PART TWO
Diagnostic Cytology
Fig. 8.37
Minimally atypical
squamous epithelium.
Irregular arrangement
of cells and slightly abnormal nuclei in the basal and parabasal layers.
Reduced maturation of cells and slight nuclear enlargement in more
superficial layers (H&E x HP).
reparative. All of these reactive changes may result in some form
of epithelial atypia in that certain morphologic features that are
present represent a departure from the normal.
Repair epithelium in experimental animals has been found
to be more susceptible to the action of carcinogenic agents than
nontraumatized tissue.22
Regeneration of cells as a manifestation of a reparative
change can occur in squamous epithelium, in squamous meta-
plasia epithelium, and in columnar epithelium.23 Geirsson and
colleagues found 51.3% of the cells in tissue repair to be of glan-
dular origin, 38.7% of squamous metaplasia origin, and 10% of
squamous origin.24
Reparative reactions are frequent in patients who have had severe
recurrent cervicitis and in patients who have had recent treatment
such as punch biopsies, conization, cryosurgery, laser therapy, and
endocervical curettage. This type of reaction is also found after
hysterectomy, together with evidence of granulation tissue, in the
postirradiation stage and in cases of true erosion or ulceration of
the cervical stroma, which may be caused by a prolapsed uterus, by
pressure necrosis from a ring or a shield pessary, or by an IUD.
Cytology
Reparative changes are characterized morphologically by sig-
nificant nuclear enlargement and usually the presence of large,
prominent nucleoli as a sign of active protein synthesis in the
fast-growing cells, which try to replace the damaged epithelial
cells (Fig. 8.38).
Cells from reparative epithelium usually desquamate as large,
sheet-like aggregates with indistinct cytoplasmic boundaries.
Fig. 8.38 Reparative reaction.
Syncytial arrangement of immature cells
with relatively large, round-to-oval nuclei, prominent nucleoli, and a finely
granular evenly distributed nuclear chromatin. Variation in nuclear size
(Papanicolaou x OI).
In these aggregates, mitoses may be present (Fig. 8.39). It is not
unusual to find that leukocytes have infiltrated the larger aggre-
gates of epithelial cells. Rarely, abnormal singly lying cells are
found. The cells have a wide variation in size and shape. The cyto-
plasm is usually cyanophilic and sometimes is finely vacuolated
or may contain large vacuoles. Nuclei are mostly round to oval,
with some nuclear enlargement and variation in nuclear size.
Nucleoli are prominent, and multiple macronucleoli are some-
times present. As a rule, the nuclear chromatin is finely granular,
almost always evenly distributed, and not hyperchromatic. Cells
have essentially the characteristics as immature columnar cells
(Fig. 8.40), immature squamous cells, or immature squamous
metaplastic cells.25 Depending on the severity of the stimu-
lus causing the epithelial damage, the replacing epithelium—
regeneration and repair—will be blocked in its maturation and
show a degree of abnormal configuration or hyperchromasia
(Figs 8.41 and 8.42).
Key features of repair
• Nuclear enlargement with wide variability of size and
shape;
• Prominent nucleoli;
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