2. INFLAMMATION
• Inflammatory changes in cervix may occur as a
result of physical or chemical injury to the cervix or
infection from a variety of microorganisms
❖ ACUTE NON-SPECIFIC CERVICITIS
• May be part of local response to injury or a
generalised cervico-vaginitis
• Characterised by presence of abundant
well-preserved neutrophils with histiocytes and
epithelial cells of various degrees of maturity
showing inflammatory changes – all three
squamous cell types present
• Epithelial cells show degenerative changes
3. • Degenerative changes-
• Refers to the deterioration of live cells following
injury, with the possibility of injured cells returning
to normal when injury is removed
• Deterioration of cells is evaluated in terms of
morphological changes.
• Cytoplasmic changes include:
– Frayed cell borders producing a ragged appearance to
the cells
– Variation in the staining reactions with polychromasia
and eosinophilia
– Vacuolation – coarse or fine; perinuclear
4. • Nuclear changes consist of:
– Enlargement
– Hyperchromasia
– Anisonucleosis
– Wrinkled nuclear membrane
– Nuclear duplication
– Karypyknosis and karyorrhexis
• Background appears dirty containing fibrin and
cellular debris from cytolysis and necrosis
• Involvement of the endocervical epithelium causes
poorly defined cytoplasm, vacuolation and naked
nuclei
8. INFLAMMATION CONT’D
❖ HEALING AND REGENERATION
• Healing of the ulcerated or denuded is effected by
proliferation of adjacent epithelium and extension
from local gland crypts
• Flat sheets of parabasal type cells with large nuclei
and prominent eosinophilic nucleoli (may be
multiple and vary in size) and chromocentres; single
cells also occur but are few
• Cytoplasmic borders of cells in the sheets indistinct
• Cells may vary in size, occasionally may show
bizarre, sometimes elongated configuration
9. • Cytoplasm is usually cyanophilic, sometimes finely
vacuolated or may contain large vacuoles
• Nuclear chromatin is fine, evenly distributed and
normochromatic (may show some degree of
hyperchromasia) allowing distinction from
malignant cells – these three characteristics do not
occur together in any malignant lesion
• Leucocytes may be seen infiltrating larger sheets of
cells
• Mitoses, normal, may be seen and may be
numerous – reflecting reparative process
• Sometimes considerable atypia making
differentiation from neoplastic lesion difficult
10. • Virtually impossible to arrive at a conclusive
cytologic diagnosis in such cases and patients
should be further evaluated by colposcopy and
biopsy.
• In a major survey of laboratories in the US repair
was the most common source of false-positive and
false-negative smears.
13. ❖ CHRONIC CERVICITIS
• Predominant inflammatory cells are lymphocytes,
plasma cells histiocytes including multinucleated
histiocytes
• Cellular changes indicating hyperkeratosis and
parakeratosis may be seen in cases of longstanding
chronic inflammation
• In chronic granulomatous inflammation:
– Macrophages with large pale nuclei and abundant
cytoplasm are seen – epithelioid cells – elongated cells
with round or oval nuclei
– Multinucleated giant cells, some with nuclei disposed
around the periphery (Langhans giant cells), others with
nuclei distributed throughout cytoplasm (foreign body
giant cells)
16. • In follicular cervicitis
• Mixture of mature (small) and immature (large)
lymphocytes in long dense streaks
– Mixed population of lymphocytes in various stages of
maturation with a predominance of small lymphocytes
– Small mature lymphocytes have thin eccentric rim of
cytoplasm, round nucleus with dense uniform chromatin
and no nucleoli
– Larger immature lymphocytes have more cytoplasm,
open chromatin and may have irregular nuclear
membrane or prominent nucleoli
– Presence of tingible body macrophages, with
cytoplasmic cellular debris, is somewhat specific, but
may also be seen in high grade lymphoma and invasive
carcinoma Plasma cells, occasionally reticular cells, and
neutrophils may be seen
17. • Associated with Chlamydial infection in 50% to 75%
of cases
• Can occur at any age
– More common and more likely to be detected in
postmenopausal women, who have thin and atrophic
overlying epithelium, than in young women with a thick
epithelial covering
• Frequently asymptomatic with normal cervix
• Superficial ulceration may be seen
• Deep ulcers may indicate herpetic cervicitis
• No cervical mass seen
– Presence of a mass suspicious for a lymphoma
20. • Atrophic cervicitis
• Occurs in post-menopausal women
• Smear contains parabasal cells showing marked
degenerative cytoplasmic and nuclear changes
– Some parabasal cells round with scanty, eosinophilic
cytoplasm with pyknotic nuclei
– Others have abundant, cyanophilic cytoplasm with
enlarged, pale nuclei containing chromocentres
– Nuclei may be hyperchromatic and irregular suggesting
carcinoma
• Numerous polymorphs may be seen together with
large multinucleate histiocytes
• Basophilic bodies called “blue blobs” may be seen
21. • Similar in size and shape to degenerating to
parabasal cells
• Remains of a nucleus can be seen in the middle of
blue blobs
• Represent parabasal/intermediate squamous cells
with various degrees of degeneration
• In some cases it can be extremely difficult to
distinguish between atrophic changes and
malignancy.
• In such cases repeat smear after treatment with
oral or topical oestrogens and repeat smear a week
later may make diagnosis easier
27. ❖ INTRAUTERINE CONTRACEPTIVE DEVICE (IUCD)
EFFECTS
• Mechanical effect may result in:
– Shedding of endocervical cells with distended,
vacuolated cytoplasm; vacuoles occasionally infiltrated
by polymorphs – mimicking endometrial
adenocarcinoma
– Squamous metaplasia
– Repair reaction
• Presence of Actinomyces
• Occasionally amorphous debris that are sometimes
calcified are present – fragments of the plastic
– May form small concentrically calcified bodies
surrounded by macrophages – similar to psammoma
bodies seen in ovarian and endometrial carcinomas
32. BENIGN PROLIFERATIVE REACTIONS
❖ HYPERKERATOSIS
• Cervical squamous epithelium is non-keratinised but
still retains the potential to undergo keratinization
• Occurs when the epithelium is affected by chronic,
severe stimulation.
– Chronic irritation – prolapse of the uterus
– Chronic inflammation
– Hyperoestronism of long duration
• Epithelium increases its protective role by:
– Increasing the overall thickness of the epithelium -
acanthosis
33.
34. – Addition of a granular layer
– Development of several layers of keratinised cells
• Excessive formation of keratin over the surface of
the stratified squamous epithelium is called
hyperkeratosis
• Seen in cytologic smears by presence of numerous
anucleate squames lying singly or in sheets
• Cytoplasm shows orangeophilic staining
• Remnants of nuclei may be seen as a central clear
zone – nuclear ghosts
• Cells from granular layer may be seen –
intermediate or superficial cells containing
eosinophilic or cyanophilic keratohyaline
cytoplasmic granules
35. ❖ PARAKERATOSIS
• Another protective reactionof the cervical
squamous epithelium
• Characterised by presence of varying numbers of
layers of small squamous cells, sharply demarcated
from the underlying superficial zone
• In smears cells from parakerotosis appear as:
– Relatively small superficial cells lying singly or in sheets
– Round or oval to polygonal or spindle in shape
– Cytoplasm staining usually is dark or light eosinophilic,
rarely cyanophilic
– Nuclei are small and often hyperchromatic - pyknotic
36. • Hyperkeratosis and parakeratosis, although benign
reactive changes, may overlay an abnormal
epithelium
• Patients with these changes should be re-examined
to exclude more serious lesions, hidden by the
hyperkeratotic or parakeratotic layer.
• The doctor should be advised to repeat smear
taking two scrapes in succession – the first to
remove the superficial keratinised layers, the
second to sample the underlying epithelium
