Definition of cytopathology

Cytopathology is the study of normal and abnormal

exfoliated cells in tissue fluid.

The individual cells reflect the normal and abnormal

morphology of the tissue from which they are derived.

 Types of exfoliated cyto-pathology
Natural spontaneous exfoliation
Natural covering epithelium: skin, urinary tract, vagina, and

cervix.
Glandular epithelial secretion: Breast (Nipple secretion).

Sputum

Urine

Exudates and transudate:

 Pleural fluid Peritoneal fluid

 Pericardial fluid Joint fluid CSF
Artificial enhanced exfoliation:

Scrapings from cervix, vagina, oral cavity, and skin

Brushing and lavage: bronchi, GIT, and urinary tract

Fine needle aspiration (FNA) for:

 Body cavity fluid: pleural, pericardial & peritoneal

fluids

 Cysts: neck, breast & ovary

 Solid tissue: body organs, tumors & other swell

 Role of cytopathology
Early detection of unsuspected diseases (malignant

or pre-malignant lesions).
Confirmation of suspected diseases without surgical

trauma.
Diagnosis of hormonal imbalance.

Useful in flow up the course of disease or

monitoring therapy.
 Advantage of Cytopathology

Rapid diagnosis - Inexpensive - Simple

It is better in evaluating the infectious diseases.

Supplement or replace frozen section or biopsy

No injury to tissue allowing repeated sampling

It is better for hormonal assay

Cytopathological smear cover a wider surface than

that involved in surgical biopsy.

 Disadvantage of Cytopathology

Interpretation of the morphological cellular changes is

based only on individual cell observation.

Not always finally diagnosis, so it is confirmed by

histopathology in some cases.

Not determine the size and type of lesion of some cases.

 Factors that determine the appearance of
cells
Type of the technique used.

Level of cell maturation at the time of cell collection.

Nature of the parents tissue: soft tissue, cyst, or solid organ.

Medium of the exfoliated cells.

Interval between the stain of the exfoliated cells and collection

of samples.
Type of fixative, stain, and processing of the technique

used.
 PAP smear: named after
Dr. George Papanicolaou (1883-1962)
Vaginal smears from guinea pigs (1917)

Women (1920)
Hormonal cycles
Pathological conditions (1928)
Normal Cervix
Taking the Sample
 
Liquid Based Cytology – lab processing 
 Cytologic screening for cervical cancer

Cervical cancer screening has decreased morbidity and

mortality
Deaths from cervical cancer decreased from 26,000 to

less than 5,000 between 1941 and 1997

 Pap smears are not perfect
For a high grade lesion, the sensitivity of a single pap 

smear is only 60-80%

Estimated false negative rate is 30-50%

Requires adequate specimen collection

Requires adequate cytological review
Requires adequate patient and physician follow-up

10% of women with cervical cancer had inappropriate

follow-up.

Requires access to care

50% of women with cervical cancer were never

screened and 10% had not been screened within 5 years

of diagnosis.
 Who to screen

Any woman with a cervix who has ever had sexual

activity.
 When to screen
Start within 3 years of onset of sexual activity or by age

of 21, whichever is first.

Risk factors for cervical dysplasia

Early onset of sexual activity

Multiple sexual partners

Tobacco

Oral contraceptives
 Screening frequency

Yearly until three consecutive normal pap smears, then

may decrease frequency to every three years

Annual screening for high-risk women is highly

recommend.
 When to stop routine screening
Age 65 and “adequate recent screening” 

Three consecutive normal pap smears

No abnormal pap smears in last 10 years

No history of cervical or uterine cancer

Hysterectomy for benign disease

Hysterectomy for invasive cervical cancer
Original Squamous Epithelium

Vagina and outer ectocervix

4 cell layers

Well-glycogenated (pink) unless atrophic

 Columnar Epithelium

Upper and middle endo-cervical canal

Single layer of columnar cells arranged in

folds

Mucin producing (not true glands)

 Squamous Metaplasia
Central ectocervix and proximal endocervical canal

Replacement of columnar cells by squamous epithelium

Progressive and stimulated by

Acidic environment with onset of puberty

Estrogen causing eversion of endocervix

 Transformation Zone

Zone between original squamo-columnar junction and

the “new” squamo-columnar junction

Nabothian cysts visually identify the transformation

zone if present
 Original Squamo-columnar Junction

Placement determined between 18-20 weeks gestation

Most often found on ectocervix

Can be found in vagina or vaginal fornices

Less apparent over time with maturation of

epithelium
 “New” Squamo-columnar Junction

Border between squamous epithelium and columnar

epithelium
Found on ecto-cervix or in endo-cervical canal

Majority of cervical cancers and precursor lesions

arise in immature squamous metaplasia, i.e. the

leading edge of the squamo-columnar junction
Squamous Epithelium
Parabasal Cells
Intermediate Cells
Superficial Cells
Endocervix
Endocervical Cells
Endometrial Cells
 Non-Epithelial Cells

Lymphocytes Polymorphs

sperms
Normal smear
 Ectropion / Erosion
At puberty & pregnancy the endocervical cells are

pushed out to lie on the ectocervix

Normal Ectropion
Wide Ectropion
 Metaplasia
The endocervical cells are transformed into squamous

cells through the process of squamous metaplasia

Metaplastic Cells