Cylinderepitelforandringer i cervix uteri. Jalil Hariri Klinisk patologi Sønderborg og Vejle

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1 Cylinderepitelforandringer i cervix uteri Jalil Hariri Klinisk patologi Sønderborg og Vejle jalil.hariri@rsyd.dk jalil.hariri2@rsyd.dk 1

2 ..og Gud skabte kvinden.. Men det er fanden, der skabte hendes cylinderepitel 2

3 Fleksibelt agenda Pladeepitel vs. cylinderepitel AGC/AIS vs. tubar metaplasi AIS vs. adenocarcinom Cervix vs. corpus 3

4 Negative for Intraepithelial Lesion or Malignancy EC s EC s EC s EC s EC s EC s 4

5 Endocervical & Metaplastic Cells 5

6 Endocervical Cells: Orientation On End Picket fence Honeycomb 6

7 NILM, Reactive and Repair Normal Reactive / repair Reactive changes 7

8 NILM, Reactive, Repair and AGC? Reactive / repair Reactive AGC? 8

9 Reactive Endocervical Cells 9

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12 Decidual reaktion Reaktive cyl. i cervix 12

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Hariri, Dansk Cytologiforenings årsmøde 2018 16

16 Hariri, Dansk Cytologiforenings årsmøde BD SurePath liquid-based Pap Test. BD, BD Logo & all other trademarks are the property of Becton, Dickinson and Company BD Rev A

17 17

18 Samme celletype? 18

19 AGC Adenocarcinoma in-situ Endocervikalt Adenocarcinoma 19

20 Atypical Endocervical Cells Crowding Hyperchromasia AIS 20

21 Referencing Normal Cells for Perspective Atypical Glandular Cells Hariri, Dansk Cytologiforenings Normal årsmøde Endocervical 2018 Cells 21

22 Referencing AGC / AIS for Perspective AGC / AIS Atypical Glandular Cells Atypical Glandular Cells 22

23 Strips, abnormal pattern Strips, benign pattern 23

24 24

25 Apoptosis Deranged nuclei Strips, abnormal pattern 25

26 Pseudostratification, nucleoli, and mitosis 26

27 Deranged & slightly hyperchromatic nuclei 27

28 Adenocarcinoma in situ Rosette Pseudostratification Increased N/C ratio Oval nuclei Salt & pepper chromatin Feathering 28

29 Rosette Cartwheel 29

30 Atypical Endocervical Cells Strip Palisading Hyperchromasia Increased N:C ratio Biopsy AIS (ICC) Passer det?? /JH 30

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33 AGC vs. tubal metaplasia 33

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38 Tubar metaplasi 38

39 Tubar metaplasi 39

40 Tubar metaplasi 40

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Hariri, 2017 44 BD SurePath liquid-based

44 Hariri, BD SurePath liquid-based Pap Test. BD, BD Logo & all other trademarks are the property of Becton, Dickinson and Company BD Rev A

45 45

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47 47

Hariri, 2017 48 BD SurePath liquid-based Pap Test.

48 Hariri, BD SurePath liquid-based Pap Test. BD, BD Logo & all other trademarks are the property of Becton, Dickinson and Company BD Rev A

Hariri, 2017 49 BD SurePath liquid-based Pap Test.

49 Hariri, BD SurePath liquid-based Pap Test. BD, BD Logo & all other trademarks are the property of Becton, Dickinson and Company BD Rev A

50 Tubal metaplasia vs AGC 50

51 Tubal metaplasia vs AGC 51

52 Tubal metaplasia vs AGC 52

53 Cylinderepitel med tubarmetaplasi (TM) Cilie & terminal bar Perinuklære vakuoler Sammenklumpede kerner (oftest benigne) Jo højere oppe i Cx., jo flere celler med TM Jo ældre patient er, jo flere celler med TM 53

54 Atypical Endocervical Cells 2-D crowded group Columnar cells Hyperchromasia 54

55 Atypical Endocervical Cells Apoptosis Mitosis Biopsy: AIS 55

56 AGC 56

57 AGC? AGC AGC 57

58 58

59 Adenocarcinoma in situ Strip & Pseudostratification Mitosis 59

60 Adenocarcinoma in situ 60

61 HSIL & AIS Look Alikes HSIL AIS 61

62 Hariri, Dansk Cytologiforenings årsmøde

63 p16 Hariri, Dansk Cytologiforenings årsmøde

64 AIS R/O Adenocarcinoma Biopsy Endocervical adenocarcinoma 64

65 Endocervical Adenocarcinoma Diathesis Enlarged crowded nuclei Nuclear stratification, palisading Moderate to marked anisonucleosis 65

66 Endocervical Adenocarcinoma Two-dimensional sheets Single cells Granular / vacuolated cytoplasm Nuclear membrane irregularities Prominent nucleoli 66

67 Endocervical Adenocarcinoma Diathesis Chromatin: Fine to Coarse, Irregular distribution Prominent Nucleoli Diathesis 67

68 68

69 Criteria Endocervical Adenocarcinoma Single cells Two-dimensional sheets Three-dimensional clusters Granular or vacuolated cytoplasm Stratified and palisading nuclear arrangement Enlarged, crowded nuclei with moderate to marked anisonucleosis Fine to coarse, irregularly distributed chromatin Parachromatin clearing and nuclear membrane irregularities Presence of nucleoli tumor diathesis May have co-existing squamous lesion present 69

70 Normal Endometrial Cells 70

71 NILM: Benign Endometrial Cells Note clean background 71

72 Normal Endometrial Cells 72

73 Normal Endometrial Cells 73

74 Endometrial Stromal Cells 74

75 Endometrial Stromal Cells 75

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78 Exodus 78

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81 CD10 81

82 Hariri,

83 Exodus? HSIL? 83

84 Endometrial cells vs contamination 84

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86 AGC Atypiske Endometrieceller Endometrieadenocarcinom 86

87 IUD 87

88 IUD Changes: Single cells Mimicking HSIL 88

89 IUD 89

90 IUD 90

91 IUD 91

92 IUD 92

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95 Endometrial Adenocarcinoma Increased nuclear size Nucleoli 3 D group Scalloped edges NILM for Comparison 95

96 Endometrial Adenocarcinoma Increased nuclear size Nucleoli 3 D group Scalloped edges IUD for comparison 96

97 Endometrial Adenocarcinoma Engulfed neutrophils Biopsy: Grade II 97

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102 Endometrial Adenocarcinoma Papillary Serous 102

103 Endometrial Adenocarcinoma Note Atrophic Background 103

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106 Mindre sandsynlige sammentræf IUD & endometriehyperplasia / -cancer Alle spiral typer (også hus postmnauposale) HSIL & endometriehyperplasia / cancer To forskellige organer & patientkategorier Exodus & endometriehyperplasia / cancer Gælder også (mange) stromaceller 106

107 OBS. Post-konus LUS & tubarmetaplasi Cervix afkortet Brug HPV-test med omtanke Cylinderepitelforandringer Udgangspunkt i cervix eller corpus Endocervikalt smear er ikke et smear 107

108 Tag med hjem citater Vi inviterer raske kvinder De må ikke sygeliggøres pga. vores usikkerhed (Euphemia McGoogan) Det er os, der skal lægge vågen om natten Ikke patienten (Frede Olesen) 108

109 Tak for opmærksomheden 109

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111 ICC / IHC Reactive cervical Tubal metaplasia ER VIM CEAM BCL2 + - (+) (+) AIS+ (-) - + (+) Endometrial (+) 111

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115 Endometrial cells vs contamination 115

116 as yet there is no known substance or characteristic that is present in all malignant cells and absent in all benign or normal cells... Marluce Bibbo 116

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