warning

for the boys

baknush background ahead

Gynecologic Pathology Module:
Cervical Neoplasia

Since mahilig naman si Teacher Doctor sa PURPLE background…

 case abstract
A 36 year old G6P3 (1-2-3-1)
consulted for post-coital bleeding.

There was associated anorexia and weight loss.

A cervicovaginal smear done 10 years ago showed

mild dysplasia with koilocytosis which was
documented on cervical punch biopsy.

Patient was lost to follow up

as she apparently became asymptomatic
after one course of treatment.
 Initial Pap Smear taken 10 years ago

Crisp and clear and even

nuclear membrane
Fine chromatin
Small nucleus Perinuclear clearing
Evidence of pleomorphism
Irregular edges
 case abstract
She started working as an
entertainer in a disco pub at the age of 15,
and dated several of his regular customers.

She had lived in

with the cashier of the club for 5 years
for which she bore three children,
two of whom died
as they were both delivered prematurely.

She is presently the

common law wife of a former bar client
and has had three pregnancies with him
and these were all aborted.
Her boyfriend apparently had a
warty penile growth
removed last year by a urologist.
 case abstract
Pertinent gynecologic examinations revealed
a bulky cervix with a fungating mass
and a small nodule in the vaginal fornix
which bled easily.
There was also
foul smelling serosanguinous discharge.

A pap smear and cervical punch biopsy were performed.

The smear revealed

individual and loose cell sheets of oval to polygonal atypical cells
with increased N:C ratio
in a dirty background with blood, cell debris, necrotic material,
and fibrin.

The cervical biopsy showed

anastomosing tongues and cords of large masses of neoplastic
squamous cells infiltrating the fibrous stroma of the cervix.
Cells have Result of Present Pap Smear
large nuclei (nucleomegaly)
small rings of cytoplasm
coarse chromatin

Dirty background
Evidence of inflammation
Necrotic Debris
 Result of Present Pap Smear
The Verdict?
What about this slide?
FIGO Stage IB! What does it tell us?

Same as the findings in the other slide!

The cells have
large nuclei (nucleomegaly)
small rings of cytoplasm
coarse chromatin
And the Background is composed of
evidences of inflammation
necrotic debris!
Well. All we know is
Wait lang. that there’s a cervical
Clinical Stage mass na obvious
yun! How do clinically. But, we
you know it’s don’t know if it spread
FIGO Stage IB? elsewhere!
 Cervical Punch Biopsy of the Cervical Mass
“Malamang cancer cells.” Hmm. Oo nga naman.
-- unidentified preceptor

Keratin Pearl! Whooo! = Squamous Cell CA!

What can be found in this slide? Remember!

A diagnosis of
a Squamous
Cell CA cannot
be made based
on Pap Smear
Ano to? alone. You
have to see a
biopsy result
first.

“Eh Cervical Mass nga ang

“Huh? Bakit po?” pinanggalingan eh! Eh di sa loob
lang yan ng tumor mismo!”
 final diagnosis?

Clinical Stage (FIGO)

Stage IB
(but additional examinations should be done to make sure that the
lesion did not affect other areas other than the cervix)

Histologic Classification
CIN III / Squamous Cell CA
Bethesda System Terminology
HSIL
(High-Grade Squamous Intraepithelial Lesion)

Sabi lang ng preceptor namin yan ha?

 -- The End --

Haha. Ang sabog.

Clueless.
Owel.
Goodluck everyone!

We’d like to apologize for any misinformations and/or lack of information. 

If there’s any additional information you might have regarding the SGD case and the test results,
please do share them with us and we’d gladly disseminate the information…
Or make a new Powerpoint Presentation. 
You can find clearer and bigger trans images on succeeding slides.
Figure 1. Koilocytosis
Page 1, Column 2
Figure 4. Diagram of cervical epithelium showing
various terminologies used to characterize
progressive degrees of cervical neoplasia
Page 3, Column 2
Figure 5. Mild Dysplasia
Page 3, Column 2
Figure 6.Moderate Dysplasia
Page 3, Column 2
Figure 6. Severe Dysplasia
Page 4, Column 1
Figure 7. Carcinoma In Situ with
Gland Involvement
Page 4, Column 2
Figure 8. Cervical Scrape
Page 4, Column 2
Figure 9. Cervical cytology specimen interpreted as atypical
squamous cells of undetermined significance (ASC-US)
Page 5, Column 1
Figure 10. Liquid-based cytology specimen showing a single
atypical parabasal cell
Page 5, Column 2
Figure 11. Cytopathic effects of human papillomavirus (HPV)
Page 5, Column 2
Figure 12. Cytologic features of enlarged nuclei and
reduced cytoplasm
Page 5, Column 2
Figure 13. Liquid-based cytology specimen showing atypical
glandular cells (AGC) of undetermined significance
Page 6, Column 1
Figure 14. LSIL/CIN i
Page 4, Column 2
Figure 15. HSIL/ CIN II
Page 6, Column 1
Figure 15. HSIL/CIN III
Page 6, Column 1
Figure 16. Clinical Stages of Cervical Carcinoma
Page 6, Column 2
Thank you!