1 - Cervical and Vaginal Cytology

Abstract

The Pap test has been remarkably successful in reducing death from cervical cancer in developed countries. In many countries, the standard for reporting Pap test results is known as the Bethesda System. The normal Pap test specimen consists of squamous cells, endocervical cells, vaginal flora, and inflammatory cells. Certain infectious organisms have characteristic cytomorphologic manifestations and can be recognized on the Pap test result. Benign squamous and endocervical changes, including repair, radiation changes, and the changes associated with intrauterine devices need to be recognized and distinguished from neoplastic changes. The squamous intraepithelial lesion is the precursor to invasive squamous cancer and is graded as either low-grade or high-grade. "Atypical Squamous Cells" is a category of diagnostic uncertainty that conveys a suspicion of squamous intraepithelial lesion. Endocervical abnormalities are reported as atypical endocervical cells, adenocarcinoma in situ, or adenocarcinoma depending on the severity of the morphologic features. Similarly, endometrial abnormalities are reported as atypical endometrial cells or adenocarcinoma, depending on the quality and quantity of the cytologic changes. Benign-appearing endometrial cells are reported in women ≥ 45 years of age because of the small risk of endometrial neoplasia associated with this finding.