PART TWO
Diagnostic Cytology
Fig. 9.28 Examples of typical repair. (A) A flat, 2-dimensional sheet of cells with well-defined cytoplasmic boundaries and regular nuclei with uniform
chromatin, and with nucleoli in each nucleus. (B) The typical voluminous "taffy pull" cytoplasm at the group margin, indicative of normal cohesion. (C) Acute
inflammation in association with the group, and (D) the presence of a mitotic figure (arrow).
intrauterine Device Effect
The use of intrauterine devices (IUD) for contraception has
increased in recent years. With this increase, a re-emergence
of cytologic patterns well
documented in
past literature
has been identified.84-86 These cytologic changes are more
characteristically mimickers of endometrial and squamous
neoplasias, as opposed to those of endocervical origin, but
will be covered here because they involve cells derived from
the endocervical canal. IUDs cause irritation of the endome-
trial lining that can lead to mild cases of chronic endometritis.
Endometritis can be associated with the finding of
Actino-
myces
organisms being present in the cervical cytology speci-
men (about 25% of such cases), and its presence can be a
hint that the patient may have an undisclosed IUD87 (Fig.
9.30A). In addition, the IUD can cause irritation of cells in the
upper endocervical canal, leading to reactive and degenerative
changes. These cells then spontaneously exfoliate, travel in the
endocervical mucus, and can be picked up by the cytology sam-
pling device. This exfoliative process allows time for the cells
to "ball up" into 3-dimensional arrangements more reminis-
cent of spontaneously exfoliated endometrial cells (Fig. 9.30B).
However, closer examination will show characteristic features
of large degenerative vacuoles in the cytoplasm ("bubble gum"
vacuoles), which is dense and more voluminous that typically
noted in endometrial cells (Figs. 9.30C, D). In addition, iso-
lated spontaneously exfoliated cells which very closely mimic
HSIL can be seen (Fig. 9.31). The presence of nucleoli in these
cells, a history of IUD, and co-finding of the 3-dimensonal
groups noted above, along with
Actinomyces
organisms, may be
the only hints that such cells may actually be part of the overall
IUD process. In some cases, interpretations of ASC-H or follow-
up with colposcopy or HPV testing may be necessary to exclude
a squamous dysplastic process.
Key features of intrauterine device
Actinomyces
organisms may be present (about 25% of
cases);
• 3-Dimensional clusters of cells;
• Endometrioid appearance of the cells (may look like
shed endometrium);
• Prominent large cytoplasmic vacuoles ("bubble gum"
vacuoles);
• Cells may have prominent nucleoli; and
• Isolated cells can mimic HSIL.
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