PART TWO
Diagnostic Cytology
Fig. 7.4 Lactobacilli.
Vaginopancervical smear (Papanicolaou x HP).
Fig. 7.5 Nuclear degeneration.
Vaginopancervical smear
(Papanicolaou x HP).
Cellular Changes
In the cervicovaginal smears, intermediate and superficial cells
occur predominantly among healthy and normally menstruating
women. Heavy inflammation frequently causes an exfoliation
of parabasal cells in the vaginal smear. Although often present
in postmenopausal women and in the immediate postpartum
period, occurrence of these three types of cells in the premeno-
pausal age group should be carefully evaluated. Caution need to
be exercised in rendering hormonal evaluation in smears with
excessive inflammation. The parabasal cells may exfoliate from
ulceration of the squamous epithelium of the vagina and the
ectocervix.
Under the persistent effect of various microbial infections
and inflammatory reactions, both squamous and columnar
epithelial cells may undergo degenerative changes. Almost all
these changes are nonspecific, but their identification helps in
the proper interpretation of more serious cellular alterations.
This is critical because most degenerative changes may be
accompanied by concurrent regenerative, reactive, and meta-
plastic changes. An extremely heterogenous group of cellular
changes that includes reactive, degenerative, metaplastic, and
neoplastic features is termed atypical squamous cells (ASC).
Fig. 7.6 Perinuclear clearing or halos.
Vaginopancervical smear
(Papanicolaou x MP).
Fig. 7.7 Nuclear degeneration
among endocervical cells infected with
adenovirus infection. Vaginopancervical smear (Papanicolaou x HP).
Morphological features of these cells overlap and generally are
nonspecific, meaning that they cannot be precisely separated
between neoplastic and non-neoplastic changes. Additional
studies are often necessary for further characterization of these
changes (discussed elsewhere).
Degeneration
In inflammatory states cytoplasm of the squamous and colum-
nar cells may be completely or partially disintegrated. However,
the major changes are observed within the nuclei. These have
been detailed by Frost.7 Briefly; the nuclei may become compact,
dense, and pyknotic with loss of all chromatin details (Fig. 7.5).
Such nuclei may have a distinct circumferential cytoplasmic
clearing or hollow, causing a perinuclear "halo"(Fig. 7.6), often
seen in association with
Trichomonas
and other infections. Nuclei
undergoing degenerative changes frequently lose the sharp
details of their nuclear envelope, the chromatin, and the inter-
phase. The nuclear chromatin may clump irregularly or appear
beaded along the nuclear margins. They may become blurry and
opaque. Other changes include nuclear swelling, with partial or
total disintegration of the nuclear envelope, karyorrhexis, and
karyopyknosis (Fig. 7.7).
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