PAP SMEAR PATHOLOGY Various slide ABOUTE many candition can see in popanicula smear test short disscution about epidemiology and screening hpv bethesda reporting and how to pop smearing when to pop smear and organism metaplasia and other condition lsil hsil cin1 cin2 cin3 ascus asch
3. What is pop smear?
Is obtaining sample of
exfoliated cervical cell
The test was invented by
Dr. Georgios Papanikolaou
(1928)
4. purpose
• .to detect potentially precancerous changes
(called cervical intraepithelial neoplasia (CIN)
or squamous intraepithelial lesion system (SIL))
caused by human papillomavirus
• .detect infections and abnormalities in the endocervix
and endometrium
5. How to do
• Time : tow week after
LMP
• Don’t intercourse for 3
day
• Don’t use vaginal cream
• Empty bladder before
• In speculum insertion
Don’t use lubricant gel (if
need use sterile water)
8. When to do pop smear
• Start: 21 y o or 3 year after first
sexual activity
• 21-30:every 3 years
• 30-65:
• if last 3 test is normal repeat
every 3 year
• With normal HPV test every 5
year
• After 65:if last 3 test normal not
necessary
• annual screening should not be
done
9. • In case of total hysterectomy pop smear not
necessary if it due to benign cause other than
positive HPV
• In case that don’t have cervix sample from vigina
cuff
• In case supera cervical hysterectomy follow guide
line
• 5 year co-test If person don’t :
• Use DES(Diethylstilbestrol is an estrogen )
• History of CIN3
• Immune deficiency (HIV , transplant)
10. Epidemiology : cervical cancer
• the fourth most common cancer in women in
world
• The second most common cancer in woman in iran
• Two HPV types (16 and 18) cause 70% of cervical
cancers and pre-cancerous cervical lesions (WHO)
• Other source say hpv exist 99% of cervical cancer
• About 660 million persons infected by HPV
11. hpv
• is the most common sexually transmitted infection
in the world
• Cause of cervical cancer and wart
• Has 200 type
• Tow vaccine exist
• Cervarix = for type 18,16
• Gardasil = for type 18,16,11,6
• Vaccine can’t alternative to pop smear
• Mechanism: attach to p53 and
retinoplastoma(tumor suppressor pro)
22. Endometrial cell (exodus ball)
Seen in 6-10 day
menstural cycle
it is group of
endometrial cell like
ball
Last remnant of
endometrial shedding
and the cells show
degenerative changes
After 40 yo must be
reported and can
phathologic
27. Satisfactory Squamous
Cellularity
In past:
Presence or absence
endocervical cell is
important
Now:
Enough number of
squamous cell
In conventional 8000
In liquid base 5000
Presence of endocervical
cell Confirm taking
sample from
transformation zone
47. HSIL
HSIL
1 – increased number of parabasal cells, enlarged nuclei,
irregular nuclear margins, expressed hyperchromia and
the presence of rough chromatin deposits.
48.
49.
50. Squamus cell carcinoma
Squamous cell carcinoma
1 – signs of HSIL;
2 – large nuclei and irregular chromatin deposits;
3 – tumor diathesis;
4 – cellular polymorphism.
51.
52.
53. Atypical Glandular Cell
. Atypical glandular cells: AGC-NOS
1 – endocervical (glandular) cells
arranged in piles, hyperchromasia.
Not Otherwise Specified (AGC-NOS)
(can be classified as endocervical,
endometrial or non classified)
54.
55.
56. Atypical Glandular Cells
. Atypical glandular cells, which are more neoplastic: AGC-FN
1 – nuclear hyperchromia, nuclei can almost not be visualized.
– Favor Neoplasia (AGC-FN) Atypical glandular cells, which
are more neoplastic.
57. Adenocarcinoma in situ AIS
Adenocarcinoma in situ – AIS
A characteristic arrangement of cells in a “rosette-shaped-pattern” is
common; increased N and C ratio; nuclei appear oval-shaped; irreglar
chromatin deposits “Salt-Pepper”; mucosal cells are diversified.
58. Adenocarcinoma Fig. 19. Adenocarcinoma
1 – round and large nuclei; increased cellular cytoplasma;
2 – macronucleoli are common;
3 – tumor diathesis.