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Case 7

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

CINister Orange

Pap smear taken from a 36-year old woman, day 22:


 

 

 

 

Select the correct diagnosis:

You answered: Degenerative endocervical and metaplastic cells
Sorry, that is INCORRECT 


The correct diagnosis is: Keratinizing Dysplasia (HSIL)


CYTOPATHOLOGY:

  • The smear contains numerous single, pleomorphic keratinized squamous cells with dense orangeophilic or cyanophilic cytoplasm.
  • These cells have a high N/C ratio with enlarged hyperchromatic nuclei that have uniform chromatin and nuclear membrane irregularities.
  • Tumour diathesis is not seen.

 

DISCUSSION:

  • A cervical biopsy taken 3 months after the Pap smear revealed Keratinizing Dysplasia (CIN II) with dysplastic cells replacing two-thirds of the epithelium and abnormal surface keratinized squamous cells present. Invasion was not identified.
  • Keratinizing dysplasia is a precursor of Keratinizing Squamous Cell Carcinoma. The keratosis may be hyperkeratosis, typical parakeratosis, or atypical parakeratosis.
  • The differential diagnoses of Pap smears with keratinizing dyskaryosis includes keratinizing squamous cell carcinoma and keratinizing dysplasia. Keratinizing dysplasia is favoured by the absence of pleomorphic/bizarre cells and less than 15% of the total cellularity on the slide (DeMay 1996). Features favouring carcinoma are prominent nucleoli, irregular chromatin and tumour diathesis.
  • Keratinizing dysplasia may also be misdiagnosed as Squamous Carcinoma in Situ, but, in the latter, true keratinization is not possible because it is an undifferentiated cell population represented by hyperchromatic crowded groups or single dysplastic cells with scant cytoplasm
  • Degenerative glandular or metaplastic cells may have intensely stained eosinophilic cytoplasm with angulated, irregular hyperchromatic appearing nuclei, which may be confused with a keratinizing dysplasia. However, features such as disrupted nuclear membranes, nuclear holes and nuclear eosinophilia would favour degenerative change.

BACK TO IMAGES


HISTOLOGY


REFERENCES:

DeMay RM. The Art & Science of Cytopathology. Chicago: ASCP Press, 1996; pages 79, 85.

Ramzy I. Clinical Cytopathology and Aspiration Biopsy. New York: McGraw-Hill, 2001; page 80.

Koss LG, Gompel C. Introduction to Gynecologic Cytopathology with Histologic and Clinical Correlations. Maryland: Williams & Wilkins, 1999; page 95.

 

You answered: Keratinizing Dysplasia (HSIL)     

That is CORRECT!

 

CYTOPATHOLOGY:

  • The smear contains numerous single, pleomorphic keratinized squamous cells with dense orangeophilic or cyanophilic cytoplasm.
  • These cells have a high N/C ratio with enlarged hyperchromatic nuclei that have uniform chromatin and nuclear membrane irregularities.
  • Tumour diathesis is not seen.

DISCUSSION:

  • A cervical biopsy taken 3 months after the Pap smear revealed Keratinizing Dysplasia (CIN II) with dysplastic cells replacing two-thirds of the epithelium and abnormal surface keratinized squamous cells present. Invasion was not identified.
  • Keratinizing dysplasia is a precursor of Keratinizing Squamous Cell Carcinoma. The keratosis may be hyperkeratosis, typical parakeratosis, or atypical parakeratosis.
  • The differential diagnoses of Pap smears with keratinizing dyskaryosis include keratinizing squamous cell carcinoma and keratinizing dysplasia. Keratinizing dysplasia is favoured by the absence of pleomorphic/bizarre cells and less than 15% of the total cellularity on the slide (DeMay 1996). Features favouring carcinoma are prominent nucleoli, irregular chromatin and tumour diathesis.
  • Keratinizing dysplasia may also be misdiagnosed as Squamous Carcinoma in Situ, but in the latter, true keratinization is not possible because it is an undifferentiated cell population represented by hyperchromatic crowded groups or single dysplastic cells with scant cytoplasm
  • Degenerative glandular or metaplastic cells may have intensely stained eosinophilic cytoplasm with angulated, irregular hyperchromatic appearing nuclei, which may be confused with a keratinizing dysplasia. However, features such as disrupted nuclear membranes, nuclear holes and nuclear eosinophilia would favour degenerative change.

BACK TO IMAGES


HISTOLOGY


REFERENCES:

DeMay RM. The Art & Science of Cytopathology. Chicago: ASCP Press, 1996; pages 79, 85.

Ramzy I. Clinical Cytopathology and Aspiration Biopsy. New York: McGraw-Hill, 2001; page 80.

Koss LG, Gompel C.  Introduction to Gynecologic Cytopathology with Histologic and Clinical Correlations. Maryland: Williams & Wilkins, 1999; page 95.

You answered: Squamous Carcinoma in Situ
Sorry, that is INCORRECT

 

The correct diagnosis is: Keratinizing Dysplasia (HSIL)


CYTOPATHOLOGY:

  • The smear contains numerous single, pleomorphic keratinized squamous cells with dense orangeophilic or cyanophilic cytoplasm.
  • These cells have a high N/C ratio with enlarged hyperchromatic nuclei that have uniform chromatin and nuclear membrane irregularities.
  • Tumour diathesis is not seen.

DISCUSSION:

  • A cervical biopsy taken 3 months after the Pap smear revealed Keratinizing Dysplasia (CIN II) with dysplastic cells replacing two-thirds of the epithelium and abnormal surface keratinized squamous cells present. Invasion was not identified.
  • Keratinizing dysplasia is a precursor of Keratinizing Squamous Cell Carcinoma. The keratosis may be hyperkeratosis, typical parakeratosis, or atypical parakeratosis.
  • The differential diagnoses of Pap smears with keratinizing dyskaryosis includes keratinizing squamous cell carcinoma and keratinizing dysplasia. Keratinizing dysplasia is favoured by the absence of pleomorphic/bizarre cells and less than 15% of the total cellularity on the slide (DeMay 1996). Features favouring carcinoma are prominent nucleoli, irregular chromatin and tumour diathesis.
  • Keratinizing dysplasia may also be misdiagnosed as Squamous Carcinoma in Situ, however, in the latter, true keratinization is not possible because it is an undifferentiated cell population represented by hyperchromatic crowded groups or single dysplastic cells with scant cytoplasm
  • Degenerative glandular or metaplastic cells may have intensely stained eosinophilic cytoplasm with angulated, irregular hyperchromatic appearing nuclei, which may be confused with a keratinizing dysplasia. However, features such as disrupted nuclear membranes, nuclear holes and nuclear eosinophilia would favour degenerative change.

BACK TO IMAGES


HISTOLOGY


REFERENCES:

DeMay RM. The Art & Science of Cytopathology. Chicago: ASCP Press, 1996; pages 79, 85.

Ramzy I. Clinical Cytopathology and Aspiration Biopsy. New York: McGraw-Hill, 2001; page 80.

Koss LG, Gompel C. Introduction to Gynecologic Cytopathology with Histologic and Clinical Correlations. Maryland: Williams & Wilkins, 1999; page 95.

You answered: Keratinizing Squamous Cell Carcinoma
Sorry, that is INCORRECT

 

The correct diagnosis is: Keratinizing Dysplasia (HSIL)


CYTOPATHOLOGY:

  • The smear contains numerous single, pleomorphic keratinized squamous cells with dense orangeophilic or cyanophilic cytoplasm.
  • These cells have a high N/C ratio with enlarged hyperchromatic nuclei that have uniform chromatin and nuclear membrane irregularities.
  • Tumour diathesis is not seen.

DISCUSSION:

  • A cervical biopsy taken 3 months after the Pap smear revealed Keratinizing Dysplasia (CIN II) with dysplastic cells replacing two-thirds of the epithelium and abnormal surface keratinized squamous cells present. Invasion was not identified.
  • Keratinizing dysplasia is a precursor of Keratinizing Squamous Cell Carcinoma. The keratosis may be hyperkeratosis, typical parakeratosis, or atypical parakeratosis.
  • The differential diagnoses of Pap smears with keratinizing dyskaryosis includes keratinizing squamous cell carcinoma and keratinizing dysplasia. Keratinizing dysplasia is favoured by the absence of pleomorphic/bizarre cells and less than 15% of the total cellularity on the slide (DeMay 1996). Features favouring carcinoma are prominent nucleoli, irregular chromatin and tumour diathesis.
  • Keratinizing dysplasia may also be misdiagnosed as Squamous Carcinoma in Situ, however, in the latter, true keratinization is not possible because it is an undifferentiated cell population represented by hyperchromatic crowded groups or single dysplastic cells with scant cytoplasm
  • Degenerative glandular or metaplastic cells may have intensely stained eosinophilic cytoplasm with angulated, irregular hyperchromatic appearing nuclei, which may be confused with a keratinizing dysplasia. However, features such as disrupted nuclear membranes, nuclear holes and nuclear eosinophilia would favour degenerative change.

BACK TO IMAGES


HISTOLOGY


REFERENCES:

DeMay RM. The Art & Science of Cytopathology. Chicago: ASCP Press, 1996; pages 79, 85.

Ramzy I. Clinical Cytopathology and Aspiration Biopsy. New York: McGraw-Hill, 2001; page 80.

Koss LG, Gompel C. Introduction to Gynecologic Cytopathology with Histologic and Clinical Correlations. Maryland: Williams & Wilkins, 1999; page 95.

From the Cytopathology files of the BC Cancer Agency
Submitted by: Brian Murray, BSc and Tom Thomson, MD
SOURCE: Case 7 ( )
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