Cytopathology Conference 12/01/05 - Case 2

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Cytopathology Conference 12/01/05 - Case 2

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Cytopathology Conference 12/01/05 - Case 2

  1. 1. Cytopathology Conference 12/01/2005
  2. 2. Case 2 <ul><li>Pap test from a 32-year-old female. </li></ul>
  3. 8. Diagnosis?
  4. 9. Differential Diagnosis <ul><li>AGUS </li></ul><ul><li>Reactive change associated with intrauterine device. </li></ul><ul><li>Adenocarcinoma (endometrial, endocervical or ovarian) </li></ul><ul><li>Metastatic carcinoma </li></ul><ul><li>Radiation/chemo effect </li></ul>
  5. 10. NILM; reactive changes associated with IUD
  6. 11. IUD Changes <ul><li>Three types of atypical cells with IUD changes: </li></ul><ul><ul><li>Endocervical </li></ul></ul><ul><ul><li>Metaplastic cells </li></ul></ul><ul><ul><li>Endometrial cells </li></ul></ul>
  7. 12. IUD Change -Endocervical <ul><li>Clusters </li></ul><ul><li>Large, hypervacuolated, columnar cells </li></ul><ul><li>May have neutrophils phagocytosed in cytoplasm </li></ul><ul><li>Vacuoles are degenerative in nature </li></ul>
  8. 13. IUD Change – Metaplastic cells <ul><li>Vacuolated with nuclei pushed to the periphery </li></ul><ul><li>Bland chromatin, nonsecretory nature of vacuoles, absence of a tumor diathesis </li></ul>
  9. 14. IUD Change – Endometrial cells <ul><li>May shed singly or in clusters </li></ul><ul><li>Scant cytoplasm, uniform nuclear size and shape, slight hyperchromasia (if any) </li></ul><ul><li>May have evidence of endometritis </li></ul>
  10. 15. IUD Effect - Actinomyces <ul><li>Clusters of branching filamentous organisms </li></ul><ul><li>Usually found in patients with IUD </li></ul><ul><li>Helpful for diagnosis if found </li></ul>
  11. 16. IUD Effect <ul><li>Cockleburrs are usually associated with pregnancy but can be with IUD or birth control pills </li></ul><ul><li>Cockleburrs are probably from cellular debris. Not immunoglobulin, Not hematoidin. </li></ul>

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