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warningfor the boys

baknush background ahead

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Gynecologic Pathology Module:Gynecologic Pathology Module:

Cervical NeoplasiaCervical Neoplasia

Since mahilig naman si Teacher Doctor sa PURPLE background

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case abstractcase abstract

A 36 year old G6P3 (1-2-3-1)

consulted for post-coital bleeding.

There was associated anorexia and weight loss.

A cervicovaginal smear done 10 years ago showedmild dysplasia with koilocytosis which was

documented on cervical punch biopsy.

Patient was lost to follow upas she apparently became asymptomatic

after one course of treatment.

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Initial Pap Smear taken 10 years ago

Perinuclear clearing

Evidence of pleomorphism

Irregular edges

Crisp and clear and even

nuclear membrane

Fine chromatin

Small nucleus

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She started working as an

entertainer in a disco pub at the age of 15,and dated several of his regular customers.

She had lived in

with the cashier of the club for 5 years

for which she bore three children,two of whom died

as they were both delivered prematurely.

She is presently the

common law wife of a former bar client

and has had three pregnancies with him

and these were all aborted.

Her boyfriend apparently had a

warty penile growth

removed last year by a urologist.

case abstractcase abstract

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Pertinent gynecologic examinations revealed

a bulky cervix with a fungating massand a small nodule in the vaginal fornix

which bled easily.

There was also

foul smelling serosanguinous discharge.

A pap smear and cervical punch biopsy were performed.

The smear revealed

individual and loose cell sheets of oval to polygonal atypical cellswith increased N:C ratio

in a dirty background with blood, cell debris, necrotic material,and fibrin.

The cervical biopsy showed

anastomosing tongues and cords of large masses of neoplastic

squamous cells infiltrating the fibrous stroma of the cervix.

case abstractcase abstract

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Dirty background

Evidence of inflammation

Necrotic Debris

Result of Present Pap SmearCells have

large nuclei (nucleomegaly)

small rings of cytoplasm

coarse chromatin

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The Verdict?

FIGO Stage IB!

Wait lang.

Clinical Stage

yun! How do

you know its

FIGO Stage IB?

Well. All we know is

that theres a cervical

mass na obvious

clinically. But, we

dont know if it spread

elsewhere!

What about this slide?

What does it tell us?

Same as the findings in the other slide!

The cells have

large nuclei (nucleomegaly)

small rings of cytoplasm

coarse chromatin

And the Background is composed of

evidences of inflammation

necrotic debris!

Result of Present Pap Smear

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Cervical Punch Biopsy of the Cervical Mass

Malamang cancer cells.

-- unidentified preceptor

Huh? Bakit po?Eh Cervical Mass nga ang

pinanggalingan eh! Eh di sa loob

lang yan ng tumor mismo!

Hmm. Oo nga naman.

What can be found in this slide?

Keratin Pearl! Whooo! = Squamous Cell CA!

Remember!

A diagnosis of

a Squamous

Cell CA cannot

be made based

on Pap Smear

alone. You

have to see a

biopsy resultfirst.

Ano to?

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Clinical Stage (FIGO)

Stage IB(but additional examinations should be done to make sure that the

lesion did not affect other areas other than the cervix)Histologic Classification

CIN III / Squamous Cell CA

Bethesda System TerminologyHSIL(High-Grade Squamous Intraepithelial Lesion)

final diagnosis?final diagnosis?

Sabi lang ng preceptor namin yan ha?

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-- The End --

Haha. Ang sabog.

Clueless.

Owel.

Goodluck everyone!

Wed like to apologize for any misinformations and/or lack of information.

If theres any additional information you might have regarding the SGD case and the test results,

please do share them with us and wed gladly disseminate the information

Or make a new Powerpoint Presentation.

You can find clearer and bigger trans images on succeeding slides.

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Figure 1. Koilocytosis

Page 1, Column 2

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Figure 4. Diagram of cervical epithelium showing

various terminologies used to characterize

progressive degrees of cervical neoplasia

Page 3, Column 2

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Figure 5. Mild Dysplasia

Page 3, Column 2

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Figure 6. Severe Dysplasia

Page 4, Column 1

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Figure 7. Carcinoma In Situ with

Gland Involvement

Page 4, Column 2

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Figure 8. Cervical Scrape

Page 4, Column 2

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Figure 9. Cervical cytology specimen interpreted as atypical

squamous cells of undetermined significance (ASC-US)

Page 5, Column 1

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Figure 10. Liquid-based cytology specimen showing a single

atypical parabasal cell

Page 5, Column 2

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Figure 11. Cytopathic effects of human papillomavirus (HPV)Page 5, Column 2

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Figure 12. Cytologic features of enlarged nuclei and

reduced cytoplasm

Page 5, Column 2

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Figure 13. Liquid-based cytology specimen showing atypical

glandular cells (AGC) of undetermined significance

Page 6, Column 1

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Figure 14. LSIL/CIN i

Page 4, Column 2

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Figure 15. HSIL/ CIN II

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Figure 15. HSIL/CIN III

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Figure 16. Clinical Stages of Cervical Carcinoma

Page 6, Column 2

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Thank you!