Cylinderepitelforandringer i cervix uteri Jalil Hariri Klinisk patologi Sønderborg og Vejle jalil.hariri@rsyd.dk jalil.hariri2@rsyd.dk 1
..og Gud skabte kvinden.. Men det er fanden, der skabte hendes cylinderepitel 2
Fleksibelt agenda Pladeepitel vs. cylinderepitel AGC/AIS vs. tubar metaplasi AIS vs. adenocarcinom Cervix vs. corpus 3
Negative for Intraepithelial Lesion or Malignancy EC s EC s EC s EC s EC s EC s 4
Endocervical & Metaplastic Cells 5
Endocervical Cells: Orientation On End Picket fence Honeycomb 6
NILM, Reactive and Repair Normal Reactive / repair Reactive changes 7
NILM, Reactive, Repair and AGC? Reactive / repair Reactive AGC? 8
Reactive Endocervical Cells 9
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Decidual reaktion Reaktive cyl. i cervix 12
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Hariri, Dansk Cytologiforenings årsmøde 2018 16 BD SurePath liquid-based Pap Test. BD, BD Logo & all other trademarks are the property of Becton, Dickinson and Company. 2007 BD 980-06918-00 Rev A
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Samme celletype? 18
AGC Adenocarcinoma in-situ Endocervikalt Adenocarcinoma 19
Atypical Endocervical Cells Crowding Hyperchromasia AIS 20
Referencing Normal Cells for Perspective Atypical Glandular Cells Hariri, Dansk Cytologiforenings Normal årsmøde Endocervical 2018 Cells 21
Referencing AGC / AIS for Perspective AGC / AIS Atypical Glandular Cells Atypical Glandular Cells 22
Strips, abnormal pattern Strips, benign pattern 23
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Apoptosis Deranged nuclei Strips, abnormal pattern 25
Pseudostratification, nucleoli, and mitosis 26
Deranged & slightly hyperchromatic nuclei 27
Adenocarcinoma in situ Rosette Pseudostratification Increased N/C ratio Oval nuclei Salt & pepper chromatin Feathering 28
Rosette Cartwheel 29
Atypical Endocervical Cells Strip Palisading Hyperchromasia Increased N:C ratio Biopsy AIS (ICC) Passer det?? /JH 30
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AGC vs. tubal metaplasia 33
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Tubar metaplasi 38
Tubar metaplasi 39
Tubar metaplasi 40
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Hariri, 2017 44 BD SurePath liquid-based Pap Test. BD, BD Logo & all other trademarks are the property of Becton, Dickinson and Company. 2007 BD 980-06918-00 Rev A
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Hariri, 2017 48 BD SurePath liquid-based Pap Test. BD, BD Logo & all other trademarks are the property of Becton, Dickinson and Company. 2007 BD 980-06918-00 Rev A
Hariri, 2017 49 BD SurePath liquid-based Pap Test. BD, BD Logo & all other trademarks are the property of Becton, Dickinson and Company. 2007 BD 980-06918-00 Rev A
Tubal metaplasia vs AGC 50
Tubal metaplasia vs AGC 51
Tubal metaplasia vs AGC 52
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
Atypical Endocervical Cells 2-D crowded group Columnar cells Hyperchromasia 54
Atypical Endocervical Cells Apoptosis Mitosis Biopsy: AIS 55
AGC 56
AGC? AGC AGC 57
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Adenocarcinoma in situ Strip & Pseudostratification Mitosis 59
Adenocarcinoma in situ 60
HSIL & AIS Look Alikes HSIL AIS 61
Hariri, Dansk Cytologiforenings årsmøde 2018 62
p16 Hariri, Dansk Cytologiforenings årsmøde 2018 63
AIS R/O Adenocarcinoma Biopsy Endocervical adenocarcinoma 64
Endocervical Adenocarcinoma Diathesis Enlarged crowded nuclei Nuclear stratification, palisading Moderate to marked anisonucleosis 65
Endocervical Adenocarcinoma Two-dimensional sheets Single cells Granular / vacuolated cytoplasm Nuclear membrane irregularities Prominent nucleoli 66
Endocervical Adenocarcinoma Diathesis Chromatin: Fine to Coarse, Irregular distribution Prominent Nucleoli Diathesis 67
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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
Normal Endometrial Cells 70
NILM: Benign Endometrial Cells Note clean background 71
Normal Endometrial Cells 72
Normal Endometrial Cells 73
Endometrial Stromal Cells 74
Endometrial Stromal Cells 75
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Exodus 78
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CD10 81
Hariri, 2015 82
Exodus? HSIL? 83
Endometrial cells vs contamination 84
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AGC Atypiske Endometrieceller Endometrieadenocarcinom 86
IUD 87
IUD Changes: Single cells Mimicking HSIL 88
IUD 89
IUD 90
IUD 91
IUD 92
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Endometrial Adenocarcinoma Increased nuclear size Nucleoli 3 D group Scalloped edges NILM for Comparison 95
Endometrial Adenocarcinoma Increased nuclear size Nucleoli 3 D group Scalloped edges IUD for comparison 96
Endometrial Adenocarcinoma Engulfed neutrophils Biopsy: Grade II 97
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Endometrial Adenocarcinoma Papillary Serous 102
Endometrial Adenocarcinoma Note Atrophic Background 103
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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
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
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
Tak for opmærksomheden 109
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ICC / IHC Reactive cervical Tubal metaplasia ER VIM CEAM BCL2 + - (+) (+) + + - + AIS+ (-) - + (+) Endometrial + + - (+) 111
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Endometrial cells vs contamination 115
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