Conosci la citologia ?Livello 2

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• Reactive change

oppure• More than reactive change

oppure• Normal

Reactive changes Normal Changes more than reactive

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Image 1 - reactive changesSmear with inflammation: some granulocytes.  Image 2 - normalNormal smear in progestinic (post-ovulatory) phase. Image 3 – changes more than reactive Squamous cell carcinoma: a group of cells, some with a slight spindle shape, with nuclear enlargement and hyperchromasia. Image 4 - changes more than reactive L-SIL: typical koylocytes with hyperchromatic nuclei with irregular edges and a clear perinuclear halo. Image 5 – reactive changesHSV (herpetic) infection: mononucleated cells with intranuclear viral inclusion. Sorry for the bad image, but you’re already so skilled.... Image 6 – reactive changesActinomyces: a typical aggregate of pseudofilamentous material.  Image 7 – changes more than reactive H-SIL: parabasal cells arranged in a pile with nuclear enlargement, irregular nuclear outlines and coarse chromatin. (obj. 20x) Image 8 – changes more than reactive ASCUS: the cell in central field shows some features of koylocytosis, but these changes aren’t so clear for a diagnosis of L-SIL; note also the thin perinuclear halo in an intermediate cell above it, that is clearly an inflammatory change. Remember that even an isolated cell with “more than reactive” changes requires a second look, so you MUST send a picture by Coolscope!.

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Image 9 – reactive changesTypical repair: a sheet of metaplastic squamous cells with enlarged nuclei, multinucleolation but with regular chromatin (NOT coarse). Image 10 - normalIntermediate and superficial squamous cells, basophilic or eosinophilic. Some polymorphs are present. I know, this image is also bad.... Image 11 – changes more than reactive H-SIL: parabasal cells with nuclear enlargement, irregular nuclear outlines, with anisokaryosis and anisocytosis in a homogenous cell population. (obj. 20x) Image 12 – reactive changesA sheet of metaplastic cells, with slight changes related to typical repair. Image 13 – changes more than reactive A group of atypical squamous cell with high N/C ratio and hyperchromatic nuclei. Image 14 – changes more than reactive ASCUS: An isolated binucleated cell with hyperchromatic nuclei and clumped chromatin in a cellular background with only slight reactive changes. Image 15 – reactive changesTrichomoniasis: “dirty” background with granulocytes: have you seen the Trichomonas? Image 16 – reactive changesAn obvious fungal infection...

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Image 17 – normalA superficial cell and some intermediate cells. Image 18 – changes more than reactive ASCUS. A sheet of parabasal and metaplastic cells, as you can see in atrophic smear, with an isolated slightly atypical cell (top right). Image 19 – reactive changes Fungal infection: “dirty” background and some segmented hyphae: note the characteristics disposition of cells that look strongly embedded one another by them. Image 20 – changes more than reactive L-SIL: a group of intermediate cells with cytoplasmatic amphophilia, slight nuclear hyperchromasia and multinucleolation. Image 21 - changes more than reactive Squamous cell carcinoma: pleomorphic malignant cells, isolated or in clusters, sometimes with markedly atypical nuclei or elongated nuclei. Inflammation, blood and necrosis in the background. (obj. 20x) Image 22 – normalA group of endocervical cells in a “honeycomb” fashion: the optically clear cytoplasm is probably due to a dry artifact. Image 23 – changes more than reactive H-SIL. Parabasal cells with enlarged and hyperchromatic nuclei and irregular nuclear outlines. Note the presence of some spindle-shaped cells. Image 24 – changes more than reactive H-SIL. Isolated basophilic and eosinophilic cells with hyperchromatic nuclei with irregular edges.

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Image 25 – changes more than reactive Squamous cell carcinoma: pleomorphic malignant cells isolated and with bizarre cell shapes. Note that is some nuclei hyperchromasia prevails, but in others the main feature is the clumped chromatin: in both cases, there are signs related to high-grade atypia. Image 26 – changes more than reactive L-SIL: in a strong inflammatory background, there are squamous cells with an enlarged nucleus, surrounded by an ill-defined clear halo, associated with parakeratotic cells. Image 27 – reactive changesSome granulocyes that partially cover isolated superficial and intermediate cells with no significant changes. Image 28 - changes more than reactive Squamous cell carcinoma: group of pleomorphic malignant cells, more or less differentiated and with spindle cell shape. (obj. 40x) Image 29 – reactive changesBacterial infection. Note the typical “dusty” appearance of the cytoplasm. Image 30 – normalIsolated parabasal and intermediate cells with cytoplasmatic disgregation due to the presence of many Lactobacilli, normally present in squamous cervical and vaginal epithelium.

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