2 Definition of cytopathology Cytopathology is the study of normal and abnormal exfoliated cells in tissue fluid.The individual cells reflect the normal and abnormal morphology of the tissue from which they are derived.
3 Types of exfoliated cyto-pathology Natural spontaneous exfoliationNatural covering epithelium: skin, urinary tract, vagina, and cervix.Glandular epithelial secretion: Breast (Nipple secretion).SputumUrineExudates and transudate:Pleural fluid Peritoneal fluidPericardial fluid Joint fluid CSF
4 Artificial enhanced exfoliation: Scrapings from cervix, vagina, oral cavity, and skinBrushing and lavage: bronchi, GIT, and urinary tractFine needle aspiration (FNA) for:Body cavity fluid: pleural, pericardial & peritoneal fluidsCysts: neck, breast & ovarySolid tissue: body organs, tumors & other swell
5 Role of cytopathologyEarly detection of unsuspected diseases (malignant or pre-malignant lesions).Confirmation of suspected diseases without surgical trauma.Diagnosis of hormonal imbalance.Useful in flow up the course of disease or monitoring therapy.
6 Advantage of Cytopathology Rapid diagnosis Inexpensive SimpleIt is better in evaluating the infectious diseases.Supplement or replace frozen section or biopsyNo injury to tissue allowing repeated samplingIt is better for hormonal assayCytopathological smear cover a wider surface than that involved in surgical biopsy.
7 Disadvantage of Cytopathology Interpretation of the morphological cellular changes is based only on individual cell observation.Not always finally diagnosis, so it is confirmed by histopathology in some cases.Not determine the size and type of lesion of some cases.
8 Factors that determine the appearance of cells Type of the technique used.Level of cell maturation at the time of cell collection.Nature of the parents tissue: soft tissue, cyst, or solid organ.Medium of the exfoliated cells.Interval between the stain of the exfoliated cells and collection of samples.Type of fixative, stain, and processing of the technique used.
9 PAP smear: named after Dr. George Papanicolaou (1883-1962) Vaginal smears from guinea pigs (1917)Women (1920)Hormonal cyclesPathological conditions (1928)
15 Cytologic screening for cervical cancer Cervical cancer screening has decreased morbidity and mortalityDeaths from cervical cancer decreased from 26,000 to less than 5,000 between 1941 and 1997
16 Pap smears are not perfect For a high grade lesion, the sensitivity of a single pap smear is only 60-80%Estimated false negative rate is 30-50%Requires adequate specimen collectionRequires adequate cytological review
17 Requires adequate patient and physician follow-up 10% of women with cervical cancer had inappropriate follow-up.Requires access to care50% of women with cervical cancer were never screened and 10% had not been screened within 5 years of diagnosis.
18 Who to screenAny woman with a cervix who has ever had sexual activity.
19 When to screenStart within 3 years of onset of sexual activity or by age of 21, whichever is first.Risk factors for cervical dysplasiaEarly onset of sexual activityMultiple sexual partnersTobaccoOral contraceptives
20 Screening frequencyYearly until three consecutive normal pap smears, then may decrease frequency to every three yearsAnnual screening for high-risk women is highly recommend.
21 When to stop routine screening Age 65 and “adequate recent screening”Three consecutive normal pap smearsNo abnormal pap smears in last 10 yearsNo history of cervical or uterine cancerHysterectomy for benign diseaseHysterectomy for invasive cervical cancer
23 Original Squamous Epithelium Vagina and outer ectocervix4 cell layersWell-glycogenated (pink) unless atrophic
24 Columnar Epithelium Upper and middle endo-cervical canal Single layer of columnar cells arranged in foldsMucin producing (not true glands)
25 Squamous Metaplasia Central ectocervix and proximal endocervical canal Replacement of columnar cells by squamous epitheliumProgressive and stimulated byAcidic environment with onset of pubertyEstrogen causing eversion of endocervix
26 Transformation ZoneZone between original squamo-columnar junction and the “new” squamo-columnar junctionNabothian cysts visually identify the transformation zone if present
27 Original Squamo-columnar Junction Placement determined between weeks gestationMost often found on ectocervixCan be found in vagina or vaginal fornicesLess apparent over time with maturation of epithelium
28 “New” Squamo-columnar Junction Border between squamous epithelium and columnar epitheliumFound on ecto-cervix or in endo-cervical canalMajority of cervical cancers and precursor lesions arise in immature squamous metaplasia, i.e. the leading edge of the squamo-columnar junction