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cervix Body of the uterus Fundus of the uterus The uterus Uterus is lined by simple columnar ciliated cells.

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Presentation on theme: "cervix Body of the uterus Fundus of the uterus The uterus Uterus is lined by simple columnar ciliated cells."— Presentation transcript:

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2 cervix Body of the uterus Fundus of the uterus The uterus Uterus is lined by simple columnar ciliated cells

3 The cervix AnatomyHistology vaginaStratified squamous non-keratinzed epithelium rich in glycogen Ectocervix Stratified squamous non-keratinzed epithelium rich in glycogen EndocervixPseudo-stratified columnar ciliated epithelium, rich in mucus secretion Cervical canalPseudo-stratified columnar ciliated epithelium, rich in mucus secretion

4 The vagina Function: protection of upper genital tract. Thickness: Child: thin (few cells) and atrophy Menopause: thin and atrophy Puberty (reproductive period): thick (more than one layer, 7-10 layers).

5 Cytology of normal female genital tract 1- Epithelial cells: Stratified squamous epithelium Columnar epithelium Endometrium Glandular endometrial cells Stromal endometrial cells: Superficial cells Deep cells

6 SquamousEpithelium

7 Superficial Intermediate Parabasal Basal

8 Glandular endometrial cells Physiologically: they are present as normal cells in the following conditions, in routine vaginal smear Menstrual flow ( early 2-3 days). Early pregnancy Abortion Post-partum period In case of intra-uterine device at the end of menstrual cycle.

9 Glandular endometrial cells Pathologically: present in endometrial lesions as: Polyp Endometritis Submucous fibroid Endometrial hyperplasia Adeno-carcinoma

10 2- Non-epithelial cells Smooth muscle cells: normally not present except in deep traumatic scrapping of ulcerative lesion as in polyp, fibroma, and abortion. RBCs Plasma cells Histocytes (macrophages) Sperms Yeast Trichomanos vaginalis

11 Inflammatory cells usually posterior fornix or cervical smears Inflammatory changes in epithelial cells Presence of polymorphs Intra-cellular diplococci Polymorphs Diplococci Bacterial Vaginosis

12 Presence of micro-organisms Trichomonas Candida Bacteria Mites Dust mitesTrichomonas Candida spores-hyphae

13 Methods of collecting endometrial samples Endometrial aspiration Endometrial lavage Endometrial scraping Endometrial biopsy

14 Cervical – vaginal smears Several possibilities Cervical scrape taken from the squamo-columnar junction; the level of the SC junction varies with sexual maturity Posterior fornix aspiration Lateral vaginal wall [upper third] scrape

15 Squamo-Columnar Junction Junction of pink cervical skin and red endocervical canal Inherently unstable Key portion of the cervix to sample Most likely site of dysplasia

16 Vaginal Speculum

17 Ayers Spatula Concave end to fit the cervix Convex end for vaginal wall and vaginal pool scrapings

18 Cytobrush Insert ~ 2 cm (until brush is fully inside canal) Rotate only 180 degrees (otherwise will cause bleeding)

19 Squamous epithelial cells Keratinized type: skin, valva Non-keratinized: vagina, ectocervix - Basal cells: usually not seen unless there is sever ulceration with destruction of whole thickness of epithelium: deep basophilic - Parabasal cells - Intermediate cells - Superfacial cells - Non-nucleated cells

20 Differentiating feature of normal squamous cells ParabasalIntermediateSuperficial Cell formation Single cells or sheet Single cells or clump Diameter 15 – 25 um um33 – 55 um Nucleus Vesicular with finely granular chromatin um Vesicular with finely granular chromatin 8 – 10 um Pyknotic or absent 4 – 6 um Cytoplasm Oval, thick, and dark basophilic Thin, flat or folded, polyhydral, pale basophilic Polyhydral, thin, flat, eosinophilic

21 Feature of cell maturation NucleusCytoplasm Basal cellsReticular chromatin Greenish blue (basophilic) Parabasal and intermediate cells Granular chromatinYellow Superficial cellsPyknotic chromatinRed (acidophilic)

22 Make Pap Smear As thin as possible Properly labeled

23 Spray with Fixative Within seconds Allow to fully dry before packaging Cytologic Fixative

24 Causes of unsatisfactory smear Air drying smear before fixation ---- less differentiation between cytoplasm and nucleus. Inadequate fixation Uncleaned slides Incorrect staining time Dryness during staining procedures

25 Characters of unsatisfactory smear Thick Poorly spread Blood smear with clotting

26 Thank you


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