Perubahan Sitologi Reaktif,

Regeneratif, Reparatif
Oleh:
Harniyatie Mohamad
KSKB Kuching

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 Objektif Kuliah
• Menerangkan definisi bagi sel perubahan
reaktif, regeneratif, dan reparatif
• Menerangkan morfologi sel perubahan reaktif,
regeneratif dan reparatif
• Menerangkan perubahan nukleus dan
sitoplasma sel reaktif, regeneratif dan reparatif
• Menerangkan differential diagnosis

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 Pengenalan
• Permukaan uterin servik dilapisi oleh:
– Epitelium stratified skuamus (ektoservik)
– Epitelium kolumnar ringkas (endoservik)
• Pendedahan kepada ransangan dalaman
(internal stimuli) seperti perubahan hormon
atau kepincangan penyakit dan ransangan
luaran (external stimuli) seperti luka dan
perubahan pH dapat mempengaruhi
sitomorfologi sel pada permukaan uterin servik

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• Perubahan morfologi ini dikategorikan
sebagai:
– Pertahanan (protective)
– Kemusnahan (destructive)
– Reparatif
– Regeneratif
– Neoplastik – boleh menjadi epitelial atypia/ kanser

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 Definisi perubahan sel dalam saluran
pembiakan wanita
• Perubahan sel reaktif – keadaan sel yang aktif
• Perubahan sel reparatif – keadaan sel yang
menunjukkan keadaan pembaikpulihan
• Perubahan sel regeneratif – pertumbuhan
semulajadi
• Faktor fisiologi dan ransangan luaran boleh
merangsang perubahan reaktif, reparatif dan
regeneratif pada sitologi sel yang melapisi
permukaan uterin servik

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• Perubahan-perubahan reaktif, reparatif dan regeneratif
ini dapat dilihat pada smear pesakit yang menjalani
rawatan:
– Radioterapi
– Pembuangan servik (recent hysterectomy)
– Cautery and biopsy,curettage
– Cryocoagulation, diathermy
– Pressure necrosis from use of IUCD or ring pessary
– Severe inflammation lesion causing partial or total destruction
of epithelium

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 Gambaran sitomorfologi perubahan sel

• Gambaran secara umum – menyerupai

immature columnar cells, immature squamous
cells atau immature metaplastic cells
• Sel dikeluarkan (exfoliate) dalam large sheets
atau syncytial aggregates dengan pinggiran
sitoplasma yang tak jelas (indistinct
cytoplasmic boundaries)
• Binucleation

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• Mitotic figure boleh kelihatan (kromosom
yang sedang membahagi)
• Leucocytic infiltration kerap berlaku
• Single atypical cells kadang-kadang boleh
dijumpai
• Latarbelakang smer – pelbagai bergantung
kepada sebabnya
• Boleh salah diagnose sebagai malignansi

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 Morfologi nukleus
• Saiz nukleus membesar sehingga 3 kali ganda
• Bulat, bujur, tepi licin/ rata (smooth)
• Kedudukan di tengah (centrally placed)
• Nisbah N/C meningkat
• Kromatin – tidak hiperkromatik, bergranul halus – kasar
dengan taburan kadang-kadang tidak sekata
• Nukleoli – hadir, besar, boleh berganda (multiple
macronucleoli) , ungu kemerahan
• Kromosenter – hadir, biru keunguan

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 Sitoplasma
• Lapisan sel (cohesive monolayer) dengan
sitoplasma yang tidak bertindih (filmsy)
• Gabungan sitoplasma kelihatan renggang dan
terbuka
• Kadang-kadang bentuk bizarre, kelihatan ada
ekor
• Kadang-kadang terdapat vakuol
• Sempada sitoplasma ada kalanya tidak jelas

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Type of Preparation:
Conventional
Magnification:
Medium
Interpretation:
NILM: Reactive squamous
metaplasia
Cytomorphologic Criteria:
Higher N/C ratio than mature cells.
Nuclear membranes smooth and
chromatin finely granular and
evenly distributed. Small round
nucleoli/chromatin centers present.
Explanatory Notes:
Note the "spidery" cytoplasmic
processes, a feature that may be
seen in conventional smears.

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Type of Preparation:
Conventional

Magnification:
Medium

Interpretation:
NILM: Repair

Cytomorphologic Criteria:

Squamous cells in flat

monolayer sheet with
maintenance of nuclear
polarity and a prominent
nucleolus in almost every
cell.

Explanatory Notes:
If marked anisonucleosis, irregularities in the chromatin distribution, or variation in size and
shape of nucleoli are present, so-called "atypical repair", the changes should be categorized as
atypical glandular cells or atypical squamous cells. 12
Type of Preparation:
ThinPrep/ LBP

Magnification:
Medium

Clinical History:
32 year old female.

Interpretation:
NILM: Repair

Cytomorphologic Criteria:

Changes are similar to those

seen on conventional
smears, but cell streaming
may be less apparent due to
rounding of cell clusters.
Note the intracytoplasmic
polymorphonuclear
leucocytes, another feature
seen in repair.
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Type of Preparation:
ThinPrep/ LBP

Magnification:
Medium

Clinical History:
32 year old; routine Pap test

Interpretation:
NILM: Reactive squamous
cell

Cytomorphologic Criteria:

Mature squamous cell.

Explanatory Notes:
While there is nuclear enlargement in the cells on the right side, the smooth nuclear contours and
finely distributed chromatin favor reactive change over ASC-US.
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Type of Preparation:
ThinPrep/ LBP

Magnification:
High

Interpretation:
NILM: Reactive squamous
metaplasia

Cytomorphologic Criteria:

Enlarged nuclei in
metaplastic cells but fine
uniform chromatin. N/C
ratio is usually 50% or less.

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Type of Preparation:
Conventional

Magnification:
High

Interpretation:
NILM: Reactive
squamous cells

Cytomorphologic
Criteria:
Reactive squamous cells
showing mild nuclear
enlargement without any
significant chromatin
abnormalities

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Type of Preparation:
SurePath/ LBP

Magnification:
High

Clinical History:
Routine Pap test

Interpretation:
NILM: Repair

Cytomorphologic
Criteria:
The cell cluster shows
inter-cellular windows
(school-of-fish
appearance) and a
streaming pattern. Nuclei
are uniformly large, and
contain prominent
nucleoli. Chromatin
abnormalities are absent. 17
Type of Preparation:
Conventional

Magnification:
High

Interpretation:
NILM: Repair

Cytomorphologic Criteria:

Squamous cells in flat

monolayer sheet with
maintenance of nuclear
polarity and prominent
nucleoli in most cells

Explanatory Notes:
If marked anisonucleosis, irregularities in the chromatin distribution, or variation in size and
shape of nucleoli are present, so-called "atypical repair", the changes should be categorized as
atypical glandular cells or atypical squamous cells 18
Type of Preparation:
Conventional

Magnification:
High

Interpretation:
NILM: Repair

Cytomorphologic Criteria:
Increased nuclear size and
prominent nucleoli. Cells in
monolayer sheet with nuclei
oriented in the same
direction (streaming).

Explanatory Notes:
Absence of single cells with nuclear changes and lack of marked anisonucleosis or irregularities
in chromatin distribution or variation in size and shape of nuclei indicates this is typical repair (as
opposed to "atypical repair") which would be categorized as atypical glandular cells or atypical
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squamous cells.
Type of Preparation:
SurePath/ LBP

Magnification:
Medium

Clinical History:
32 year old woman

Interpretation:
NILM: Endocervical cells:
reparative

Cytomorphologic Criteria:
Monolayer sheet of
endocervical cells with orderly
arrangement. Streaming effect
is observed. Nuclei are
enlarged with nucleoli but Explanatory Notes:
have smooth borders and are Repair is characterized by cohesive cell groups with few or no
not hyperchromatic. single cells. In liquid preparations, the groups may appear more
rounded with less streaming.

Follow-up: 20
No abnormal follow-up
Type of Preparation:
SurePath/ LBP

Magnification:
Medium

Clinical History:
24 year old female

Interpretation:
NILM: Endocervical cells,
reactive

Cytomorphologic Criteria:
Nuclear enlargement with
some bi- and
multinucleation. Nuclear
outlines are smooth and
uniform. Chromatin is fine
with small nucleoli. Cells are
present in flat orderly sheet.

Follow-up:
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No abnormal follow-up
Type of Preparation:
Conventional

Magnification:
High

Interpretation:
NILM: Reactive
endocervical cells

Cytomorphologic Criteria:

Cohesive orderly sheet of

endocervical cells with
enlarged nuclei and
nucleoli. There is some
variation in nuclear size.
Nuclei are generally round
and smooth without
significant hyperchromasia.

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Type of Preparation:
SurePath/ LBP

Magnification:
Medium

Interpretation:
NILM: Reactive endocervical
cells

Cytomorphologic Criteria:
Increased N/C ratio.
Prominent nucleoli but
delicate chromatin and even
nuclear membranes.

Explanatory Notes:
Endocervical repair.

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Type of Preparation:
SurePath/ LBP

Magnification:
High

Interpretation:
NILM: Reactive
endocervical cells

Cytomorphologic Criteria:
Reactive endocervical cells
showing nuclear enlargement
and prominent nucleoli. A
few intracytoplasmic
polymorphonuclear
leukocytes are visible

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Type of Preparation:
Conventional

Magnification:
Medium

Clinical History:
67 year old woman with
uterine prolapse

Interpretation:
NILM: Reactive cellular
changes, Repair

Cytomorphologic
Criteria:
Flat monolayer sheets with
distinct cytoplasmic
outlines, streaming nuclear
polarity, prominent
nucleolus in almost every
cell.

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 Perbezaan diagnosis antara sel reparatif
dengan displasia
Ciri Sel reparatif Sel displasia
Jenis sel Banyak sel kolumnar Skuamus, isolated,
dalam lapisan loosely cohesive group
Sitoplasma Sianofilik, lompang Siano – eosinoflik,
kecil tiada lompang
Nukleus Hipokromatik, Hiperkromatik, single,
binucleated, kromatin kromatin granul kasar
granul halus
Nukleoli Prominent, biasa ada Tiada, kalau ada kecil
Mitosis Ada Jarang

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 Perbezaan diagnosis antara sel reparatif
dengan large cell carcinoma25
Ciri Sel repairatif Large cell carcinoma
Tumour diathesis Tiada Ada
Isolated cell Jarang kelihatan Banyak, ¾ sel
kelihatan berasingan
Syncytium ½ sel kelihatan ¼ sahaja
syncytium
Kromatin Taburan rata dan Taburan tidak rata
halus dan kasar
Makronuclei Boleh dilihat dalam Jarang
semua nukleus,
irregular

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Go beyond that limit, you’re
gonna fly high!
- alienonearth, landed on 210782 -

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