Cylinderepitelforandringer i cervix uteridanskcytologiforening.dk/Årsmøde/Årsmøde...

Cylinderepitelforandringer i cervix uteri

Jalil Hariri

Klinisk patologi

Sønderborg og Vejle

[email protected]

[email protected]

1 Hariri, Dansk Cytologiforenings årsmøde 2018

mailto:[email protected]

mailto:[email protected]

..og Gud skabte kvinden..

Men det er fanden, der

skabte hendes cylinderepitel


Fleksibelt agenda

►Pladeepitel vs. cylinderepitel

►AGC/AIS vs. tubar metaplasi

►AIS vs. adenocarcinom

►Cervix vs. corpus

Hariri, Dansk Cytologiforenings årsmøde 2018 3

Negative for Intraepithelial Lesion or Malignancy

EC’s

EC’s

EC’s EC’s

EC’s

EC’s


Endocervical & Metaplastic Cells


Endocervical Cells: Orientation

Honeycomb

Picket fence

On End


NILM, Reactive and Repair

Normal

Reactive changes

Reactive / repair


NILM, Reactive, Repair and AGC?


AGC?

Reactive / repair

Reactive

Reactive Endocervical Cells



Decidual reaktion

Reaktive cyl. i cervix

980-06918-00 Rev A BD SurePath™ liquid-based Pap Test. BD, BD Logo & all other trademarks are the property of Becton, Dickinson and Company. ©2007 BD 980-06918-00 Rev A BD SurePath™ liquid-based Pap Test. BD, BD Logo & all other trademarks are the property of Becton, Dickinson and Company. ©2007 BD

16 Hariri, Dansk Cytologiforenings årsmøde

2018


Samme celletype?

AGC

Adenocarcinoma in-situ

Endocervikalt Adenocarcinoma


AIS

Atypical Endocervical Cells

• Crowding

• Hyperchromasia


Referencing Normal Cells for Perspective

Normal Endocervical Cells Atypical Glandular Cells 21 Hariri, Dansk Cytologiforenings årsmøde 2018

Referencing AGC / AIS for Perspective

Atypical Glandular Cells 22 Hariri, Dansk Cytologiforenings årsmøde 2018

AGC / AIS Atypical Glandular Cells

Strips, benign pattern

Strips, abnormal pattern


Strips, abnormal pattern

Apoptosis

Deranged nuclei


Pseudostratification, nucleoli, and mitosis


Deranged

& slightly hyperchromatic nuclei 27 Hariri, Dansk Cytologiforenings årsmøde 2018

Adenocarcinoma in situ

• Rosette

• Pseudostratification

• Increased N/C ratio

• Oval nuclei

• “Salt & pepper” chromatin

• Feathering


Rosette Cartwheel



• Strip

• Palisading

• Hyperchromasia

• Increased N:C ratio

Biopsy AIS (ICC)

Passer det?? /JH


AGC vs. tubal metaplasia


Tubar metaplasi



Hariri, 2017 44


Hariri, 2017 48


Hariri, 2017 49

Tubal metaplasia vs AGC 50 Hariri, Dansk Cytologiforenings årsmøde 2018

Tubal metaplasia vs AGC


Cylinderepitel med tubarmetaplasi (TM)

►Cilie & terminal bar

►Perinuklære vakuoler

►Sammenklumpede kerner (oftest benigne)

►Jo højere oppe i Cx., jo flere celler med TM

►Jo ældre patient er, jo flere celler med TM



• 2-D crowded group

• Columnar cells

• Hyperchromasia



Mitosis

Apoptosis

Biopsy: AIS 55 Hariri, Dansk Cytologiforenings årsmøde 2018


AGC


AGC?

AGC

AGC


Mitosis

Strip & Pseudostratification


HSIL & AIS Look Alikes

HSIL AIS


62 Hariri, Dansk Cytologiforenings årsmøde

2018

63

p16

Hariri, Dansk Cytologiforenings årsmøde 2018

AIS R/O Adenocarcinoma

Biopsy – Endocervical adenocarcinoma 64 Hariri, Dansk Cytologiforenings årsmøde 2018

Endocervical Adenocarcinoma

Diathesis

• Enlarged crowded nuclei

• Nuclear stratification, palisading

• Moderate to marked anisonucleosis



• Two-dimensional sheets

• Single cells

• Granular / vacuolated cytoplasm

• Nuclear membrane irregularities

• Prominent nucleoli



Diathesis

• Chromatin: Fine to Coarse, Irregular distribution

• Prominent Nucleoli

• Diathesis


Criteria Endocervical Adenocarcinoma

► Single cells

► Two-dimensional sheets

► Three-dimensional clusters

► Granular or vacuolated cytoplasm

► Stratified and palisading nuclear arrangement

► Enlarged, crowded nuclei with moderate to marked anisonucleosis

► Fine to coarse, irregularly distributed chromatin

► Parachromatin clearing and nuclear membrane irregularities

► Presence of nucleoli

► tumor diathesis

► May have co-existing squamous lesion present


Normal Endometrial Cells


NILM: Benign Endometrial Cells

Note clean background


Endometrial Stromal Cells


Exodus


CD10


Hariri, 2015 82

Exodus? HSIL?


Endometrial cells vs contamination


AGC

Atypiske Endometrieceller

Endometrieadenocarcinom


IUD


IUD Changes: Single cells Mimicking HSIL


IUD


Endometrial Adenocarcinoma

• Increased nuclear size

• Nucleoli

• 3 – D group

• Scalloped edges

NILM for Comparison 95 Hariri, Dansk Cytologiforenings årsmøde 2018


• Increased nuclear size

• Nucleoli

• 3 – D group

• Scalloped edges

IUD for comparison 96 Hariri, Dansk Cytologiforenings årsmøde 2018


Biopsy: Grade II

Engulfed neutrophils



Papillary Serous 102 Hariri, Dansk Cytologiforenings årsmøde 2018


Note Atrophic Background 103 Hariri, Dansk Cytologiforenings årsmøde 2018

Mindre sandsynlige sammentræf

►IUD & endometriehyperplasia / -cancer

► Alle spiral typer (også hus postmnauposale)

►HSIL & endometriehyperplasia / cancer

► To forskellige organer & patientkategorier

►Exodus & endometriehyperplasia / cancer

► Gælder også (mange) stromaceller


OBS.

►Post-konus LUS & tubarmetaplasi

Cervix afkortet

►Brug HPV-test med omtanke

Cylinderepitelforandringer

Udgangspunkt i cervix eller corpus

►Endocervikalt smear er ikke et ”smear”


Tag med hjem citater

►Vi inviterer raske kvinder

De må ikke sygeliggøres pga. vores usikkerhed

(Euphemia McGoogan)

►Det er os, der skal lægge vågen om natten

Ikke patienten (Frede Olesen)



Tak for opmærksomheden

ICC / IHC

ER VIM CEAM BCL2

Reactive cervical

+ - (+) (+)

Tubal metaplasia

+ + - +

AIS+ (-) - + (+)

Endometrial + + - (+)


Endometrial cells vs contamination


…as yet there is no known

substance or characteristic that is

present in all malignant cells and

absent in all benign or normal

cells...


Marluce Bibbo

Cylinderepitelforandringer i cervix uteridanskcytologiforening.dk/Årsmøde/Årsmøde...

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