Benign Proliferative Reactions, Intraepithelial Neoplasia, and Invasive cancer of the Uterine cervix
Fig. 8.39 Reparative reaction.
Syncytium of immature cells with irregular
arrangement of nuclei, finely granular chromatin, and prominent nucleoli
(Papanicolaou x OI).
• Chromatin typically finely granular, evenly distributed,
and not hyperchromatic;
• Mitoses may be present;
• Sheet-like 2-dimensional arrangements;
• Leukocyte infiltration of groups;
• Rarely abnormal isolated cells are found; and
• Abundant cytoplasm with "taffy pull" appendages.
Differentiating between cells from reparative changes and
cells from invasive neoplastic processes may be difficult. The
predominant arrangement of cells in sheet-like aggregates, even
though the cytoplasmic boundaries may be indistinct, together
with the normochromatic, finely granular, evenly distributed
chromatin, and the presence of macronucleoli usually can pro-
vide the correct diagnosis. In no other epithelial abnormality
and particularly in no invasive process do these three character-
istics occur simultaneously.
Inflammation-Associated Cellular Changes
Inflammation alone causes minor cytologic abnormalities, such
as a dual staining reaction, lysis or vacuolation of the cytoplasm,
slightly disproportionate nuclear enlargement, and an increase
of the nucleocytoplasmic ratio (Fig. 8.43). Nuclear chromatin is
more often hypochromatic than hyperchromatic (see Chapter 7,
Fig. 8.40 Reparative reaction.
Aggregate of immature cells with round-
to-oval, eccentrically located nuclei, finely granular nuclear chromatin, and
one to two prominent nucleoli (Papanicolaou x OI).
Microbiology, Inflammation, and Viral Infections, for additional
D egenerative Changes
Degenerative changes of nuclei such as folding of the nuclear
membrane, karyorrhexis, karyolysis, and pyknosis in cases of
inflammation must be differentiated from abnormal nuclear
changes in premalignant or malignant epithelial lesions.
Cytomorphologic alterations caused by inflammation or
physical or chemical trauma usually are nonspecific. Changes are
cell destruction, cytolysis, karyorrhexis (Fig. 8.44), and karyoly-
sis. In cases of nuclear alterations, such as nuclear enlargement,
binucleation, and multinucleation, as well as coarse clumping
and irregular distribution or a complete loss of structure of the
chromatinic material, the differential diagnosis with true atypical
changes, such as dysplastic lesions or even invasive carcinoma,
becomes relevant (Fig. 8.45). The correct diagnosis usually can be
made on the basis of the cytoplasmic vacuolation due to hydropic
degeneration and the fading of nuclear contours due to autolysis.
Unsatisfactory Quality
Extreme admixture of inflammatory cells can occasionally
obscure epithelial cells or dilute the number of diagnostic cells
in a specimen, thus reducing the chance of detection of abnormal
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