Image Based Question-72044

Identify this abnormality on pap smear:

A. Normal

B. Adenocarcinoma

C. Low grade Squamous Intraepithelial Lesions

D. Squamous cell carcinoma

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Correct Answer » C Explanation

Ans:C. Low grade Squamous Intraepithelial Lesions

Image shows:

1. enlarged nuclei (approximately 5 x intermediate cell nucleus);
2. multinucleated cells;
3. irregular nuclear margins;
4. presence of rough chromatin deposits;
5. presence of koilocytes.

Pathology of squamous cells:

• Atypical Squamous Cells-Undetermined Significance(ASC-US)

• Atypical Squamous Cells – cannot exclude HSIL (ASC-H)

• Low grade Squamous Intraepithelial Lesions (LSIL)

• High grade Squamous Intraepithelial Lesions (HSIL)

• Squamous cell carcinoma

HSIL	LSIL
NC ratio	~1:2	~1:3
Nuclear membrane irregularities	Marked – distinct notches	Moderate
Chromatin granularity	Coarse, clumped, +/-nucleolus (red)	Coarse, no nucleolus
Cytoplasmic staining	Dark	Light
Perinuclear clearing	Usually absent	Often present
Binucleation	Uncommon	May be present
Maturity of squamous cell	Normal maturity	Hypermature (orangeophilic cell present)