Squamous Cell Abnormalities (of Uterine Cervix)

Cytology Criteria

ASC-US

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  Nuclei: approx. 2.5 to 3 times the area of the nucleus of a normal intermediate squamous cell.
  
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  Slightly increased N/C ratio.
  
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  Minimal nuclear hyperchromasia & irregularity in chromatin distribution or nuclear shape.
  
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  Nuclear abnormalities associated with dense orangeophilic cytoplasm (“atypical parakeratosis”).
  

ASC-H

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  Metaplastic cells occur singly or in small fragments of less than 10 cells.
  
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  Nuclei size 1.5 to 2.5 larger than normal.
  
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  N/C ratio may approximate that of HSIL.
  
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  Nuclear abnormalities: focal irregularities favour an interpretation of HSIL.
  

“Crowded Sheet Pattern”

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  A microbiopsy of crowded cells containing nuclei that may show loss of polarity or are difficult to visualize.
  
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  Dense cytoplasm, polygonal cell shape, and fragments with sharp linear edges that favour squamous over glandular differentiation.
  

LSIL

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  Cells occur singly and in sheets.
  
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  Cytologic changes are usually confined to cells with “mature” or superficial type cytoplasm.
  
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  Overall cell size is large.
  
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  Nuclear enlargement more than 3 times the area of normal intermediate nuclei.
  
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  Slight increase in N/C ratio.
  
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  Variable degrees of nuclear hyperchromasia and variation in nuclear size, number and shape.
  
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  Binucleation and multinucleation
  
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  Chromatin is often uniformly distributed, but coarsely granular, alternatively the chromatin may appear smudged or densely opaque.
  
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  Nucleoli are generally absent or inconspicuous if present.
  
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  Contour of nuclear membranes is often slightly irregular, but may be smooth.
  
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  Cells have distinct cytoplasmic borders.
  
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  Perinuclear cavitation (koilocytosis) might present.
  

HSIL

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  Cytologic changes affect cells that are smaller and less “mature” than the cells in LSIL.
  
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  Cells occur singly, in sheets, or in syncytial-like aggregates.
  
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  Overall cell size is variable, and ranges from cells that are similar in size to those in LSIL to quite small basal-type cells.
  
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  Nuclear hyperchromasia is accompanied by variations in nuclear size and shape
  
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  Degree of nuclear enlargement is more variable than in LSIL.
  
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  Chromatin may be fine or coarsely granular and evenly distributed.
  
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  Contour of nuclear membrane is quite irregular with frequently prominent indentations or grooves.
  
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  Nucleoli are generally absent, but may occasionally be seen, particularly when HSIL extends into endocervical gland spaces.
  
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  Appearance of cytoplasm is variable; it can appear “immature”, lacy, and delicate or densely metaplastic; occasionally the cytoplasm is “mature” and densely keratinised.
  

Keratinizing Squamous Cell Carcinoma

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  Relatively few cells may be present; often as isolated single cells and less commonly in aggregates.
  
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  Marked variation in cellular size and shape is typical, with caudate and spindle cells that frequently contain dense orangeophilic cytoplasm.
  
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  Nuclei vary markedly in size, nuclear membranes may be irregular in configuration, and numerous dense opaque nuclei are often present.
  
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  Chromatin pattern, when discernible, is coarsely granular and irregularly distributed with parachromatin clearing.
  
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  Macronucleoli may be seen but are less common than in nonkeratinizing squamous cell carcinoma.
  
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  Associated keratotic changes (“hyperkeratosis” or “pleomorphic parakeratosis”) may be present but are not sufficient for the interpretation of carcinoma in the absence of nuclear abnormalities.
  
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  A tumour diathesis may be present, but is usually less than that seen in nonkeratinizing squamous cell carcinomas.
  

Nonkeratinizing Squamous Cell Carcinoma

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  Cells occur singly or in syncytial aggregates with poorly defined cell borders.
  
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  Cells are frequently somewhat smaller than those of many HSIL, but display most of the features of HSIL.
  
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  Nuclei demonstrated markedly irregular distribution of coarsely clumped chromatin.
  
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  A tumor diathesis consisting of necrotic debris and old blood is often present.
  
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  Large cell variant tumors may show prominent macronucleoli and basophilic cytoplasm.
  

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