Medical

2. Definition of cytopathology
Cytopathology is the study of normal and abnormal
exfoliated cells in tissue fluid.
The individual cells reflect the normal and abnormal
morphology of the tissue from which they are derived.

3. Types of exfoliated cyto-pathology
Natural spontaneous exfoliation
Natural covering epithelium: skin, urinary tract, vagina, and
cervix.
Glandular epithelial secretion: Breast (Nipple secretion).
Sputum
Urine
Exudates and transudate:
Pleural fluid Peritoneal fluid
Pericardial fluid Joint fluid CSF

4. Artificial enhanced exfoliation:
Scrapings from cervix, vagina, oral cavity, and skin
Brushing and lavage: bronchi, GIT, and urinary tract
Fine needle aspiration (FNA) for:
Body cavity fluid: pleural, pericardial & peritoneal
fluids
Cysts: neck, breast & ovary
Solid tissue: body organs, tumors & other swell

5. Role of cytopathology
Early detection of unsuspected diseases (malignant
or pre-malignant lesions).
Confirmation of suspected diseases without surgical
trauma.
Diagnosis of hormonal imbalance.
Useful in flow up the course of disease or
monitoring therapy.

6. Advantage of Cytopathology
Rapid diagnosis - Inexpensive - Simple
It is better in evaluating the infectious diseases.
Supplement or replace frozen section or biopsy
No injury to tissue allowing repeated sampling
It is better for hormonal assay
Cytopathological smear cover a wider surface than
that involved in surgical biopsy.

7. Disadvantage of Cytopathology
Interpretation of the morphological cellular changes is
based only on individual cell observation.
Not always finally diagnosis, so it is confirmed by
histopathology in some cases.
Not determine the size and type of lesion of some cases.

8. Factors that determine the appearance of
cells
Type of the technique used.
Level of cell maturation at the time of cell collection.
Nature of the parents tissue: soft tissue, cyst, or solid organ.
Medium of the exfoliated cells.
Interval between the stain of the exfoliated cells and collection
of samples.
Type of fixative, stain, and processing of the technique
used.

9. PAP smear: named after
Dr. George Papanicolaou (1883-1962)
Vaginal smears from guinea pigs (1917)
Women (1920)
Hormonal cycles
Pathological conditions (1928)

10. Normal Cervix

11. Taking the Sample

13. Liquid Based Cytology – lab processing

15. Cytologic screening for cervical cancer
Cervical cancer screening has decreased morbidity and
mortality
Deaths from cervical cancer decreased from 26,000 to
less than 5,000 between 1941 and 1997

16. Pap smears are not perfect
For a high grade lesion, the sensitivity of a single pap
smear is only 60-80%
Estimated false negative rate is 30-50%
Requires adequate specimen collection
Requires adequate cytological review

17. Requires adequate patient and physician follow-up
10% of women with cervical cancer had inappropriate
follow-up.
Requires access to care
50% of women with cervical cancer were never
screened and 10% had not been screened within 5 years
of diagnosis.

18. Who to screen
Any woman with a cervix who has ever had sexual
activity.

19. When to screen
Start within 3 years of onset of sexual activity or by age
of 21, whichever is first.
Risk factors for cervical dysplasia
Early onset of sexual activity
Multiple sexual partners
Tobacco
Oral contraceptives

20. Screening frequency
Yearly until three consecutive normal pap smears, then
may decrease frequency to every three years
Annual screening for high-risk women is highly
recommend.

21. When to stop routine screening
Age 65 and “adequate recent screening”
Three consecutive normal pap smears
No abnormal pap smears in last 10 years
No history of cervical or uterine cancer
Hysterectomy for benign disease
Hysterectomy for invasive cervical cancer

23. Original Squamous Epithelium
Vagina and outer ectocervix
4 cell layers
Well-glycogenated (pink) unless atrophic

24. Columnar Epithelium
Upper and middle endo-cervical canal
Single layer of columnar cells arranged in
folds
Mucin producing (not true glands)

25. Squamous Metaplasia
Central ectocervix and proximal endocervical canal
Replacement of columnar cells by squamous epithelium
Progressive and stimulated by
Acidic environment with onset of puberty
Estrogen causing eversion of endocervix

26. Transformation Zone
Zone between original squamo-columnar junction and
the “new” squamo-columnar junction
Nabothian cysts visually identify the transformation
zone if present

27. Original Squamo-columnar Junction
Placement determined between 18-20 weeks gestation
Most often found on ectocervix
Can be found in vagina or vaginal fornices
Less apparent over time with maturation of
epithelium

28. “New” Squamo-columnar Junction
Border between squamous epithelium and columnar
epithelium
Found on ecto-cervix or in endo-cervical canal
Majority of cervical cancers and precursor lesions
arise in immature squamous metaplasia, i.e. the
leading edge of the squamo-columnar junction

29. Squamous Epithelium

30. Parabasal Cells

31. Intermediate Cells

32. Superficial Cells

33. Endocervix

34. Endocervical Cells

35. Endometrial Cells

36. Non-Epithelial Cells
sperms
Lymphocytes Polymorphs

37. Normal smear

38. Ectropion / Erosion
At puberty & pregnancy the endocervical cells are
pushed out to lie on the ectocervix
Normal Ectropion

39. Wide Ectropion

40. Metaplasia
The endocervical cells are transformed into squamous
cells through the process of squamous metaplasia

41. Metaplastic Cells