Atlas de Citología

8/21/2019 Atlas de Citologa

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ATLAS

DE

CITOLOGA

ESCUELADETECNOLOGAMDICA

DOCENTE:Lic.MaraElenaFloresCava

UNIVERSIDADALASPERUANAS

2008


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Terminologa del Sistema Bethesda 2001

Tipo de Muestra: Indicar frotis convencional (Pap convencional) vs. en base lquida vs.otro

Muestra Adecuadao Satisfactoria para evaluacin (describir presencia o ausencia de componentes de

zonas de transformacin/endocervical y cualquier otro indicador de calidad, por ej.,

parcialmente teido por sangre, inflamacin, etc.)o No satisfactorio para evaluacin ... (especificar razn)

o

Muestra rechazada/no procesada (especificar razn)o Muestra procesada y examinada, pero no satisfactoria para evaluacin de

anormalidad epitelial por (especificar razn)

Categorizacin General(opcional)o Negativo para lesin intraepitelial o malignidado Anormalidad de clulas epiteliales: Ver interpretacin/Resultado (especificar

escamoso o glandular como apropiado)

o Otro: Ver interpretacin/Resultado (por ej. clulas endometriales en una mujer > 40

aos de edad)Revisin AutomatizadaSi fue examinado por un aparato automatizado, especificar aparato y resultado.

Pruebas AuxiliaresProveer de una breve descripcin de los mtodos y reportes de resultados para que sea

fcilmente comprendido por los mdicos.

Interpretacin/ResultadosNegativo para Lesin Intraepitelial o Malignidad(cuando no exista evidencia celular deneoplasia, estado en la seccin del reporte Categorizacin General y/o

Interpretacin/Resultados, ya sea o no por organismos u otros hallazgos no neoplsicos)

Organismos:

Trichomonas vaginalis

Organismos micticos morfolgicamente consistente con Candida spp Cambio en la flora sugestivo de vaginosis bacteriana

Bacterias morfolgicamente consistente con Actinomyces spp.

Cambios celulares consistentes con Herpes simplex virusOtros Hallazgos No Neoplsicos (Opcional para el reporte; lista no incluida):

Cambios celulares reactivos asociado con

i fl i (i l i i )


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Clulas endometriales (en una mujer > 40 aos de edad)(Especficamente si es negativo para lesin intraepitelial escamosa)

Anormalidades de Clulas EpitelialesClulas Escamosas

Clulas escamosas atpicas (ASC)

de significado indeterminado (ASC-US)

no puede excluirse HSIL (ASC-H)

Lesin intraepitelial escamosa de bajo grado (LSIL)

comprendiendo: HPV/displasia leve/CIN 1

Lesin intraepitelial escamosa de alto grado (HSIL)comprendiendo: displasia moderada y severa, carcinoma in situ (CIS)/CIN 2 y CIN

3

con caractersticas sospechosas para invasin (si la invasin es sospechada)

Carcinoma de clulas escamosas

Clulas glandulares

Clulas glandulares atpicas (AGC)

clulas endocervicales (no especfico - NOS o especificar en comentarios)

clulas endometriales (NOS o especificar en comentarios) clulas glandulares (NOS o especificar en comentarios)

Atpicas

clulas endocervicales, favorece neoplasia

clulas glandulares, favorece neoplasia

Adenocarcinoma endocervical in situ (AIS)

Adenocarcinoma

endocervical

endometrial

extrauterino

no especificado (NOS)

Otras Neoplasias Malignas:(especificar)

Nota Educacional y Sugerencias(opcional)

Las sugerencias deberan ser concisas y consecuentes con las guas de seguimiento clnicopublicados por organizaciones profesionales (referencias de publicaciones relevantes

pueden incluirse).

Bibli f


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EPITELIO ESCAMOSO DEL CERVIX


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Superficial squamous cells with pyknotic nuclei and abundant

transparent cytoplasm. Also seen are metaplastic squamous cells

(4 o'clock) and PMN's in the background.


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Clulas Superficiales e Intermedias


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An intermediate squamous cell displaying a round vesicular nucleus and abundant

"tissue paper-like" cytoplasm. Cluster of three squamous metaplastic cells are present at

4 o'clock. The latter cells are smaller in size with slightly larger nuclei and denser

cytoplasm.


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Epitelio Endocervical


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Fragments of endocervical epithelium displaying basally placed

uniform nuclei and apical cytoplasmic mucin. Numerous squamous

cells are scattered in the background.


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Clulas Endocervicales


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Frotis Hipotrfico


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ENDOMETRIO


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Endometrial epithelium appearing as a tightly cohesive cellular

fragment. Note the small, monomorphic hyperchromatic nuclei

with occasional nucleoli.


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A cohesive fragment of benign endometrial epithelial cells.

Endometrial cells are distinctly smaller than other glandular

epithelial cells and usually exfoliate as tight cellular balls.


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Metaplasia Escamosa


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Metaplasia Escamosa del Cervix


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Metaplasia Escamosa


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HIPERQUERATOSIS


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Cervicitis


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Cndida


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Herpes Simplex Virus


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Multinucleated giant cells representing infection by Herpessimplex virus. Note the 3 "M's"; i.e. Multinucleation,

Margination of the chromatin, Molding of the nuclei.


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Metaplastic endocervical epithelium disclosing multinucleation

and discrete intranuclear inclusions, consistent with infectionby Herpes simplex virus. Note nuclear chromatin margination

and prominent nuclear molding.


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Fragment of markedly reactive metaplastic

squamous epithelium. Note uniform round

nuclei with prominent nucleoli in a

background of vesicular chromatin andcytoplasmic prolongations. Also note

numerous inflammatory cells in the

background. Reactive / reparative

changes should be identified as benign

and not confused with an invasive

squamous cell carcinoma.

Epitelio Reparativo


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ASCUS. A comparar con las clulas escamosas normales descritas en el apartado

"criterios" . Los ncleos muestran una ligera anisonucleosis (diferencia detamao) pero permanecen muy regulares a pesar de una cromatina ms intensa.

Las dos clulas arriba a la derecha son normales.


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Endocervical epithelium disclosing enlarged nuclei with

prominent stratification. Cells are crowded with nuclear

overlap but still maintain nuclear polarity.

AGUS


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Squamous epithelial cells disclosing mild atypia (enlargednuclei). Note absence of nuclear membrane irregularities

and cytoplasmic halos.


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DISPLASIA MODERADA ASOCIADA A CONDILOMA


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Severe Cervical Dysplasia with HPV-16 infection


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Atypical squamous epithelial cells disclosing dense keratinization.Nuclei are enlarged, however, they do not disclose membrane

irregularities. Perinuclear halos are not present.


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Squamous epithelial cells with prominent cytologic atypia

(enlarged, hyperchromatic and irregular nuclei; vagueperinuclear halo formations). Compare these to the benign

intermediate squamous cells to the left of the field.


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Squamous epithelial atypia (enlarged hyperchromatic nuclei,suggestion of perinuclear halos, and binucleation).


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Exfoliated squamous epithelial cells with enlarged hyperchromatic

nuclei. Note occasional binucleation and the characteristicperinuclear halo formation (3 o'clock). These cells are referred to

as "koilocytes" and are diagnostic of LSIL (HPV infection).


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A cluster of LSIL cells depicting enlarged nuclei (more than 3 times the size of a normal

intermediate squamous cells nucleus). An eye-catching feature seen here is formation ofkoilocytes (sharply defined perinuclear cytoplasmic clearing often with a wire-loop

periphery), diagnostic of LSIL / HPV infection.


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Group of koilocytes displaying well-formed perinuclear haloswith wire-loop periphery. Note the enlarged, hyperchromatic

nuclei. These cells are diagnostic of LSIL / HPV infection.


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Condyloma o infeccin por el virus del papiloma o LSIL. Destaca sobretodo los

grandes halos perinucleares y la binucleatin. Algunos citoplasmas presentananfofilia (dos colores). La cromatina es intensa y a veces tiene un aspecto

"grosero" (clula de la derecha y tambin la de abajo).


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Displasia leve

Displasia leve Asociada a Condiloma


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Displasia leve o LSIL o CIN 1.El ndice ncleo-citoplasmaes un poco elevado. La cromatina es ms granular y los

bordes nucleares ligeramente irregulares.


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LEI DE BAJO GRADO


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LEI DE BAJO GRADO


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A cluster of LSIL cells demonstrating enlarged nuclei,hyperchromasia, and a smudgy chromatin pattern. Also notice

occasional binucleation and perinuclear halos.


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DISPLASIA MODERADA


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DISPLASIA SEVERA


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Carcinoma In Situ del Cervix


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Numerous metaplastic-type squamous epithelial cells withmarkedly enlarged nuclei, hyperchromasia associated with

coarse chromatin, and irregular nuclear membranes.


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Single discohesive squamous cells with a metaplatic appearance. Note hyperchromatic

nuclei, coarse chromatin, and prominent irregularity of the nuclear membrane. Also notethe markedly enlarged nuclear size in comparison to an intermediate squamous cell

nucleus (bottom of the field).


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Displasia severa o HSIL o CIN 3. El ndice ncleo-citoplasmaes signif icativamente ms elevado. Los ncleos presentan

muescas y la cromatina es mucho ms granular.


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LEI DE ALTO GRADO


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Atypical squamous metaplastic cells with enlarged hyperchromatic nuclei and prominent

irregularity of the nuclear outline. Follow-up biopsy on this case revealed CIN III. HSILmay exfoliate cells that sometimes are difficult to differentiate from immature squamous

metaplastic cells.


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CARCINOMA INVASOR DEL CERVIX


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Fragments of heavily keratinized malignant squamous epithelium appearing as brightly

orangeophilic cells. Smear shows subtle but definite background diathesis. Although

densely keratinized cells can be seen in benign conditions or low grade squamousintraepithelial lesions, possibility of squamous cell carcinoma should be carefully

excluded in their presence.


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Fragment of poorly differentiated non-keratinizing squamous cell carcinoma seen as asyncytial aggregate of pleomorphic malignant cells. Note cytomorphologic similarities

with reactive / reparative changes. Also noted is an inflammatory smear background.


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Poorly differentiated squamous cell carcinoma with discohesive

cells displaying high N:C ratio and hyperchromatic pleomorphicnuclei with occasional prominent nucleoli. Note the prominent

inflammatory diathesis in the background.


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Poorly differentiated non-keratinizing squamous cell carcinoma.

Note the hyperchromatic pleomorphic cells often with elongatedspindled nuclei containing coarse chromatin. Tumor diathesis is

also present in the background.


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Citologa del Carcinoma Invasor del Cervix


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CARCINOMA INVASOR


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ADENOCARCINOMA DEL ENDOCERVIX


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A large fragment of glandular epithelium with enlarged, hyperchromatic, and crowded

nuclei often containing prominent nucleoli. This morphology is consistent with a well-differentiated adenocarcinoma. A cytomorphologic distinction with reactive epithelium

sometimes might be difficult.


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Malignant epithelial fragment with glandular differentiation. Notemarkedly enlarged nuclei, vesicular chromatin, and prominent

nucleoli. There is extensive tumor diathesis in the background.


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A tightly cohesive fragment of adenocarcinoma in a background of prominent estrogeneffect (numerous intermediate and superficial squamous cells). Note the three-

dimensional architecture, cytoplasmic vacuoles, and intracytoplasmic PMN's.


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ADENOCARCINOMA DEL ENDOMETRIO


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