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Case 5

View the images and select the correct diagnosis from the list below.

The mystery package

Cervical smear from a 32-year-old woman, day 24

Image 1 

Image 2 

Image 3 

Image 4 

Select the correct diagnosis:

You answered: Atypical squa mous cells of undetermined significance

Sorry, that is INCORRECT 


The correct diagnosis is: High-grade squamous intra-epithelial lesion


CYTOPATHOLOGY:

  • Disordered and irregular aggregates of highly atypical cells are present.
  • Cell crowding is readily apparent, with altered nuclear polarity.
  • Cytoplasm is scant to absent in many groups, while other clusters have well-defined, dense basophilic cytoplasm.
  • The nuclei are irregular and hyperchromatic

DISCUSSION:

  • The cervical biopsy reveals a high-grade squamous intra-epithelial lesion.
  • Interpretation of crowded cell clusters can be very difficult. Looking for hyperchromatic nuclei, irregular nuclear membranes, and dense cytoplasm would aid in the diagnosis of a squamous lesion.
  • Nuclear palisading can be seen in fragments from squamous carcinoma in situ and in the absence of definite gland formation, rosettes or feathering, are more likely squamous than endocervical.

BACK TO IMAGES


HISTOLOGY


REFERENCES:

Bonfiglio TA, Erozan YS. Gynecologic Cytopathology. Philadelphia: Lipincott-Raven 1997:145.

Solomon D, Nayar R et al. The Bethesda System for Reporting Cervical Cytology 2nd Edition. New York: Springer-Verlag 2004: 80-81.

You answered: High-grade squamous intra-epithelial lesion
That is CORRECT!

CYTOPATHOLOGY: 

  • Disordered and irregular aggregates of highly atypical cells are present
  • Cell crowding is readily apparent, with altered nuclear polarity
  • Cytoplasm is scant to absent in many groups, while other clusters have well-defined, dense basophilic cytoplasm
  • The nuclei are irregular and hyperchromatic

DISCUSSION:

  • The cervical biopsy reveals a high-grade squamous intra-epithelial lesion.
  • Interpretation of crowded cell clusters can be very difficult.  Looking for hyperchromatic nuclei, irregular nuclear membranes, and dense cytoplasm would aid in the diagnosis of a squamous lesion.
  • Nuclear palisading can be seen in fragments from squamous carcinoma in situ and in the absence of definite gland formation, rosettes or feathering, are more likely squamous than endocervical.

BACK TO IMAGES


HISTOLOGY


REFERENCES:

Bonfiglio TA, Erozan YS. Gynecologic Cytopathology. Philadelphia: Lipincott-Raven 1997:145.

Solomon D, Nayar R et al. The Bethesda System for Reporting Cervical Cytology 2nd Edition. New York: Springer-Verlag 2004: 80-81.

You answered: Atypical glandular cells, favour neoplastic
Sorry, that is INCORRECT


The correct diagnosis is: High-grade squamous intra-epithelial lesion 


CYTOPATHOLOGY:

  • Disordered and irregular aggregates of highly atypical cells are present.
  • Cell crowding is readily apparent, with altered nuclear polarity.
  • Cytoplasm is scant to absent in many groups, while other clusters have well-defined, dense basophilic cytoplasm.
  • The nuclei are irregular and hyperchromatic

DISCUSSION:

  • The cervical biopsy reveals a high-grade squamous intra-epithelial lesion.
  • Interpretation of crowded cell clusters can be very difficult. Looking for hyperchromatic nuclei, irregular nuclear membranes, and dense cytoplasm would aid in the diagnosis of a squamous lesion.
  • Nuclear palisading can be seen in fragments from squamous carcinoma in situ and in the absence of definite gland formation, rosettes or feathering, are more likely squamous than endocervical.

BACK TO IMAGES


HISTOLOGY


REFERENCES:

Bonfiglio TA, Erozan YS. Gynecologic Cytopathology. Philadelphia: Lipincott-Raven 1997:145.

Solomon D, Nayar R et al. The Bethesda System for Reporting Cervical Cytology 2nd Edition. New York: Springer-Verlag 2004: 80-81.

You answered: Adenocarcinoma in situ
Sorry, that is INCORRECT

The correct diagnosis is: High-grade squamous intra-epithelial lesion

CYTOPATHOLOGY:

  • Disordered and irregular aggregates of highly atypical cells are present.
  • Cell crowding is readily apparent, with altered nuclear polarity.
  • Cytoplasm is scant to absent in many groups, while other clusters have well-defined, dense basophilic cytoplasm.
  • The nuclei are irregular and hyperchromatic. 

DISCUSSION:

  • The cervical biopsy reveals a high-grade squamous intra-epithelial lesion
  • Interpretation of crowded cell clusters can be very difficult.  Looking for hyperchromatic nuclei, irregular nuclear membranes, and dense cytoplasm would aid in the diagnosis of a squamous lesion.
  • Nuclear palisading can be seen in fragments from squamous carcinoma in situ and in the absence of definite gland formation, rosettes or feathering, are more likely squamous than endocervical.

BACK TO IMAGES


HISTOLOGY


REFERENCES:

Bonfiglio TA, Erozan YS. Gynecologic Cytopathology. Philadelphia: Lipincott-Raven 1997:145.

Solomon D, Nayar R et al. The Bethesda System for Reporting Cervical Cytology 2nd Edition. New York: Springer-Verlag 2004: 80-81.

 

 
 
From the Cytopathology files of the BC Cancer Agency
Submitted by: Brenda Smith, BSc and Tom Thomson, MD
SOURCE: Case 5 ( )
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