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

1. ‫الرحیم‬ ‫الرحمن‬ ‫هللا‬ ‫بسم‬
in the name of GOD the compassionate the merciful

2. Pop smear
M.A.Nourani
MEDICAL STUDENT

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)

6. Conventional(slide) or liquid base

7. No
problem

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)

12. Transformation zone
Endocervix=columnar
Ectocervix=squamous
Between them =
squamocolomnar
junction
A dynamic zone affected
by puberty pregnancy
menopause …

13. Cervix NORMAL Histology

14. Normal Squamous Epithelium

15. Basal cell
PMN

16. Parabasal cell

17. Intermediate cell

18. Superficial cell: Dark and picknotic nucleus

19. Normal pop smear

20. glandular cells from endocervix
Always in cluster(group)
Normal columnar

21. Columnar cell from fallopian tube have cillia

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

23. lymphocyte

24. Polymorphs

25. sperm

26. Metaplastic Cells
A cell that was
endocervical are changing
to squamous cell

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

28. Satisfactory: Borderline adequate
squamous cellularity

29. Unsatisfactory due to scant squamous
cellularity

30. Unsatisfactory: Obscuring RBCs
and WBCs

31. Unsatisfactory- obscuring RBCs
and WBCs

32. Trichomonas Vaginalis

33. Candida : characteristic hyphes

34. bacterial vaginosis
the presence
of multiple
microorganism
s, which are
attached to a
single
squamous
epithelial cell.

35. Chlamydia : target inclusion

36. herpes simplex virus
Multnuclated – molding
1 – „milk glass“ nuclei;
2 – multinucleated cells; fused
nuclei;
3 – nuclear chromatin is present
only close to the nuclear
membrane.

37. Atrophy : all similar to parabasal and basal

38. radiation
Cellular changes induced by
radiation therapy / exposure:
vacuolization; cytomegaly;
multinucleated cells; signs of
cellular repair / reparation.’

39. IUD
1 – prominent large
cytoplasmic vacuole;
2 – small cells can
mimic HSIL.

40. CIN VS SIL

41. CIN VS SIL

42. Atypical Squamous Cells-
Undetermined Significance(ASC-US)

43. LSIL koilocyte
LSIL
1 – enlarged nuclei
(approximately 5 x
intermediate cell
nucleus);
2 – multinucleated
cells;
3 – irregular nuclear
margins;
4 – presence of
rough chromatin
deposits;
5 – presence of
koilocytes

47. HSIL
HSIL
1 – increased number of parabasal cells, enlarged nuclei,
irregular nuclear margins, expressed hyperchromia and
the presence of rough chromatin deposits.

50. Squamus cell carcinoma
Squamous cell carcinoma
1 – signs of HSIL;
2 – large nuclei and irregular chromatin deposits;
3 – tumor diathesis;
4 – cellular polymorphism.

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)

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.

62. The Bethesda System for Reporting PAP
Smear Results

63. The Bethesda
System for
Reporting
PAP Smear
Results

64. Thank you