cervix

Body of the uterus

Fundus of the uterus

The uterus

Uterus is lined by simple columnar ciliated cells

The cervix

Anatomy Histology

vagina Stratified squamous non-keratinzed epithelium rich in glycogen

Ectocervix Stratified squamous non-keratinzed epithelium rich in glycogen

Endocervix Pseudo-stratified columnar ciliated epithelium, rich in mucus secretion

Cervical canal Pseudo-stratified columnar ciliated epithelium, rich in mucus secretion

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).

Cytology of normal female genital tract

Squamous Epithelium

Superficial

Intermediate

Parabasal

Basal

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.

Glandular endometrial cells

Pathologically: present in endometrial lesions as:

Polyp

Endometritis

Submucous fibroid

Endometrial hyperplasia

Adeno-carcinoma

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

Inflammatory cellsusually posterior fornix or cervical smears

Inflammatory changes in epithelial cells

Presence of polymorphs

Intra-cellular diplococci

Polymorphs DiplococciBacterialVaginosis

Presence of micro-organisms Trichomonas

Candida

Bacteria

Mites

Dust mites Trichomonas Candida spores-hyphae

Methods of collecting endometrial samples

Endometrial aspiration

Endometrial lavage

Endometrial scraping

Endometrial biopsy

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

Squamo-Columnar JunctionJunction of pink

cervical skin and red endocervical canal

Inherently unstable Key portion of the

cervix to sampleMost likely site of

dysplasia

Vaginal Speculum

Ayers Spatula

Concave end to fit the cervix

Convex end for vaginal wall and vaginal pool scrapings

Cytobrush

Insert ~ 2 cm (until brush is fully inside canal)

Rotate only 180 degrees (otherwise will cause bleeding)

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

Differentiating feature of normal squamous cells

Parabasal Intermediate Superficial

Cell formation Single cells or sheet

Single cells or clump

Single cells or clump

Diameter 15 – 25 um 30 -55 um 33 – 55 um

Nucleus Vesicular with finely granular chromatin 10 -12um

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

Feature of cell maturation

Nucleus Cytoplasm

Basal cells Reticular chromatin Greenish blue

(basophilic)

Parabasal and

intermediate cells

Granular chromatin Yellow

Superficial cells Pyknotic chromatin Red (acidophilic)

Make Pap SmearAs thin as possibleProperly labeled

Spray with Fixative

Within 10-15 seconds

Allow to fully dry

before packaging

Cytologic Fixative

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

Characters of unsatisfactory smear

Thick

Poorly spread

Blood smear with clotting

Thank you