Cytopathology Conference 12/01/05 - Case 2
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Cytopathology Conference
12/01/2005
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Case 2
• Pap test from a 32-year-old female.
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Diagnosis?
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Differential Diagnosis
• AGUS• Reactive change associated with intrauterine device.
• Adenocarcinoma (endometrial, endocervical or ovarian)• Metastatic carcinoma• Radiation/chemo effect
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NILM; reactive changes associated with IUD
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IUD Changes
• Three types of atypical cells with IUD changes:
– Endocervical– Metaplastic cells– Endometrial cells
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IUD Change -Endocervical
• Clusters
• Large, hypervacuolated, columnar cells
• May have neutrophils phagocytosed in cytoplasm
• Vacuoles are degenerative in nature
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IUD Change – Metaplastic cells
• Vacuolated with nuclei pushed to the periphery
• Bland chromatin, nonsecretory nature of vacuoles, absence of a tumor diathesis
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IUD Change – Endometrial cells
• May shed singly or in clusters
• Scant cytoplasm, uniform nuclear size and shape, slight hyperchromasia (if any)
• May have evidence of endometritis
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IUD Effect - Actinomyces• Clusters of branching
filamentous organisms
• Usually found in patients with IUD
• Helpful for diagnosis if found
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IUD Effect
• Cockleburrs are usually associated with pregnancy but can be with IUD or birth control pills
• Cockleburrs are probably from cellular debris. Not immunoglobulin, Not hematoidin.