Trouble-makers in cytologic interpretation of the uterine cervix

Abstract

The development and standardization of cytologic screening of the uterine cervix has dramatically decreased the prevalence of squamous cell carcinoma of the uterine cervix. Advances in the understanding of biology of human papillomavirus have contributed to upgrading the histologic diagnosis of the uterine cervix; however, cytologic screening that should triage those that need further management still poses several difficulties in interpretation. Cytologic features of high grade intraepithelial squamous lesion (HSIL) mimics including atrophy, immature metaplasia, and transitional metaplasia, and glandular lesion masquerades including tubal metaplasia and HSIL with glandular involvement are described with accentuation mainly on the differential points. When the cytologic features lie in a gray zone between the differentials, the most important key to the more accurate interpretation is sticking to the very basics of cytology; screening the background and cellular architecture, and then scrutinizing the nuclear and cytoplasmic details.

Cytological features of human papillomavirus‐infected immature squamous metaplastic cells from cervical intraepithelial neoplasia grade 2

“…Distinct HSILs were sheet-like or syncytial aggregates with loss of polarity and composed of metaplastic or parabasal cells with a high nuclear-cytoplasmic ratio, hyperchromatic nuclei with fine to coarsely clumped chromatin, irregular nuclear membrane with indentations, and inconspicuous nucleoli. 15 Although the cytological characteristics of IM are ambiguous, clusters of cells with pale cytoplasm, indistinct borders, uniformly distributed fine-granular chromatin patterns, and prominent nucleoli were defined as IM 19,20 regardless of nuclear enlargement. The target IM clusters included indistinguishable mature squamous metaplasia, repair cells, and normal cervical glandular cells but not nuclear abnormalities seen in ASC-H and HSIL.…”

"Clangorous and Inbred-High Grade Squamous Intraepithelial Lesion-Uterine Cervix"

“…High grade squamous intraepithelial lesion (HSIL) is associated with high-risk variants of human papilloma virus (HPV) which induce clonal proliferation of stratified squamous epithelial cells. Viral E6 protein appears adherent to p53 tumour suppressor protein with consequent occurrence of protein degradation [3,4].…”

“…High grade squamous intraepithelial lesion (HSIL) is an asymptomatic disease arising within females of reproductive age group. Upon colposcopy, foci of leucoplakia, mosaic pattern, vascular alterations, and whitish epithelium upon exposure to acetic acid may be discerned [3,4]. Cytological examination exhibits enhanced nucleocytoplasmic (N/C) ratio, nuclear enlargement of up to three times, hyperchromatic nuclei, coarse chromatin with irregular nuclear membrane and inconspicuous nucleoli.…”

“…Tumour cells may configure a syncytium, crowded groups, cellular clusters or disseminated singular cells permeated with hyperchromatic nuclei. Upon gross examination, lesion preponderantly appears as 'flat' wherein discernment may be challenging in the absence of acetic acid application [3,4].…”

“…Mitotic figures are enhanced with discernible atypical mitoses [3,4]. High grade squamous intraepithelial lesion (HSIL) may configure patterns as ~'thin' high grade squamous intraepithelial cell lesion (HSIL) composed of lesions <10 cells thick.…”