?????(exfoliative cytology) :?????,????????????????????????????????????,????,??????????????,???????????????,???????(clinical cytology) ,?????(cytopathology)

1
?????????????

• ??????????????
• ? ?

2
??????????

• ?????(exfoliative cytology) ?????,?????????????
  ???????????????????????,????,??????????????,??????
  ?????????,???????(clinical cytology)
  ,?????(cytopathology)

3
??????????

• 1928?,Papaniculaou ?????????, ????????.
• 50??,??????
• 70??,???????????
• ???,???????DNA???PCR??????????

4
???????????

1. ?????(???????????)
2. ?????(?????????????)
3. ???????(?????????????????)

5
??? ????????

• ????????
• ????????????????????,?????????????.
• ??? (Basal Cells, Parabasal Cells)
• ?? (Intermediate Cells)
• ?? (Superficial Cells)

6
??????Squamous epithelium cells
7
(No Transcript)
8
??? ????????

• ??????
• ???????????????????????.
• ???????????????.

9
????????Ciliated columnar epithelium cell
10
????????Ciliated columnar epithelium cell

• Ciliated columnar epithelium cell with terminal
  bars and cilia.

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????????Mucus columnar epithelium cell

• Mucus columnar epithelium cell
• Note that the nuclei are uniform, basal, and do
  not stratify

12
??? ????????

• ?????????????
• ?????
• ?????

13
??? ????????

• ????????????
• ????????????????????????????????????.
• ?????????.

14
??? ????????????

• ???(dyskaryosis) ????????,?????????????????,????,
  ???????,????????????????????????????,?????????????
  ???
• ????????????????,?????????????????????????

15
??????
16
??? ????????

• ????????????
• ??????????,?????,??????,??,???,?????,????,??,????
  ??,??????,??
• ???????????????????????????
• ?????????,?????

17
?????Squamous cell carcinoma

• ???????,??????,?????,??????????????????????,??
  ??????,??????????????????????,??????

18
?????Squamous cell carcinoma
19
?? Adenocarcinoma

• ??????, ????????,???????????????? ???????,
  ????????,????,??????, ???????,?????,???????

20
?? Adenocarcinoma
21
???? Undifferentiated Carcinoma

• ?????????????????????,??????????????
• ????????, ?????,???????????????????,???????,??????
  ??????,???,????.

22
??????? Small cell carcinoma
23
?????????Gynecologic Cytology

• ??????????????????,??????????????

24
????????? (Gynecology Cytology)

• (?)??????
• ????
• ????
• ????????????
• (?)??????
• ???????
• ?????????
• ????????
• ??????

25
??? ????????

• ????????
• ????????????????????,?????????????.
• ??? (Basal Cells, Parabasal Cells)
• ?? (Intermediate Cells)
• ?? (Superficial Cells)

26
??????-??????
27
??????-??????
28
??????-??????
29
????????? (Gynecology Cytology)

• ??????
• ?????????????
• ???????
• ?????????
• ????????
• ??????

30
??????? (Endocervical cells)

• Endocervical cells.
• Note uniformity of cells Prominent cell
  borders-a benign feature of endocervical
  cells-results in characteristic "honeycomb"
  appearance.
• Nuclei are round to oval with smooth outlines.
• This is the classic cytologic appearance of
  benign glandular epithelium from virtually any
  site.

31
??????? (Endocervical cells)

• Endocervical cells
• Note that the nuclei are uniform, basal, and do
  not stratify

32
??????? (Endocervical cells)

• Ciliated endocervical cells with terminal bars
  and cilia.

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?????? (Endometrial cells)

• In contrast with usually flat lying,
  well-preserved endocervical cells, endometrial
  cells tend to be "packed together" and
  degenerated.
• Note that the normal endometrial cell nucleus is
  approximately the size of the intermediate
  squamous cell nucleus.

34
?????? (Endometrial cells)

• Classic "double contour" arrangement (stroma in
  center surrounded by epithelium) is associated
  with "exodus" (days 6 to 10).

35
????????

• Cervix (tissue)
• Transformation zone, from simple columnar
  epithelium of endocervix into squamous
  metaplasia.
• This area is of particular interest because it is
  where most neoplastic lesions of the cervix
  arise.

36
????????

• The presence of endocervical cells is one
  measure of the adequacy of a Pap smear,
  indicating that the transformation zone has been
  sampled.

37
????????

• ??????
• ????????
• ??????
• ???????????? (??????,???????)

38
?????? Trichomonas vaginalis
39
?????? Atrophic Vaginitis
40
?????????????? Cellular changes associated with
Herpes Simplex Virus
41
??????????????? Cellular changes associated with
Human Papiloma Virus

• HPV infection (tissue)
• Note well-defined cytoplasmic vacuoles and
  nuclear atypia of the koilocytes.

42
??????????????? Cellular changes associated with
Human Papiloma Virus
43
??????????????? Cellular changes associated with
Human Papiloma Virus

• Koilocytes HPV infection, low-grade squamous
  intraepithelial lesion.
• To be a diagnostic koilocyte, the cytoplasmic
  vacuole must be clear and extremely well defined,
  with condensation of the peripheral cytoplasm.
• In addition, the nucleus must appear abnormal
  Binucleation is common.

44
????????? (LSIL)

• Low-grade Squamous Intraepithelial Lesion (LSIL)
• Note resemblance to normal intermediate cells,
  although the cytoplasm is slightly thick and
  dense.
• The nuclei are "big and dark" .

45
????????? (HSIL)

• High-grade Squamous Intraepithelial Lesion (HSIL)
• This is represented by small cells with high
  nuclear/cytoplasmic ratios and irregular nuclei.
• Note thin rim of dense cytoplasm

46
????????? (Gynecology Cytology)

• ???????????????????,?????????????(95)??????????
  ??

47
???????Squamous cell carcinoma

• ???????,??????,?????,??????????????????????,??
  ??????,??????????????????????,??????

48
???????Squamous cell carcinoma

• Keratinizing squamous cell carcinoma
• Markedly pleomorphic or bizarre shaped, heavily
  keratinized tumor cells, and marked
  hyperchromasia are characteristic.
• Cells tend to occur singly.

49
???????Squamous cell carcinoma
50
???????Squamous cell carcinoma

• Keratinizing squamous cell carcinoma (tissue).
• Note squamous pearl (aka squamous eddy) pearls
  are pathognomonic of keratinization.

51
???????Squamous cell carcinoma

• Nonkeratinized squamous cell carcinoma.
• Compared with keratinizing SCC, the cells of
  nonkeratinizing SCC are more uniform and more
  often occur in aggregates.
• Nuclear abnormalities are usually easier to
  appreciate in nonkeratinizing SCC.

52
????????? Gynecology Cytology

• ????????????5??,??????????????????????????,?????
  ???,????,???????,?????,?????????????,????,????????
  ,??????????????,?????,?????

53
???? (Endocervical Adenocarcinoma)

• Endocervical adenocarcinoma is represented by a
  rosette-like arrangement of malignant
  endocervical cells.
• Note prominent nucleoli.

54
???? (Endocervical Adenocarcinoma)

• Endocervical adenocarcinoma in situ.
• Crowded rosette, Benign endocervical cells rarely
  form rosettes.

55
???? (Endocervical Adenocarcinoma)
56
????????? Gynecology Cytology

• ??????
• ???,????????1,?????????????????,????,?????
  ???????,??????????????????????

57
????????? (Small cell neuroendocrine carcinoma)

• A rare cause of HCGs, small cell neuroendocrine
  carcinoma is cytologically similar to the far
  more common small "oat" cell carcinoma that
  occurs in the lung.
• Note high nuclear /cytoplasmic ratios, fine, dark
  chromatin, and inconspicuous nucleoli.
• There is an attempt at rosette formation by the
  cells in this field.

58
??????

• Malignant mixed mesodermal (müllerian) tumor or
  carcinosarcoma.
• Often, only the malignant epithelial component is
  seen in the Pap smear. The adenocarcinoma can
  range from well differentiated to poorly
  differentiated.

59
????????? Gynecology Cytology

• ???????
• I ? ??????--????
• ?? ??????,?????
• ?? ???????
• ?? ??????????,???????,?????????,????
• ?? ????,????????.

60
????????? Gynecology Cytology

• TBS???????,?????????????????TBS???????????
• ??????????
• ?????????????????????

61
?????????????????????????????????????????
???????? (Pap x200 obj).
62
????????? Gynecology Cytology

• TBS??????????????(????????????????????????????)??
  ????(???????????????)?

63
????????? Gynecology Cytology

• TBS??????????????????????(ASCUS)????????????HPV??
  ??????????(LSIL)????????????(AGUS)?

64
????????? Gynecology Cytology

• TBS?????????????????????(HSIL)???????????????????
  ????????

65
???

• ????????????
• ??????????????
• ??????????????
• ???????????????
• ???????????????????
• ????????????????????
• ???????The Bethesda System (TBS)?????????