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128 Cards in this Set

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pap smear
pap smear
actinomyces, associated with IUD - IUD cells can mimic HSIL but have smooth nuclear membranes, washed out chromatin
pap smear
pap smear
actinomyces IUD assoc- IUD cells can mimic HSIL but have smooth nuclear membranes, washed out chromatin
pap smear
pap smear
AIS - feathering, rosettes, gland like
pap smear
pap smear
AIS - feathering, rosettes, gland like
pap smear
pap smear
AIS - feathering, rosettes, gland like
pap smear
pap smear
ariasstella, pregnancy
pap smear
pap smear
atrophy - dark blue blobs, degenerated parabasals, granular background
pap smear
pap smear
atrophy - dark blue blobs, degenerated parabasals, granular background
pap smear
pap smear
atrophy - dark blue blobs, degenerated parabasals, granular background
pap smear
pap smear
atypical parakeratosis - in regular parakeratosis - pyknotic nuclei and hypereosinophilic cytoplasm
pap smear
pap smear
benign keratin pearl
pap smear
pap smear
candida - skewered
pap smear
pap smear
chronic follicular cervicitis
pap smear
pap smear
chylamydia
pap smear
pap smear
cockleburr crystals - no clinical significance, found with pregnancy
pap smear
pap smear
cockleburrs - no clinical significance, found with pregnancy
pap smear
pap smear
endometrial cells - occasional kidney bean shaped nuclei
pap smear
pap smear
endometrial cells- occasional kidney bean shaped nuclei
pap smear
pap smear
endometrial ca - usu no tumor diathesis on Pap, single cells, vacuoles, prominent nucleoli
pap smear
pap smear
endometrial ca- usu no tumor diathesis on Pap, single cells, vacuoles, prominent nucleoli
pap smear
pap smear
endometrial ca- usu no tumor diathesis on Pap, single cells, vacuoles, prominent nucleoli
pap smear
pap smear
endometrial cells - occasional kidney bean shaped nuclei
pap smear
pap smear
clue cells - usu relatively clean backgroun, treatment is metronidazole
pap smear
pap smear
granuloma
pap smear
pap smear
HSIL - 3x nuclei of intermediate cell, 1 nuclei fits into cytoplasm
pap smear
pap smear
HSIL- 3x nuclei of intermediate cell, 1 nuclei fits into cytoplasm
pap smear
pap smear
HSIL- 3x nuclei of intermediate cell, 1 nuclei fits into cytoplasm
pap smear
pap smear
HSIL- 3x nuclei of intermediate cell, 1 nuclei fits into cytoplasm
pap smear
pap smear
HSIL- 3x nuclei of intermediate cell, 1 nuclei fits into cytoplasm
pap smear
pap smear
HSIL- 3x nuclei of intermediate cell, 1 nuclei fits into cytoplasm
pap smear
pap smear
HSV
pap smear
pap smear
HSV
pap smear
pap smear
HSV
pap smear
pap smear
IUD effect - mimics HSIL, but round nuclear membranes, fine chromatin pattern
pap smear
pap smear
lactobacilli - often bare nuclei
pap smear
pap smear
leptothrix- often found with trich
pap smear
pap smear
LSIL - 3 x nuclei of intermediate cell with 2 or more nuclei fitting into cytoplasm, perinuclear cavity, rolled up thick cytoplasm
pap smear
pap smear
LUS
pap smear
pap smear
endocervical cells
ovarian
ovarian
ovarian serous borderline
ovarian
ovarian
ovarian serous ca
pap smear
pap smear
postpartum - can be yellow staining glycogen or single parabasals
pap smear
pap smear
psammoma
pap smear
pap smear
radiation - two tone cytoplasm, increase cellular size, increase nuclei but also cytoplasm, multinucleation, vacuolization of cytoplasm and increased pmns (last two go away with time)
pap smear
pap smear
radiation- two tone cytoplasm, increase cellular size, increase nuclei but also cytoplasm, multinucleation, vacuolization of cytoplasm and increased pmns (last two go away with time)
pap smear
pap smear
repair - no hyperchromasia persay but increase nuclear size, school of fish, not really single cells
pap smear
pap smear
repair no hyperchromasia persay but increase nuclear size, school of fish, not really single cells
pap smear
pap smear
repair - no hyperchromasia persay but increase nuclear size, school of fish, not really single cells
pap smear
pap smear
invasive scca - tadpoles, single cells, tumor diathesis, prominent nucleoli
pap smear
pap smear
squamous metaplasia - dense cytoplasm, fine chromatin, interlocking parabasals, active nuclei (chromocenters present),streaming but cookie cutter
pap smear
pap smear
squamous metaplasia - dense cytoplasm, fine chromatin, interlocking parabasals, active nuclei (chromocenters present),streaming but cookie cutter
pap smear
pap smear
squamous metaplasia - dense cytoplasm, fine chromatin, interlocking parabasals, active nuclei (chromocenters present),streaming but cookie cutter
pap smear
pap smear
surepath, sedimentation
pap smear
pap smear
thinprep liquid based smear
pap smear
pap smear
transitional metaplasia
pap smear
pap smear
trich- reactive type haloes, associated with leptothrix, treated with metronidazole, fuzzy pear shapes
pap smear
pap smear
tumor diathesis
sufficient number of cells for liquid based Pap smear
5000
sufficient number of cells for conventional Pap smear
10,000
where is the HPV virus in invasive SCCa
integrated into genome
what is the nuclear size of LSIL cells compared to intermediate cell
3x
how many nuclei fit into the cytplasm in a LSIL cell
two or more
how many nuclei fit into the cytoplasm in an HSIL cell
1
what is the nuclear size of an HSIL cell compared to an intermediate cell
3x
learn the cyto stains
diffiquik, etc and their artifacts
describe the Digene II process
RNA probe targets vDNA with an antibody to these together with an associated light emission probe
learn the recommendations for screening
for Pap vs. HPV
when to report endometrial cells
>40 years, >12 days past LMP
what is the frequency of progression to invasive ca for LSIL
<1%
what is the frequency of progression to invasive SCCa from HSIL
CIN II - 5%
CIN 3 - 12%
when is the earliest one should colpo postpartum
>6 weeks
what are the daughters of DES use at risk for
vaginal adenosis, clear cell carcinoma
of HPV early genes, what binds what
E6 binds p53
E7 binds rb
low risk HPV types
6, 11, 42-44, 53,54, 57, 66
high risk HPV types
16, 18, 31-35, etc
how to distinguish on Pap between mets to cx vs. direct extension to cx
mets to cx - no tumor diathesis
direct extension to cx - tumor diathesis can be seen
one useful identifier of mesothelial cells in pelvic washing
mesothelial cells have a prominent nucleoli
what is the mesothelial skirt made of
made of ectoplasm and endoplasm (perinuclear organelles)
how does HMBE-1 compare to calretinin in staining mesothelial cells
HMBE1 is less specific but as sensitive as calretinin
learn more about thin prep/sure path
- process
- differences
what affect does alcohol fixation in a Pap smear have on cells
smaller cellular size
compare histologic fx of HSIL vs. invasive SCCa on Pap smear
in HSIL you really shouldn't see prominent nucleoli and definitely not tumor diathesis
what is the specificity and sensitivity of a Pap
sensitivity - 47%
specificity 95%
where might you see a reallly granular/dirty background
atrophic vaginitis
what percent of cases should be ASCUS coming out of an individual lab
5%
what should the ASCUS/SIL ratio be coming out of a lab
less than or equal to 3:1
three indications for colpo
LSIL, HSIL, ASC-H
compare histologic fx of repair vs. invasive SCCa
repair - fine chromatin, flat sheets but cohesive cells
invasive SCCa - coarse chromatin, marked crowding, single cells
How often does ASCUS lead to HSIL on biopsy
10-20%
what percent of Paps are nl
91%
compare exfoliated EM cells vs. HSIL
HSIL cells are larger and in flatter sheets
what % of LSIL cells will regress
50%
what is the most common cause of small cell ca of the cx
HPV 18
maturation indices for 1 hour old child
95-5 - Intermediate and superficial
maturation indices for child
80- parabasals
20- intermediates
maturation indices for menstruating females
40-60 intermediate-superficial if premenses
70-30 intermediate-superficial if in menses
maturation indices for OCP use
95-5 intermediate-superficial
maturation indices for postmenopausal
100 -0-0 parabasal/intermediate vs. superficial
what's a normal vaginal pH
4.5
what do anucleated squames mean
contamination from vulva or leukoplakia in vagina
describe nuclei and cytoplasm of endocervical cells
definite chromatin detail is seen and nucleoli are evident; cytoplasm is more delicate and foamy but size of endocervical nuclei are slightly larger than seen for squames (2n intermediate cell)
most accurate e2 indices come from where
lateral wall of vagina
what is leptothrix
filamentous bacteria - strings of spaghetti
fx you might find in a histological picture with trich
- associated inflammation
- reactive haloes
- shot gun pmns
- grey background
if you hear a clinical story of a pregnant woman in her 3rd trimester and see radiation-like changes in her Pap smear, what should you think of
folate deficiency
if you've had radiation, how long should you wait before a pap smear
~2 months
what histo fx should you think of with OCP
parakeratosis
if you see parakeratosis, what should you think of clinically
OCP use
what histologic fx do you see with Chylamydia
- intracytoplasmic bugs
- lymphocytic cervicitis (+ tingible body macs)
where do you find alternaria
water contaminant
what is the depth of invasion required to call an invasive scca microinvasive
less than or equal to 3 mm
appearance of air-dried artifact
hazy, grey
compare repair vs endocervical adenocarcinoma
repair - macronucleoli; endocervical adenoca - micronucleoli
repair fine granular chromatin; endocervical adenoca - coarse
repair cellular aggregates; endocervical adenoca - isolated or syncytial
repair - inflammation, endocervical adenoa - more clean background
repiar - often well-defined cell borders, endocervical adenoca - overlapping of cells with little cytoplasm
compare repair to large cell in situ
repair - aggregates, fine chromatin, macronucleoli, cell borders
large cell in situ - isolated, coarse chromatin, less common macronucleoli, less distinct cell border
criteria for ASCUS
1. nucleus 2-3 x cross diameter of intermediate cel
2. chromatin: increased, even, no granularity
3. number of affected cells 3-5
specimen adequacy
satis for evaluation
1. appropriate labeling, clinical data
2. adequate # cells (covers >10% slide)
3. adequate t zone (2 clusters of 5 or more cells)
4. endocervicals or lots of metaplasitics
specimen adequacy:
satis but limited by can include
- lack of pertinent info.
- partially obscuring blood, inflammation, thick area (precluding interpretation of 50-75% of slide)
- no endocervical cells
if see a psammoma, what should you do
look further - may see papillary clusters s/o ovarian
tricky slide: melanoma
may hide pigment, grey background
when to start screening
21 years, 3 years post first intercourse
how often to screen - age dependent
21-30: conventional/q year, LBP every 2
30-70: if nl 3x/q 3yrs (if HPV), q 2yrs if not HPV
70: can stop if negative for 10 years
can stop if no uterus
if DES/iC must do every year
when testing HR or LR HPV types
HR only
in whom do you do HPV genotyping?
30+
what are the two relevant parameters for reporting endometrial cells
>12 days post LMP
>40 years
if see clue cells, what do you treat with
metronidazole
if see trich, what treat with
metronidazole (+sexual partner) - remember,with trich can see small halo
what buys an adolescent a colpo
HSIL (arguable with ASC-H)
when do you colpo a pregnant person
ONLY if invasive cancer; no colpo until 6 wks postpartum