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Case 8

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

Crowds make me nervous 

Pap smear taken from a 40-year-old woman, day 10:










Select the correct diagnosis:

You answered:  Negative for malignancy   
That is CORRECT ! 

CYTOPATHOLOGY:

  • The smear contains numerous hyperchromatic crowded groups of cells, red blood cells and occasional ciliated gland cells, consistent with a brush sample.
  • High power examination of the crowded groups reveals cells with small, round and uniform nuclei with fine, evenly dispersed chromatin, inconspicuous nucleoli and very scant or ill-defined cytoplasm.  Apoptotic bodies seen within the groups suggest degeneration and proliferation.  The background contains stromal cells and histiocytes.  These cytologic features are consistent with fragments of proliferative endometrium on day 10 of the cycle.
  • The smear is interpreted as negative.

DISCUSSION:

  • Important features in determining the diagnosis for this smear are day of cycle, background characteristics and recognition of fine nuclear features.
  • The differential diagnosis includes:
    • HSIL also represented by hyperchromatic crowded groups, but with characteristic irregular coarse hyperchromatic nuclei.
    • Small cell carcinoma, due to the presence of the small dark cells in the background.  The lack of distinctive nuclear detail (hyperchromatic or salt and pepper chromatin) and nuclear molding rule out this diagnosis.
    • Endocervical adenocarcinoma, ruled out by the absence of nuclear elongation, hyperchromasia, and stratification and the lack of typical architectural features (feathering, acinar formation and rosettes).
  • Brush specimens, particularly those sampling lower uterine segments, may present diagnostic challenges.  It is important to pay attention to nuclear features of individual cells as well incorporate background and clinical information into the final diagnosis.

BACK TO IMAGES                           

REFERENCES:

DeMay, RM.  The Art & Science of Cytopathology.  ASCP Press, Chicago, Illinois; pp 62-3, 92-4, 130, 231-2.

Chivukula M, Austin M, Shidham V.  Evaluation and significance of hyperchromatic crowded groups (HCG) in liquid-based paps. CytoJournal 2007;4:2. Jan22; 4:2.

You answered:  HSIL
Sorry, that is INCORRECT 

The correct diagnosis is:  Negative for malignancy

CYTOPATHOLOGY:

  • The smear contains numerous hyperchromatic crowded groups of cells, red blood cells and occasional ciliated gland cells, consistent with a brush sample.
  • High power examination of the crowded groups reveals cells with small, round and uniform nuclei with fine, evenly dispersed chromatin, inconspicuous nucleoli and very scant or ill-defined cytoplasm.  Apoptotic bodies seen within the groups suggest degeneration and proliferation.  The background contains stromal cells and histiocytes.  These cytologic features are consistent with fragments of proliferative endometrium on day 10 of the cycle.
  • The smear is interpreted as negative.

DISCUSSION:

  • Important features in determining the diagnosis for this smear are day of cycle, background characteristics and recognition of fine nuclear features.
  • The differential diagnosis includes:
    • HSIL also represented by hyperchromatic crowded groups, but with characteristic irregular coarse hyperchromatic nuclei.
    • Small cell carcinoma, due to the presence of the small dark cells in the background.  The lack of distinctive nuclear detail (hyperchromatic or salt and pepper chromatin) and nuclear molding rule out this diagnosis.
    • Endocervical adenocarcinoma, ruled out by the absence of nuclear elongation, hyperchromasia, and stratification and the lack of typical architectural features (feathering, acinar formation and rosettes).
  • Brush specimens, particularly those sampling lower uterine segments, may present diagnostic challenges.  It is important to pay attention to nuclear features of individual cells as well incorporate background and clinical information into the final diagnosis.

BACK TO IMAGES 


REFERENCES:

DeMay, RM.  The Art & Science of Cytopathology.  ASCP Press, Chicago, Illinois; pp 62-3, 92-4, 130, 231-2.

Chivukula M, Austin M, Shidham V.  Evaluation and significance of hyperchromatic crowded groups (HCG) in liquid-based paps. CytoJournal 2007;4:2. Jan22; 4:2.

 
You answered:  Endocervical adenocarcinoma
Sorry, that is INCORRECT
 
The correct diagnosis is:  Negative for malignancy

CYTOPATHOLOGY:
  • The smear contains numerous hyperchromatic crowded groups of cells, red blood cells and occasional ciliated gland cells, consistent with a brush sample.
  • High power examination of the crowded groups reveals cells with small, round and uniform nuclei with fine, evenly dispersed chromatin, inconspicuous nucleoli and very scant or ill-defined cytoplasm.  Apoptotic bodies seen within the groups suggest degeneration and proliferation.  The background contains stromal cells and histiocytes.  These cytologic features are consistent with fragments of proliferative endometrium on day 10 of the cycle.
  • The smear is interpreted as negative.

DISCUSSION:

  • Important features in determining the diagnosis for this smear are day of cycle, background characteristics and recognition of fine nuclear features.
  • The differential diagnosis includes:
    • HSIL also represented by hyperchromatic crowded groups, but with characteristic irregular coarse hyperchromatic nuclei.
    • Small cell carcinoma, due to the presence of the small dark cells in the background.  The lack of distinctive nuclear detail (hyperchromatic or salt and pepper chromatin) and nuclear molding rule out this diagnosis.
    • Endocervical adenocarcinoma, ruled out by the absence of nuclear elongation, hyperchromasia, and stratification and the lack of typical architectural features (feathering, acinar formation and rosettes).
  • Brush specimens, particularly those sampling lower uterine segments, may present diagnostic challenges.  It is important to pay attention to nuclear features of individual cells as well incorporate background and clinical information into the final diagnosis.

BACK TO IMAGES 

REFERENCES:

DeMay, RM.  The Art & Science of Cytopathology.  ASCP Press, Chicago, Illinois; pp 62-3, 92-4, 130, 231-2.

Chivukula M, Austin M, Shidham V.  Evaluation and significance of hyperchromatic crowded groups (HCG) in liquid-based paps. CytoJournal 2007;4:2. Jan22; 4:2.

You answered:  Small cell carcinoma
Sorry, that is INCORRECT
 
The correct diagnosis is:  Negative for malignancy

CYTOPATHOLOGY:
  • The smear contains numerous hyperchromatic crowded groups of cells, red blood cells and occasional ciliated gland cells, consistent with a brush sample.
  • High power examination of the crowded groups reveals cells with small, round and uniform nuclei with fine, evenly dispersed chromatin, inconspicuous nucleoli and very scant or ill-defined cytoplasm.  Apoptotic bodies seen within the groups suggest degeneration and proliferation.  The background contains stromal cells and histiocytes.  These cytologic features are consistent with fragments of proliferative endometrium on day 10 of the cycle.
  • The smear is interpreted as negative.

DISCUSSION:

  • Important features in determining the diagnosis for this smear are day of cycle, background characteristics and recognition of fine nuclear features.
  • The differential diagnosis includes:
    • HSIL also represented by hyperchromatic crowded groups, but with characteristic irregular coarse hyperchromatic nuclei.
    • Small cell carcinoma, due to the presence of the small dark cells in the background.  The lack of distinctive nuclear detail (hyperchromatic or salt and pepper chromatin) and nuclear molding rule out this diagnosis.
    • Endocervical adenocarcinoma, ruled out by the absence of nuclear elongation, hyperchromasia, and stratification and the lack of typical architectural features (feathering, acinar formation and rosettes).
  • Brush specimens, particularly those sampling lower uterine segments, may present diagnostic challenges.  It is important to pay attention to nuclear features of individual cells as well incorporate background and clinical information into the final diagnosis.

BACK TO IMAGES  

REFERENCES:

DeMay, RM.  The Art & Science of Cytopathology.  ASCP Press, Chicago, Illinois; pp 62-3, 92-4, 130, 231-2.

Chivukula M, Austin M, Shidham V.  Evaluation and significance of hyperchromatic crowded groups (HCG) in liquid-based paps. CytoJournal 2007;4:2. Jan22; 4:2.

 


From the Cytopathology files of the BC Cancer Agency
Submitted by: Brittney Hurd, BSc and Tom Thomson, MD
SOURCE: Case 8 ( )
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