PART TWO
Diagnostic Cytology
of comparable severity may differ from one case to the other,
depending on the method of collection and the skill of the per-
son taking the sample.26 In general, the number of abnormal
cells is related to the severity (and the extent) of the lesion. The
lesser the abnormality, the fewer abnormal cells are found in the
specimen. The more severe the lesion, the higher the number
of abnormal cells. On the basis of cell population evaluation,
one can obtain rather specific information on differentiation
characteristics of the parent lesion.73 With experience, a more
definitive interpretation can be made on the basis of cellular
specimens, because both cancerous and noncancerous changes
in the surface mucosa of the uterine cervix are reflected in the
desquamated cells.14
Abnormal cells originating from the surface of epithelial
abnormalities may be subdivided morphologically into two
groups. Those showing signs of differentiation of squamous type
have, depending on the degree of maturation, features reminis-
cent of superficial, intermediate, or parabasal squamous cells
(Figs 8.55 and 8.56). When signs of differentiation are almost
completely absent, cells bear a resemblance to reserve cells.
Patten, in an attempt to provide a morphologic terminol-
ogy for dysplasia that might be applicable to both histologic
and cellular material and might provide evidence for biologic
Fig. 8.55 Mild dysplasia.
Cells of squamous type with slightly enlarged
nuclei and some hyperchromasia (Papanicolaou x OI).
potential, introduced a subclassification of dysplasia for routine
use.12 The major subdivisions were (1) keratinizing (ectocervi-
cal) dysplasia, (2) nonkeratinizing dysplasia, and (3) metaplastic
dysplasia.
In a series of 2453 cases, the nonkeratinizing variant was
observed approximately 7 times more frequently than the meta-
plastic type and 25 times more frequently than the keratiniz-
ing variant. Admixtures of these different types are most often
represented by the simultaneous occurrence of cells consist-
ent with the nonkeratinizing and metaplastic variants. Of this
series, about 85% of dysplasias in a 5-year period progressed to
carcinoma in situ. The reactions are further classified according
to severity by adding the terms minimal, slight, moderate, and
marked (severe).73
A rrangem ent o f Cells
Abnormal cells from dysplastic lesions usually appear singly
and have well-defined cell borders. In the majority of specimens,
atypical cells are also found in sheets. Cell borders usually are
still recognizable. The presence of cell aggregates with indistinct
cell borders in a cellular specimen indicates a reduced tendency
to maturation in the mucosal lining. This reduced matura-
tion is a reflection of the dedifferentiation of the component
Fig. 8.56 Mild dysplasia.
Cells of squamous type with slightly
enlarged nuclei. The nuclear chromatin is finely granular and very slightly
hyperchromatic (Papanicolaou x OI).
158
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