I have been attached to cytology for 3 weeks.
What is cytology?
Cytology is the study of cells obtain from bodily fluids.
The cytology department receives any fluid from the body such as CSF, aspirates, FNA, smears from urinary tract, reproductive system and so on. They split all the specimens into 2 categories, gynaecological and non-gynaecological. The gynae category means Pap smears (female reproductive tract from vaginal to cervical smears). Non-gynae is everything else.
Pap stands for Papanicolaou stain. It screens to detect premalignant and malignant tissues, mainly from the cervix.
How to take a Pap smear?
I "tooth-brush" like device is used to scrap cells from the opening of the cervix. The medical officer will rotate 360 degrees to gather cells from as large area as possible (to prevent false negative because some areas may not be scrapped). Then they will be smeared onto a slide and stained using the Pap staining method.
Instead of the usual H&E staining, gynae staining is slightly different. They have modified Eosin Azure instead of the normal Eosin, orange G stain and harris haematoxylin. Orange G stains for keratin, and the eosin is special because gynae cells cannot be stained by normal eosin. (I don't know why.)
The test aims to detect cells which are potentially pre-cancerous. The newest classification of degree of malignancy of gynae cells is called Bethesda system.
1. Atypical glandular cells (AGC)
2. Atypical squamous cells of undetermined significance (ASCUS)
3. Low grade squamous intraepithelial lesion (LSIL)
4. High grade squamous intraepithelial lesion (HSIL)
5. Squamous cell carcinoma
It is recommended that females who have had sex undergo regular Pap smear testing, once a year to once in 5 years. If the results are abnormal, they need to do a confirmatory test, about 6months later again (the same test). Other confirmatory test include colposcopy and HPV DNA testing. I am unsure how these are performed.
The above picture shows HSIL.
The main things to look out for to confirm malignancy is to observe the nucleus.
They MUST have these characteristics:
1. Enlargement of nucleus
2. Increase in chromatin density
3. Chromatin appears granular or clumped
4. Loss of reticular characteristics of benign cells
They MAY have these characteristics:
1. Hyperchromasia of nucleus (hyper-extreme, chroma-colour)
2. Polychromasia of nucleus (poly-multiple)
3. Changes of the shape of nucleus
5. Abnomal mitosis
6. Multiple nucleus per cell
(7. onwards are cytoplasm)
7. Unusual staining of cytoplasm
8. Formation of syncytical sheets with faded outline (I have no idea what it means)
9. Weird shape of cell