, during pregnancy, as a result of the rela-
tive predominance of progesterone, maturation of the epithe-
lium becomes reduced. The epithelial lining is then composed
of intermediate-type cells, with cyanophilic-staining cytoplasm,
often with a pronounced outer zone. These rather characteristic
cells are also called
navicular cells.
The underlying stroma some-
times shows a large-cell—decidual—reaction, as is physiologic
in the endometrial stroma (Fig. 8.6). These large stromal cells,
when present in smears, may cause differential diagnostic prob-
lems with cells from invasive processes, particularly adenocar-
cinomas, because of large, prominent nucleoli (Fig. 8.7). Their
occurrence in sheets and as single cells, not in clusters, together
with the evenly distributed, finely granular nuclear chromatin,
against the background of the pregnancy, should provide the
correct diagnosis.
Also, after the last menstrual period—menopause—the epi-
thelium reduces in thickness and again becomes atrophic. The
epithelial cells do not contain glycogen, and the epithelium
Fig. 8.6
Atrophy of the
ectocervical squamous epithelium
during
pregnancy. Decidual change of cervical stromal cells (H&E x MP).
in its atrophic state becomes highly vulnerable to even slight
trauma and often shows signs of inflammation (see Figs 8.3,
8.16, and 8.17). An absolute or relative reduction in the level of
circulating estrogenic hormones leads to lysis of the cytoplasm
of vaginal and cervical squamous cells, as is evident during the
second, or luteal, phase of the menstrual cycle, during preg-
nancy, during lactation, and after menopause. Cytolysis may be
conspicuous, resulting in a large number of bare nuclei through-
out the smear (Fig. 8.8).
Continuous stimulation by estrogenic hormones causes
hypertrophy of the superficial layers of the ectocervical squa-
mous epithelium and induces hypersecretion of the endocervical
columnar epithelium. The superficial squamous layers are com-
posed of large polygonal cells with clear, slightly eosinophilic
staining cytoplasm and very small, almost completely pyknotic
nuclei. The presence of these cells in smears from women in
postmenopause, particularly when endometrial cells are also
found, should be a warning signal of an endometrial abnormal-
ity induced by the continuous estrogenic growth stimulus and
requires additional diagnostic evaluation.
Endocervix
The epithelial lining of the endocervical canal is formed by a sin-
gle layer of tall columnar cells (Fig. 8.9). Owing to an arrange-
ment of the nuclei on different levels and variability in size of the
columnar cells, this epithelial lining often has a pseudostratified
appearance. The surface of the endocervical canal is irregularly
shaped, with invaginations extending up to 8 mm deep into the
cervical stroma (Fig. 8.10). In tissue sections, these invaginations
are often tangentially cut and appear as round or oval epithelial
stromal inclusions. They are then often referred to as
endocervical
glands,
even though the uterine cervix does not contain glands
in the strict sense. The lining columnar epithelial cells are the
source of the mucus that covers the epithelium and composes
the mucus plug that fills the endocervical canal. The configura-
tion of the epithelium, the amount of mucus produced, and the
consistency of the mucus vary with the hormonal status.
In a normal cervical smear, endocervical columnar cells
appear as tall columnar cells with a large body of clear, finely
Fig. 8.7 Large stromal cells
in a cervical smear during pregnancy show
large nuclei with prominent nucleoli and an evenly distributed finely granular
chromatin (Papanicolaou x MP).
Fig. 8.8 Cytolysis.
Bare nuclei are due to lysis of the cytoplasm. Doderlein
bacilli are conspicuous (Papanicolaous x HP).
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