Mamatha Chivukula MD, FASCP, FCAP Assistant Professor  Associate Director of Immunohistochemistry lab  Magee-Women’s Hospi...
Objectives   <ul><li>Present real time case studies to demonstrate the utility of cytomorphology in interpretation of ASC-...
Cytomorphology of ASC-H <ul><li>MGH-like  </li></ul><ul><li>Repair like  </li></ul><ul><li>Atrophy-like- with single cells...
Case 1 <ul><li>35 year old woman w/ a routine Pap test  </li></ul>
 
 
Groups of atypical cells  (without distinct cell borders)
-
Hyperchromatic nuclei  - Coarse to fine chromatin
<ul><li>Follow up HPV –DNA test is Positive for high risk HPV types </li></ul>
 
“ Syncytial cell” pattern Source:  Chivukula M ,  Shidham V . CytoJournal 2006, 3:14
Case 2 <ul><li>49 year old woman w/ a routine Pap test  </li></ul>
<ul><li>-  Abundant blue cytoplasm </li></ul><ul><li>Open chromatin , w/w out nucleoli </li></ul>
<ul><li>Follow up HPV –DNA test is Negative for high risk HPV types </li></ul>
 
p16
KI -67
Atrophic “ Single-cell” pattern Source:  Chivukula M ,  Shidham V . CytoJournal 2006, 3:14
Case 3 <ul><li>30 year old woman w/ a routine Pap test   </li></ul>
 
Cohesive clusters
-Prominent nucleoli - Low N/C ratio
<ul><li>Follow up HPV –DNA test is Negative for high risk HPV types </li></ul>
 
“ School of fish” Repair – like pattern Source:  Chivukula M ,  Shidham V . CytoJournal 2006, 3:14
Case 4 <ul><li>35 year old woman w/ a routine Pap test  </li></ul>
 
 
 
<ul><li>Follow up HPV –DNA test is Positive for high risk HPV types </li></ul>
 
“ Isolated cell pattern” Source:  Chivukula  M ,  Shidham  V . CytoJournal 2006, 3:14
Case 5 <ul><li>55 year old woman w/ a routine Pap test  </li></ul>
 
- HCG of parabasal cells - Small dark nuclei - Variable, usually scant cytoplasm
<ul><li>Follow up HPV –DNA test is Negative for high risk HPV types </li></ul>
 
Atrophic “ Parabasal cell groups” Source:  Chivukula M ,  Shidham V . CytoJournal 2006, 3:14
Application of two-color immunochemistry <ul><li>P16 is over expressed and accumulates in nucleus and cytoplasm of dysplas...
<ul><li>In a normal cell w/ intact cell cycle, Simultaneous expression of anti-proliferative marker (p16), proliferative m...
 
 
<ul><li>Thank you </li></ul>Thank you
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02 Asc H Continued Chivkula

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A potpourri of ASC-H and related interpretations-
(Part II)

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02 Asc H Continued Chivkula

  1. 1. Mamatha Chivukula MD, FASCP, FCAP Assistant Professor Associate Director of Immunohistochemistry lab Magee-Women’s Hospital of UPMC Pittsburgh, PA Study cases and application of two-color immunochemistry
  2. 2. Objectives <ul><li>Present real time case studies to demonstrate the utility of cytomorphology in interpretation of ASC-H pap tests </li></ul><ul><li>Cytohisto correlation and follow-up HPV testing </li></ul>
  3. 3. Cytomorphology of ASC-H <ul><li>MGH-like </li></ul><ul><li>Repair like </li></ul><ul><li>Atrophy-like- with single cells </li></ul><ul><li>Atrophy-like- with HCG of parabasal cell groups </li></ul><ul><li>ASC-H: NOS </li></ul><ul><li>Cyanophilic small atypical parakeratotic cells </li></ul><ul><li>HSIL- syncytial </li></ul><ul><li>HSIL- Single cell </li></ul>
  4. 4. Case 1 <ul><li>35 year old woman w/ a routine Pap test </li></ul>
  5. 7. Groups of atypical cells (without distinct cell borders)
  6. 8. -
  7. 9. Hyperchromatic nuclei - Coarse to fine chromatin
  8. 10. <ul><li>Follow up HPV –DNA test is Positive for high risk HPV types </li></ul>
  9. 12. “ Syncytial cell” pattern Source: Chivukula M , Shidham V . CytoJournal 2006, 3:14
  10. 13. Case 2 <ul><li>49 year old woman w/ a routine Pap test </li></ul>
  11. 14. <ul><li>- Abundant blue cytoplasm </li></ul><ul><li>Open chromatin , w/w out nucleoli </li></ul>
  12. 15. <ul><li>Follow up HPV –DNA test is Negative for high risk HPV types </li></ul>
  13. 17. p16
  14. 18. KI -67
  15. 19. Atrophic “ Single-cell” pattern Source: Chivukula M , Shidham V . CytoJournal 2006, 3:14
  16. 20. Case 3 <ul><li>30 year old woman w/ a routine Pap test </li></ul>
  17. 22. Cohesive clusters
  18. 23. -Prominent nucleoli - Low N/C ratio
  19. 24. <ul><li>Follow up HPV –DNA test is Negative for high risk HPV types </li></ul>
  20. 26. “ School of fish” Repair – like pattern Source: Chivukula M , Shidham V . CytoJournal 2006, 3:14
  21. 27. Case 4 <ul><li>35 year old woman w/ a routine Pap test </li></ul>
  22. 31. <ul><li>Follow up HPV –DNA test is Positive for high risk HPV types </li></ul>
  23. 33. “ Isolated cell pattern” Source: Chivukula M , Shidham V . CytoJournal 2006, 3:14
  24. 34. Case 5 <ul><li>55 year old woman w/ a routine Pap test </li></ul>
  25. 36. - HCG of parabasal cells - Small dark nuclei - Variable, usually scant cytoplasm
  26. 37. <ul><li>Follow up HPV –DNA test is Negative for high risk HPV types </li></ul>
  27. 39. Atrophic “ Parabasal cell groups” Source: Chivukula M , Shidham V . CytoJournal 2006, 3:14
  28. 40. Application of two-color immunochemistry <ul><li>P16 is over expressed and accumulates in nucleus and cytoplasm of dysplastic cervical cells </li></ul><ul><li>Studies on ASC-US, ASC-H </li></ul><ul><li>Advanced kits for immunostaining cervical specimens to detect both p16 and ki-67 simulatneously </li></ul>
  29. 41. <ul><li>In a normal cell w/ intact cell cycle, Simultaneous expression of anti-proliferative marker (p16), proliferative marker (ki-67) within the same cell, mutually excludes each other </li></ul><ul><li>Reversely, presence of both p16, ki-67 in the same cell, indicates disrupted cell cycle </li></ul>State of the art….work in progress
  30. 44. <ul><li>Thank you </li></ul>Thank you

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