… the

Where themicroscope
telescope
LAB
begins.
ends... DIAGNOSIS &
Newer Techniques
Ganesh P.
Pujari
PG Student

Dept. of Pathology
George N. Papanicolaou
OBJECTIVES
Comprehensive Overview of Pap
Smears
• Understand the normal and
abnormal cervix in regards to the
anatomy, cytology and histology
• Review the Bethesda Pathology
System
• Recognize the role of human
papilloma virus in cervical
carcinogenesis
• Triage of abnormal pap smears to
colposcopy and follow-up
BETHESDA,

MARYLAND
• Squamous Cell
– Atypical Squamous Cells
• Undetermined Significance (ASC-US)
(2002 Change)
• Cannot Exclude High Grade (ASC-H)
(2002 Change)
• HPV - LSIL
• LSIL (CIN I, Mild Dysplasia)
• HSIL (CIN 2 (Moderate Dysplasia) &
CIN 3 (Severe Dysplasia)
• CIS
• Squamous Cell Carcinoma
 NATURAL HISTORY OF
Ca- CERVIX

HPV Low Grade High Grade Invasive

Infection Cervical Cervical Carcinoma
Dysplasia Dysplasia
 HPV & Ca- Cervix

Vol 357:1589- October 18, 2007

No.16
• Direct effects on 1597

cell cycle • Low Risk : 6, 11, 42,

43, 44, 53, 54, 57, 66
• Effects on
centrosome • High Risk : 16, 18,
duplication 31, 33, 35, 39, 4, 51,
52, 56, 58, 59, 68
• Upregulation of
Telomerase • HPV 16 : prototype
HPV- LSIL
• Intermediate sized
• Nuclear atypia
• Enlargement
• Irregular contour
• Hyperchromasia
• Slight chromatin
coarseness
• Koilocytes
• Keratinizing variant
HSIL
• Parabasal cells
• Discrete/ syncitial
• Nuclear atypia:
- enlargement
- marked irregular
contour
- marked hyperchromasia
- marked chromatin
coarseness
- keratinizing variant
INVASIVE SQUAMOUS CARCINOMA

• Features of HSIL plus

• Macronucleoli
• Irregular chromatin
distribution
• Tumor diathesis
• “Tadpole” & “Fiber”
cells
ASC- US
• Atypical cells with
“mature” intermediate
type cytoplasm
• Cells s/o Koilocytes
• Atypical squamous cells
in atrophy
• Atypical parakeratosis
• Atypical repair
• Atypia d/t compromised
specimen
Choices for Management of
ASC- US Pap
ASC- H
• Immature squamous
metaplastic cells
• Mild-moderate
nuclear atypia
ANCILLARY

•Southern Blot
•PCR
•In Situ
Hybridization
•Hybrid Capture
 HPV DNA Test

HPV Low Grade High Grade Invasive

Infection Cervical Cervical Carcinoma
Dysplasia Dysplasia
ADENOCARCINOMA IN SITU
• Hyperchromatic crowded
groups
• Glandular differentiation
- columnar cells
- strips & rosettes
- feathering
• Neoplastic nuclei -
- hyperchromasia
- crowding, stratification
- inconspicuous nucleoli
- apoptosis
- mitoses
• No tumor diathesis
INVASIVE ADENOCARCINOMA

• Tumor diathesis
• Large round nuclei
• Prominent nucleoli
• Abundant cytoplasm
 What
Say
Garr ??