Parabasal Cells Parabasal (Squamous Cells) Criteria Parabasal cells are immature cells that relate to the deep

layer of the stratified squamous epithelium. Their presence is less frequent than intermediate or superficial cells. Y\ hen seen in smears, they normally exfoliate from an atrophic epithelium (i.e. pre puberty, lactation, post-menopausal) due to a lack of hormonal stimulation. They may also be seen if the epithelium has been traumatized. Celule Parabasal Parabasal (celule scuamoase) celule Criterii Parabasal sunt celule imature care se refer la stratul profund al epiteliului scuamos stratificat. Prezena lor este mai puin frecvent dect celulele intermediare sau superficiale. Y \ gin vazut in frotiuri, n mod normal, acestea exfoliaza de la un epiteliu atrofic (adic nainte de pubertate, lactaie, post-menopauza), din cauza lipsei de stimulare hormonal. Ele pot fi, de asemenea, vzut dac epiteliului a fost traumatizat. Parabasal Cells
Arrangement: Thev exfoliate singlv. in sheets and large fragments. 15-30 u m in diameter. Usually uniform in shape (round or spherical) Thick; dense; scanty to adequate, according to the degree of maturation; the cytoplasm stains blue or greenishblue (sometimes artificially eosinophilic secondary to air dry i n s prior to fixation). The cytoplasm sometimes shows vacuolization or glvcogen. Approximately 8 9 urn in size; usually round to oval; and central. The chromatin is granular, uniformly distributed, and shows occasional chromocentres.

Intermediate Cells
These cells exfoliate singly or in overlapping clumps of cells. 35-50 um in diameter. Usually polygonal. Thin, semitransparent (tends to be denser than superficial cells); abundant. Cytoplasmic staining is blue, greenish-blue, or sometimes pink. Glycogen deposits are often present in the cytoplasm. Folded cytoplasm is sometimes seen.

Superficial Cells
These cells usually exfoliate singly. 45-50 um in diameter. Polyhedral, also referred to as polygonal. Thin, transparent; abundant, staining pink to orange (occasionally pale blue).

Size: Shape: Cytoplasm:

Nucleus:

Approximately 78 urn in size; round to oval shape; central location. The finely granular, uniformly distributed chromatin, with occasional chromocentres is often referred to as vesicular

Regular in size (approximately 56 uniI: round to oval in shape; centrally located; pyknotic (chromatin pattern cannot be distinguished).

because the nucleus appears more "open". Liquid Based: Cells may appear somewhat smaller and are more likely to be dissociated (single cells and smaller groups). Smudged chromatin and other air-drying artifacts are minimized or eliminated.

Intermediate (Squamous Cells) Criteria Intermediate cells originate from the middle layer of the fully mature stratified squamous epithelium. Cell These cells exfoliate singly or in overlapping clumps Arrangement: of cells. Cell Size: Cell Shape: Cytoplasm: 35-50 um in diameter. Usually polygonal. Thin, semitransparent (tends to be denser than superficial cells); abundant. Cytoplasmic staining is blue, greenish-blue, or sometimes pink. Glycogen deposits are often present in the cytoplasm. Folded cytoplasm is sometimes seen. Approximately 7-8 urn in size; round to oval shape; central location. The finely granular, uniformly distributed chromatin, with occasional chromocentres is often referred to as vesicular because the nucleus appears more "open".

Nucleus:

Superfical (Squamous Cells) Criteria Superficial cells come from the uppermost layer of fully mature stratified squamous epithelium. Cell Arrangement: Cell Size: Cell Shape: Cytoplasm: Nucleus: These cells usually exfoliate singly. 45-50 um in diameter. Polyhedral, also referred to as polygonal. Thin, transparent; abundant, staining pink to orange (occasionally pale blue). Regular in size (approximately 5-6 uniI: round to oval in shape; centrally located; pyknotic (chromatin pattern cannot be distinguished).

Squamous metaplasia is a process of gradual transformation where the normal glandular epithelium is replaced by normal stratified squamous epithelium. It occurs on the ectocervix (transformation zone) in areas of congenital erosion. Congenital erosion is also referred to as eversion; this is not a

true erosion of epithelium that occurs from trauma, instead it is an area that appears red because the edematous connective tissue is more easily seen through the thinner columnar epithelium. The process of squamous metaplasia is thought to be stimulated by the female sex hormones, changes in the pH of the vagina or chronic irritation. On the ectocervix squamous metaplasia is a normally occurring process. The presence of these cells in a smear is an indication of truly sampling the transformation zone. This is an important quality indicator. The final result of the squamous metaplastic process is mature squamous epithelium covering the ectocervix. Squamous metaplasia Cell Small loose sheets, or occasionally singly. Arrangement: Cell Size: Generally smaller than mature squamous cells. Cell Shape: Round, polygonal, or irregularly shaped, showing cytoplasmic processes between the cells. Cytoplasm: Dense; stains cyanophilic. Cytoplasmic processes. Nucleus: Often larger than an intermediate cell nucleus, round, and centrally located, with finely granular, evenly distributed chromatin, and occasional small chromocentres or nucleoli. Smooth nuclear membrane. Liquid Based: Cells tend to be more dispersed and single. Cytoplasm may appear denser and cells more rounded. Anucleate Squames Anucleated Squamous Cells Criteria Anucleated keratinized squamous cells are rare in cervical smears, as the epithelium lining the cervix is not normally keratinized. When present as single cells they may be contaminants from sources such as the vulvar area. They van" in size and shape and the edges of the cells have a tendency to fold. The nucleus is absent, sometimes leaving a clear area (where it originally was located), this being referred to as a "ghost nucleus". They have thin, transparent cytoplasm, which stains yellow to orange. In sheet formations (plaques), they may indicate a benign reaction to chronic irritation, or uterine prolapse. Truly keratinized squamous cells (as opposed to pseudokeratinization or intense eosinophilia), although not diagnostic of an abnormality, should trigger a careful search for abnormal cells. Keratinized plaques can overlay significant squamous lesions. Endocervical cells are columnar cells that originate from a simple tall columnar epithelium lining the endocervix. An area of glandular epithelium may extend out on to the ectocervix (eversion). Endocervical cells are more fragile than squamous cells. Due to the fragility of columnar cells, endocervical cells may appear with their nuclei stripped of cytoplasm. These are most often seen in smears from postmenopausal patients. The nuclei are round or oval, but may show considerable variation in size and shape. Cytoplasmic remnants are occasionally present.
Squamous metaplasia

Endometrial Cells
Most frequently occurring in tight threedimensional aggregates or ball-like clusters. Cells may shed singly but accurate identification of cell origin is impossible. The cells may form a double contoured mass made up of an inner core of stromal cells and an outer layer of epithelial cells.

Endocervical cells

Cell Arran geme nt:

Small loose sheets, or occasionally singly.

Single cells; palisade or picket fence (side-by-side) formations; or in sheets. When their apical ends are in focus, this is referred to as a "honeycomb" appearance.

This is also accompanied by histiocytes in the background. Cell Size: Cell Shape : Cytop lasm: Generally smaller than mature squamous cells. Round, polygonal, or irregularly shaped, showing cytoplasmic processes between the cells. Dense; stains cyanophilic. Cytoplasmic processes. Small cells. Difficult to judge as cell borders are ill defined in the groups. Ill defined in cell groups. Their size varies greatly (10-30 u.m). Their shape (cylindrical or pyramidal) is fairly constant. Adequate, finely vacuolated with well-defined, smooth borders. Occasionally semi-transparent due to mucus contained within the cytoplasm. Moderate variation in size, approximately the same size or larger than an intermediate cell nucleus; round to oval. The chromatin is finely granular and evenly distributed. A small nucleolus may be present. Multinucleation may be observed. Often more dispersed, sometimes only present as single cells. Cell groups tend to ball up and may appear smaller with denser cytoplasm.

Nucle us:

Liqui d Based :

Often larger than an intermediate cell nucleus, round, and centrally located, with finely granular, evenly distributed chromatin, and occasional small chromocentres or nucleoli. Smooth nuclear membrane. Cells tend to be more dispersed and single. Cytoplasm may appear denser and cells more rounded.

Scanty; staining cyanophihc; cell border indistinct. Often, the cytoplasm can barely be seen. May contain degenerative vacuoles.

Small, similar in size to the normal intermediate cell, regular in size; round to oval but often folded and ridged (raisinoid); overlapping of nuclei occurs frequently. Chromatin is finely granular when well preserved and the distribution is even; chromatin may often appear clumped and degenerated in these exfoliated cells; hyperchromatic. May see apoptotic bodies (single cell necrosis) within the groups. More dispersed as single cells. Cytoplasmic vacuoles maybe more apparent. Nuclear detail is better defined -chromatin detail and inconspicuous nucleoli may be visible, nuclei appear bigger and more open. Background is cleaner.

Exfoliated Endometrial Cells Criteria Endometrial cells are columnar cells that originate from a simple low columnar epithelium lining the uterus. Spontaneously exfoliated endometrial cells may normally be present in a pap smear up to day 12 of the menstrual cycle (Day 1 being the first day of bleeding). Benign appearing endometrial cells in women under 40 years of age are rarely associated with endometrial pathology (these are more often associated with the presence of an II D. exogenous hormones, etc.) and according to Bethesda 2001 they should not be reported, regardless of menstrual status. Endometrial cells identified in a specimen from women over 40, again regardless of menstrual or menopausal status, should be reported as "Endometrial cells present". The sample should not be reported or categorized as "Negative for intraepithelial cells or malignancy" (NILM). However, a comment: "no evidence of a squamous lesion" may be added.

Endometrial Cells

Cell Arrangement:

Most frequently occurring in tight three-dimensional aggregates or balllike clusters. Cells may shed singly but accurate identification of cell origin is impossible. The cells may form a double contoured mass made up of an inner core of stromal cells and an outer layer of epithelial cells. This is also accompanied by histiocytes in the background. Cell Size: Small cells. Cell Shape: Difficult to judge as cell borders are ill defined in the groups. Cell Borders: Ill defined in cell groups. Cytoplasm: Scanty; staining cyanophihc; cell border indistinct. Often, the cytoplasm can barely be seen. May contain degenerative vacuoles. Nucleus: Small, similar in size to the normal intermediate cell, regular in size; round to oval but often folded and ridged (raisinoid); overlapping of nuclei occurs frequently. Chromatin is finely granular when well preserved and the distribution is even; chromatin may often appear clumped and degenerated in these exfoliated cells; hyperchromatic. May see apoptotic bodies (single cell necrosis) within the groups. Liquid Based: More dispersed as single cells. Cytoplasmic vacuoles maybe more apparent. Nuclear detail is better defined -chromatin detail and inconspicuous nucleoli may be visible, nuclei appear bigger and more open. Background is cleaner. Spontaneously exfoliated endometrial cells can at times be difficult to distinguish from other components of pap smears. Two examples to consider are endocervical cells and histiocytes.