Papanicolau Smear (Pap Smear) : Eastern Visayas Regional Medical Center

Eastern Visayas Regional Medical Center
Papanicolau Smear (Pap Smear)

2001 Bethesda System
Rose Teri J. Zacate UPMSHS Medical Intern

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OBJECTIVES
To have an overview of how Pap smear is done To know of its purpose/ indication To familiarize with basic terms in the Bethesda system To view pictures of samples of the different Pap smear results, seen in the microscope, with its corresponding description
Papanicolaou Test
Pap smear, Pap test, cervical smear, or smear test Greek doctor Georgios Papanikolaou
a screening test used to detect potentially precancerous and cancerous processes in the endocervical canal (transformation zone) of the female reproductive system
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a speculum is used to open the vaginal canal and allow the collection of cells from the outer opening of the cervix of the uterus and the endocervix the cells are examined under a microscope to look for abnormalities. aims to detect potentially pre-cancerous changes (called cervical intraepithelial neoplasia (CIN) or cervical dysplasia), which are usually caused by sexually transmitted HPV.
the test may also detect infections and abnormalities in the endocervix and endometrium Free Powerpoint Templates Page 4
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Types of Screening
Conventional Pap In a conventional Pap smear, samples are smeared directly onto a microscope slide after collection. Liquid based cytology The Pap smear sample is put in a bottle of preservative for transport to the laboratory, where it is then smeared on the slide.
In addition, an HPV test may be performed either as indicated for abnormal Pap results, or in some cases dual testing is done, where both a Pap smear and HPV test are done
SUMMARY OF PAP TEST INDICATIONS
Woman's characteristic
never had sexual contact under age 21, regardless of sexual history age 2025 until age 5060 no test
Indication
Rationale
HPV is usually transmitted by sexual contact more harms than benefits
no test
test every 35 years if results normal broad recommendation recommendation of USPSTF, ACOG,ACS and ASCP harms of screening after hysterectomy outweigh the benefits
over age 65; history of normal tests
no further testing
had total hysterectomy for non-cancer no further testing disease cervix removed had partial hysterectomy cervix remains Has received HPV vaccine continue testing as normal
continue testing as normal
Vaccine does not cover all cancer-causing types of HPV
post-operative transgender woman
Free Powerpoint Templates Page 7 no test cervix and cannot be evaluated with a
pap smear
the neo-vagina does not contain a
The Bethesda System

Abnormal results include:
Atypical squamous cells Atypical squamous cells of undetermined significance (ASC-US) Atypical squamous cells cannot exclude HSIL (ASC-H)
Low grade squamous intraepithelial lesion (LGSIL or LSIL) High grade squamous intraepithelial lesion (HGSIL or HSIL) Atypical Glandular Cells not otherwise specified (AGC-NOS)
Atypical Glandular Cells, suspicious for AIS or cancer (AGC-neoplastic)

Adenocarcinoma in situ (AIS)
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RESULT OF EXFOLIATIVE CYTOLOGY (PAP SMEAR)

SPECIMEN ADEQUACY
Satisfactory for evaluation Unsatisfactory for evaluation
GENERAL CATEGORIZATION
Negative for intraepithelial lesion (NILM) Epithelial cell abnormality
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INTERPRETATION/RESULT:
Infection, organisms:
Trichomonas vaginalis Fungal organisms morphologically consistent with Candida spp Shift in flora suggestive of bacterial vaginosis Bacteria morphologically consistent with Actinomyces spp Cellular changes consistent with Herpes simplex virus Others
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Non-neoplastic finding:
Reactive cellular changes
Inflammation (typical repair) Radiation IUD
Glandular cells status post hysterectomy Atrophy
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Epithelial cell abnormality
Squamous cell Glandular cell Other malignant neoplasms
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'Satisfactory for evaluation'
HPF NILM: Endocervical cells/ Squamous metaplasia Cytomorphologic Criteria: Cluster of endocervical cells from high in the endocervical canal on a liquid based preparation. Seen en face, cells may mimic squamous metaplastic cells. Note 2 columnar shaped cells to left. Interpretation is NILM. Explanatory Notes: Normal endocervical cells from the upper region of the endocervical canal can mimic squamous metaplastic cells.
Follow-up: The presence of either glandular or CytomorphologicCriteria: metaplastic cells is an indication that the Normal polygonal squamous metaplastic cells transformation zone has been sampled, a with round to oval nuclei and bland chromatin quality indicator for cervical cytology pattern. On liquid based preparations cells may specimens (a minimum of 10 wellappear more rounded, and nuclei may appear preserved endocervical or metaplastic cells required; they do not need to be in smaller. This would be interpreted as "NILM". Free Powerpoint is Templates Page 13 groups)
An "unsatisfactory" pap test result (unsat) can be caused by a number of factors, including poor sample collection, obscuring inflammation or blood, use of lubricants, or interpretive errors. Although this unsatisfactory category constitutes 1% to 2% of all pap tests, patients with unsats are more likely to have histories of abnormalities and are at increased risk of harboring precancer or invasive cervical cancer
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'Unsatisfactory for evaluation'

Adequacy Description: Unsatisfactory: scant squamous cellularity
Cytomorphologic Criteria: An adequate liquid based preparation should have an estimated minimum of 5,000 wellvisualized/preserved squamous cells. This specimen is unsatisfactory due to scant squamous cellularity seen at 10X. Explanatory Notes: Although this image cannot be directly compared to a microscopic field, this SurePath slide had fewer than 8 cells per 40X field. A SurePath specimen with this level of cellularity throughout the preparation would have less than 5000 cells. Follow-up: This patient should have repeat cervical cytology sampling or other clinical evaluation
Magnification: Free Powerpoint Templates Low
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Adequacy Description: Unsatisfactory- obscuring RBCs and WBCs
Clinical History: 55 y.o. postmenopausal woman with vaginal discharge Cytomorphologic Criteria: Unsatisfactory for evaluation of epithelial abnormality due to obscuring blood and inflammation.
Explanatory Notes: Unsatisfactory due to obscuring inflammation. Greater than 75% obscuring is considered unsatisfactory if no abnormal cells are identified.
Follow-up: If 50 - 75% of the slide has this appearance, obscuring inflammation should be mentioned in the quality indicators section of the report
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'Negative for Intraepithelial Lesion or Malignancy' (NILM)
Type of Preparation: Conventional Magnification: Medium Clinical History: A 45 year old female for a routine visit Cytomorphologic Criteria: Lower uterine segment (LUS). Large tissue fragments with a biphasic pattern of glands and spindle cells. Densely packed spindle cells are seen with glands embedded within. Glands are simple, nonbranching, with indistinct cytoplasm and round uniform nuclei. Explanatory Notes: The lower uterine segment (LUS) can easily be sampled if the endocervical sampling device is pushed into the endocervical canal far enough to reach the LUS. In isolation, the epithelial fragments may be mistaken for endocervical adenocarcinoma, endocervical adenocarcinoma in situ, tubal metaplasia or reactive endocervical cells. The spindle cells alone may also appear as "hyperchromatic groups" and cause concern. Abraded LUS does not carry the same significance as exfoliated endometrial cells and should not be reported.
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'Negative for Intraepithelial Lesion or Malignancy' (NILM)

Type of Preparation: ThinPrep/ LBP Magnification: Medium Clinical History: 24 year old, routine screening Pap Test Interpretation: NILM Cytomorphologic Criteria: Glycogen in squamous cells can give the appearance of "pseudokoilocytosis". Nuclear abnormalities required for an interpretation of ASC-US/ LSIL are absent. Explanatory Notes: Glycogen can cause "pseudokoilocytosis". This may be more prominent on ThinPrep.
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'Negative for Intraepithelial Lesion or Malignancy'

NILM: Reactive squamous cellular changes associated with Trichomonas vaginalis
Type of Preparation: Conventional Magnification: High Clinical History: 26 year old woman, LMP 2 weeks, mild vaginal discharge Explanatory Notes: Trichomonas also seen. Follow-up: Follow-up Paps Page 19 negative

NILM: Trichomonas vaginalis and Leptothrix
Cytomorphologic Criteria: Leptothrix are slender, long bacteria that may be seen in association with Trichomonas. Explanatory Notes: The finding of Trichomonas and leptothrix together has been referred to as "spaghetti and meatballs" The leptothrix should be distinguishable from Doderlein bacilli, that are normally seen. When leptothrix are seen, one should search for the possible presence of trichomonads. In liquid based preparations, the leptothrix organisms may tend to clump (as seen in this image) as opposed to Page conventional smears.
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NILM: Fungal organisms consistent with Candida spp
Type of Preparation: ThinPrep/ LBP Magnification: High
Clinical History: 27 year old woman, colposcopy visit

Cytomorphologic Criteria: Pseudohyphae and reactive changes in the squamous epithelial cells.
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NILM: Fungal organisms, consistent with Candida spp.
Cytomorphologic Criteria: Pseudohyphae formed by elongated budding yeast showing constrictions along their length. There is also spearing of epithelial cells and an inflammatory background. Explanatory Notes: Pseudohyphae should be distinguished from mucus strands.
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NILM: Shift in Flora suggestive of bacterial vaginosis
Clinical History: 25 year old female Interpretation: NILM: Shift in Flora suggestive of bacterial vaginosis Cytomorphologic Criteria: Individual squamous cells covered by a layer of bacteria that obscures the cell membrane (clue cells). Background is usually clear in liquid based preparations. Explanatory Notes: Contrast with appearance in conventional smear.
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NILM: Bacteria morphologically consistent with Actinomyces spp.
Clinical History: 41 year old. No history provided Cytomorphologic Criteria: Tangled clumps of filamentous organisms, often with acute angle branching, sometimes showing irregular wooly appearance. Swollen filaments may be seen with clubs at periphery. A cotton ball like acute inflammatory response is common. Explanatory Notes: Actinomyces is often associated with intrauterine device (IUD) usage. Organisms may alert clinician to look for evidence of pelvic infection.
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NILM: Bacteria morphologically consistent with Actinomyces spp.
Cytomorphologic Criteria: The center of this sulfur granule shows amorphous material, while the periphery exhibits thin filamentous bacilli radiating outwards. Branching may be evident in these bacilli (not seen here). Only a few polymorphonuclear cells are seen accompanying this particular colony. Explanatory Notes: Actinomyces is often associated with intrauterine device (IUD) usage. Organisms may alert clinician to look for evidence of pelvic infection.
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NILM: Cellular changes consistent with Herpes simplex virus
Cytomorphologic Criteria: The multinucleated squamous epithelial cell (top) shows degeneration of nuclei, whereas the multinucleated squamous cell (below center) shows the typical molded nuclei of HSV infection (pomegranate seed appearance). Faint nuclear inclusions are evident in this cell and a uninucleate cell beneath. Explanatory Notes: Nuclei have "ground glass" effect due to intranuclear viral particles and enhancement of the nuclear envelope caused by peripheral margination of the chromatin. Multinucleated cells are not always present.
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'Negative for Intraepithelial Lesion or Malignancy' NILM: Cellular changes consistent with Herpes simplex virus
Cytomorphologic Criteria: Cellular changes consistent with Herpes simplex virus. Note the intranuclear, Cowdry type inclusions. Explanatory Notes: The ground-glass appearance of the nuclei is due to accumulation of viral particles leading to peripheral margination of chromatin.
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NILM: Lactobacilli
Clinical History: 45 year old perimenopausal woman, routine exam Cytomorphologic Criteria: Lactobacilli and occasional cytolysis. Bacteria get more dispersed in liquid preparations and the background is thus cleaner. (contrast with lower right inset from a conventional smear). Explanatory Notes: In determining specimen adequacy, nuclear preservation and visualization are of key importance, and changes such as cytolysis and partial obscuring of cytoplasmic detail may not necessarily interfere with specimen evaluation. This specimen is satisfactory for evaluation. Abundant cytolysis(>~50%) may be mentioned as a quality indicator, but most such specimens do not qualify as unsatisfactory unless nearly all of the nuclei Page are devoid 28 of cytoplasm.

NILM: Lymphocytic cervicitis
Cytomorphologic Criteria: Polymorphous population of lymphoid cells and tingible body macrophages. Explanatory Notes: Inflammatory cells may clump on LBP.
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NILM: Reactive squamous cells
Cytomorphologic Criteria: Reactive squamous cells showing mild nuclear enlargement without any significant chromatin abnormalities
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NILM: Reactive squamous cell
Clinical History: 32 year old; routine Pap test

Cytomorphologic Criteria: Mature squamous cell. Explanatory Notes: While there is nuclear enlargement in the cells on the right side, the smooth nuclear contours and finely distributed chromatin favor reactive change over ASC-US. Free Powerpoint Templates Page 31

NILM: Repair
Cytomorphologic Criteria: Squamous cells in flat monolayer sheet with maintenance of nuclear polarity and a prominent nucleolus in almost every cell. Explanatory Notes: If marked anisonucleosis, irregularities in the chromatin distribution, or variation in size and shape of nucleoli are present, so-called "atypical repair", the changes should be categorized as atypical glandular cells or Page 32 atypical squamous cells.

NILM: Reactive cellular changes, Repair
Clinical History: 67 year old woman with uterine prolapse Cytomorphologic Criteria: Flat monolayer sheets with distinct cytoplasmic outlines, streaming nuclear polarity, prominent nucleolus in almost every cell.
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NILM: Repair
Clinical History: Routine Pap test Cytomorphologic Criteria: The cell cluster shows inter-cellular windows (school-offish appearance) and a streaming pattern. Nuclei are uniformly large, and contain prominent nucleoli. Chromatin abnormalities are absent.
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NILM: Rectovaginal fistula
Clinical History: Postmenopausal woman undergoing radiation Cytomorphologic Criteria: Benign glandular cells, tall columnar, and plaque of hyperkeratosis. Explanatory Notes: While at first glance he glandular cells may appear to be endocervical, closer examination shows goblet cell features. Fecal matter may also be seen in an RV fistula (not demonstrated here) and is an additional clue to its presence. The hyperkeratosis indicates a benign cellular change, in this case secondary to the fistula.
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NILM: Reactive cellular changes associated with Radiation
Clinical History: 40 year old woman s/p squamous cell carcinoma of the cervix. Completion of radiation therapy 8 weeks ago Cytomorphologic Criteria: Enlarged nuclei with abundant polychromatic cytoplasm with vacuolization. Mild nuclear hyperchromasia without coarse chromatin, prominent nucleoli (coexisting repair). Note multinucleation (upper right corner insert).
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NILM: Reactive cellular changes associated with Radiation
Type of Preparation: Conventional Magnification: High Interpretation: NILM: Reactive cellular changes associated with Radiation Cytomorphologic Criteria: Multinucleated cell. Abundant polychromatic cytoplasm; cytoplasmic vacuoles. Explanatory Notes: Acute radiation changes.
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NILM: Reactive cellular changes associated with IUD
Cytomorphologic Criteria: Glandular cells in small clusters with increased N/C ratio and cytoplasmic vacuoles. Nuclear degeneration and prominent nucleoli present. Explanatory Notes: The cells may be shed as clusters or singly. Clusters such as these may mimic cells from adenocarcinoma. One should diagnose adenocarcinoma with caution in the presence of an IUD. If in doubt, consider repeat sampling after removal of the IUD. Single cells may also mimic high grade SIL. One needs to look for the morphologic spectrum of Free Powerpoint Templatesabnormalities associated Page 38 with SIL.

Cytomorphologic Criteria: Note small cluster of glandular cells with cytoplasmic vacuoles displacing nuclei. The cytoplasmic vacuoles may displace the nucleus, creating a signet-ring appearance. Explanatory Notes: The cells may be shed as clusters or singly. Clusters such as these may mimic cells from adenocarcinoma. One should diagnose adenocarcinoma with caution in the presence of an IUD. If in doubt, consider repeat sampling 39 after removal ofPage the IUD.

Cytomorphologic Criteria: Single partially degenerated epithelial cells with increased nuclear size and high N/C ratio.
Explanatory Notes: Single cells may also mimic high grade SIL; however the morphologic spectrum of abnormalities usually present with squamous intraepithelial lesions is absent in cases with single atypical cells due to IUD effect. Also the presence of nucleoli in isolated cells with a high N/C ratio (right) are not Page 40 typical of HSIL.
NILM: Glandular cells post-hysterectomy (Colonic Neuralgia)
Interpretation: NILM: Glandular cells post-hysterectomy (Colonic Neuralgia) Cytomorphologic Criteria: Orderly cohesive groups of glandular cells with goblet cells. Explanatory Notes: Orderly arrangement and bland nuclear features distinguish from adenocarcinoma. Goblet cells are classic for colonic origin.
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NILM: Rectovaginal fistula
Clinical History: Elderly woman with history of hysterectomy and radiation treatment Cytomorphologic Criteria: Groups of columnar cells with glandular formation and prominent purple mucin. Background shows granular debris and blood.
Explanatory Notes: Orderly arrangement of cells helps differentiate groups from adenocarcinoma. The colonic cells originate Free Powerpoint Templates from fistula. Page 42

NILM. Atrophy
Cytomorphologic Criteria: Parabasal cells which resemble metaplastic cells in atrophy. Nuclei are usually well preserved with liquid fixation. Explanatory Notes: The transformation zone component may be difficult to assess in atrophy. Laboratories may choose to append a note indicating this in such cases.
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NILM: Atrophy with inflammation (atrophic vaginitis) Clinical History: 60 year old female Cytomorphologic Criteria: Parabasal cells with mostly bland nuclei (some showing air drying). Some degenerated cells with pyknosis also present. Basophilic granular background with inflammation also present. Explanatory Notes: This photo does not show significant atypia, but an interpretation of ASC may be indicated if degenerated cells show significant Free Powerpoint Templates Page 44 atypia.

NILM: Atrophy
Clinical History: 79 year old postmenopausal woman, being evaluated for possible Squamous cell carcinoma of vulva Cytomorphologic Criteria: Sheets of uniform orderly parabasal cells are observed representing deep parabasal cells. Some nuclei show grooves, but chromatin pattern is fine. Atrophic cells may have nucleoli (lower right insert). Explanatory Notes: Differentiate from HSIL by uniform bland nuclei and orderly cell arrangement. Background clues may be Free Powerpoint Templates helpful. Page 45
'Epithelial Cell Abnormalities'

NILM vs ASC-US
Type of Preparation: Conventional Magnification: High Clinical History: Premenopausal woman Interpretation: NILM vs ASC-US Cytomorphologic Criteria: Mature squamous cells showing mild nuclear enlargement, bi-nucleation, and even chromatin. Note benign endocervical cells at bottom of field.
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NILM: Keratotic cellular changes typical parakeratosis"
Clinical History: 49 year old woman, Pap smear following treatment of SIL Cytomorphologic Criteria: Note plaque of parakeratotic cells with persistence of nuclei. The nuclei lack any evidence of increased staining and size, and have a normal outline. Explanatory Notes: Might be an image to address the issue of parakeratosis versus ASCUS, parakeratotic type.
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NILM: Keratotic cellular changes- Hyperkeratosis
Cytomorphologic Criteria: Anucleate but otherwise unremarkable mature polygonal squamous cells. Explanatory Notes: They usually represent a benign process or result from inadvertent contamination of the specimen with vulvar material.
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NILM: Squamous metaplasia
Cytomorphologic Criteria: Small round or polygonal metaplastic cells with slightly enlarged N/C ratio. Smooth nuclear membranes. Chromatin pattern is finely granular and evenly distributed. Small round nucleoli are commonly seen.
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NILM: Microglandular hyperplasia

Clinical History: 33 year old on the "pill". Day 18 of menstrual cycle. Cytomorphologic Criteria: Endocervical cells and mucus. Explanatory Notes: Endocervical cells seen in microglandular hyperplasia (MGH) can appear "pseudokeratotic" . At low magnification, this pattern should be distinguished from HSIL and histiocytes. MGH has previously been associated with "pill effect" and is more often seen in cervical cytology in the second half of the menstrual cycle.
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'Other malignant Neoplasms'

Type of Preparation: Conventional
Squamous cell carcinoma
Magnification: High
Interpretation: Squamous cell carcinoma Cytomorphologic Criteria: Cells on the left with scant cytoplasm display nuclei with irregularly distributed, coarsely granular chromatin and prominent nucleoli. On the right, lysed blood and a stripped nucleus, tumor diathesis, is evident. Explanatory Notes: Invasive carcinoma with prominent nucleoli may suggest adenocarcinoma; however, in this case centrally located nuclei and flat arrangement of cells is consistent with squamous cell carcinoma.
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Endocervical adenocarcinoma in situ (AIS)

Type of Preparation: ThinPrep Magnification: Medium Clinical History: 64 year old woman with history of an abnormal Pap test at another institution referred for workup Interpretation: Endocervical adenocarcinoma in situ (AIS) Cytomorphologic Criteria: Aggregate of abnormal cells with elongated hyperchromatic nuclei arranged in glandular strips that have nuclear pseudostratification and suggestion of a gland lumen. There is some suggestion of feathering at the periphery. Explanatory Notes: Cells with elongated nuclei and nuclear pseudostratification are classic features of endocervical AIS. Feathering at the periphery of cells sheets may be more subtle in liquid-based preparations. Follow-up: endocervical adenocarcinoma in situ with a small component of invasive adenocarcinoma and a coexisting HSIL
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Adenocarcinoma, Endometrial
Type of Preparation: Conventional Magnification: High Clinical History: Post menopausal woman Interpretation: Adenocarcinoma, endometrial Cytomorphologic Criteria: Cluster of small cells with enlarged round or oval nuclei, small nucleoli and vacuolated cytoplasm in a background of "watery" diathesis. Explanatory Notes: In cases of endometrial adenocarcinoma on conventional smears, tumor diathesis, if present, is watery and more difficult to appreciate. Follow-up: Adenocarcinoma of the endometrium, Templates Page serous
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Metastatic gastric carcinoma
Type of Preparation: Conventional Magnification: High Clinical History: 51 year old postmenopausal woman with hx of gastric carcinoma and ascites Interpretation: Other Malignant Neoplasms: Metastatic gastric carcinoma Cytomorphologic Criteria: A small cluster of cells has malignant nuclear features and displays a cell within cell arrangement commonly seen in gastric carcinoma. A cytoplasmic vacuole is present in one of the single cells. Explanatory Notes: A clean background or lack of tumor diathesis is a common finding compatible in metastatic rather than primary tumors of the cervix. The differential diagnosis based on the cytologic features includes metastatic Templates Page 54 breast carcinoma.
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Adenocarcinoma, extrauterine (Breast carcinoma)
Type of Preparation: Conventional Magnification: High Clinical History: 42 year old woman with history of breast cancer. Interpretation: Adenocarcinoma, extrauterine (Breast carcinoma) Cytomorphologic Criteria: Group of dissociated cells with malignant features including high nuclear to cytoplasmic ratio, hyperchromatic, slightly irregular nuclei and conspicuous nucleoli. A finely vacuolated cytoplasm is consistent with glandular differentiation. Explanatory Notes: Presence of signet ring cells and cell-in-cell arrangement may suggest breast carcinoma. Typically the cervical preparation would lack tumor diathesis in metastatic tumors. The differential diagnosis includes metastatic gastric carcinoma as well as other adenocarcinomas, NOS.
Free
Follow-up: Powerpoint Templates Metastatic breast cancer
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Sarcoma
Type of Preparation: Conventional Magnification: High Clinical History: 42 year old perimenopausal woman presents with irregular bleeding and an enlarged uterus Interpretation: Other Malignant Neoplasms: Sarcoma Cytomorphologic Criteria: This single giant cells with malignant nuclear features is present in a bloody background. Explanatory Notes: Uterine sarcomas exfoliate scant cellular material in cervical cytology samples. Although malignant giant cells may be seen in high grade carcinomas, their association with a spindle cell component point towards a sarcomatous differentiation. The differential diagnosis may include choriocarcinoma. Follow-up: High grade sarcoma (hysterectomy)
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Malignant melanoma
Type of Preparation: Conventional
Magnification: Medium
Clinical History: 40 year old woman s/p resection of melanoma of the thigh presents with a small discolored submucosal lesion on the cervix; LMP 4 weeks
Interpretation: Other Malignant Neoplasms: Malignant melanoma
Explanatory Notes: Section of the inguinal lymph node showing metastatic malignant melanoma composed of polygonal cells with large eccentrically placed, hyperchromatic nuclei and prominent nucleoli.
Cytomorphologic Criteria: The presence of brown cytoplasmic pigment consistent with melanin in these malignant cells supports the interpretation of malignant melanoma.
Follow-up: Cells in the Pap smear are identical to those seen in her previous tissue interpreted as malignant melanoma
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Thank you for Listening! ^_^
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Papanicolau Smear (Pap Smear) : Eastern Visayas Regional Medical Center

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Papanicolau Smear (Pap Smear) : Eastern Visayas Regional Medical Center

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Eastern Visayas Regional Medical Center

Papanicolau Smear (Pap Smear)

Rose Teri J. Zacate UPMSHS Medical Intern

Free Powerpoint Templates

Free Powerpoint Templates

SUMMARY OF PAP TEST INDICATIONS

over age 65; history of normal tests

continue testing as normal

Vaccine does not cover all cancer-causing types of HPV

post-operative transgender woman

the neo-vagina does not contain a

The Bethesda System

Atypical Glandular Cells, suspicious for AIS or cancer (AGC-neoplastic)

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RESULT OF EXFOLIATIVE CYTOLOGY (PAP SMEAR)

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RESULT OF EXFOLIATIVE CYTOLOGY (PAP SMEAR)

RESULT OF EXFOLIATIVE CYTOLOGY (PAP SMEAR)

Glandular cells status post hysterectomy Atrophy

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RESULT OF EXFOLIATIVE CYTOLOGY (PAP SMEAR)

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'Satisfactory for evaluation'

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'Unsatisfactory for evaluation'

Magnification: Free Powerpoint Templates Low

Adequacy Description: Unsatisfactory- obscuring RBCs and WBCs

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'Negative for Intraepithelial Lesion or Malignancy' (NILM)

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'Negative for Intraepithelial Lesion or Malignancy' (NILM)

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'Negative for Intraepithelial Lesion or Malignancy'

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'Negative for Intraepithelial Lesion or Malignancy'

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'Negative for Intraepithelial Lesion or Malignancy'

NILM: Fungal organisms consistent with Candida spp

Type of Preparation: ThinPrep/ LBP Magnification: High

Clinical History: 27 year old woman, colposcopy visit

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'Negative for Intraepithelial Lesion or Malignancy'

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'Negative for Intraepithelial Lesion or Malignancy'

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'Negative for Intraepithelial Lesion or Malignancy'

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'Negative for Intraepithelial Lesion or Malignancy'

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'Negative for Intraepithelial Lesion or Malignancy'

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'Negative for Intraepithelial Lesion or Malignancy'

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'Negative for Intraepithelial Lesion or Malignancy'

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'Negative for Intraepithelial Lesion or Malignancy'

Clinical History: 32 year old; routine Pap test

'Negative for Intraepithelial Lesion or Malignancy'

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'Negative for Intraepithelial Lesion or Malignancy'

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