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9.basic Gyne Cytology
9.basic Gyne Cytology
9.basic Gyne Cytology
Lesson 9:
Basic Gynecological Cytology
Pap Test
Part of a gynecological exam
An examination under the microscope of cells
scraped from the tip of the cervix
Adequacy
Presence of abnormal cells
Number and distribution of abnormal cells
Relationship between cells
Cell size and shape
Hyperchromasia
Prominence of nucleoli and irregularity in
shape thereof
Thickening of nuclear membrane
Increase in n:c ratio
Cytoplasm scanty
Mitosis, increased number and abnormal
forms
Noncohesiveness
Metaplastic-like cells
Necrotic debris
Artifacts such as obscuring blood,
inflammation or air-drying
Tissue repair
Viral infection
Granuloma
Radiation
Squamous carcinoma
Choriocarcinoma
Uterine sarcoma
Tamoxifen cells
Smaller cell type of squamous-cell carcinoma
Small-cell anaplastic carcinoma
Differential diagnosis of
adenocarcinoma
Viral infections
Endocervical cells, benign and atypical
Endometrial cells, benign and atypical
Endometritis
Histiocytes
Metaplasia
Vaginal adenosis
Intrauterine device
Metastatic tumour
Patient-related Errors
Including failure of women to get regular Pap
tests or to seek any health care at all
Douching or sexual intercourse can
mechanically remove the superficial cell layers
that the Pap test samples, causing falsenegative results due to sampling error
Some women delay seeking medical attention
even when they have symptoms that they
know are suspicious, such as abnormal vaginal
bleeding
Clinical Errors
Failure to take a Pap test at all
Failure to take an adequate Pap test
The sample must be obtained under direct
visualization, with considerable pressure
The speculum should not be lubricated
excessively
Overzealous rubbing, swabbing or cleaning
the cervix before taking the sample can
remove the abnormal cells, leading to false
negative results
Lesion-related Errors
Some lesions fail to exfoliate sufficient
numbers of cells for detection
Small or inaccessible lesions may be difficult
to sample adequately
The shape of the cells and the quality of the
cervical mucus also affect the sampling
Pap tests are more often inadequate in
women with advanced epithelial
abnormalities