The uterus

Fundus of the
uterus

Body of the uterus

cervix

Uterus is lined by
simple columnar
ciliated cells
 The cervix
Anatomy Histology
vagina Stratified squamous non-keratinzed epithelium
rich in glycogen
Ectocervix Stratified squamous non-keratinzed epithelium
rich in glycogen
Endocervix Pseudo-stratified columnar ciliated epithelium,
rich in mucus secretion
Cervical canal Pseudo-stratified columnar ciliated epithelium,
rich in mucus secretion
 The vagina
Function: protection of upper genital tract.

Thickness:
Child: thin (few cells) and atrophy

Menopause: thin and atrophy

Puberty (reproductive period): thick (more than

one layer, 7-10 layers).
 Cytology of normal female genital tract

1- Epithelial cells:
Stratified squamous epithelium
Columnar epithelium
Endometrium
Glandular endometrial cells
Stromal endometrial cells:

Superficial cells
Deep cells
Squamous Epithelium
Superficial

Intermediate

Parabasal

Basal
 Glandular endometrial cells

Physiologically: they are present as normal cells in the

following conditions, in routine vaginal smear
Menstrual flow ( early 2-3 days).

Early pregnancy

Abortion

Post-partum period

In case of intra-uterine device at the end of menstrual

cycle.
 Glandular endometrial cells
Pathologically: present in endometrial lesions as:
Polyp

Endometritis

Submucous fibroid

Endometrial hyperplasia

Adeno-carcinoma
 2- Non-epithelial cells
Smooth muscle cells: normally not present except in deep
traumatic scrapping of ulcerative lesion as in polyp, fibroma,
and abortion.

RBCs Plasma cells

Histocytes (macrophages)

Sperms Yeast

Trichomanos vaginalis
 Inflammatory cells
usually posterior fornix or cervical smears

Polymorphs Bacterial Diplococci

Vaginosis

Inflammatory changes in epithelial cells

Presence of polymorphs

Intra-cellular diplococci
 Dust mites Trichomonas
Candida spores-hyphae

Presence of micro-organisms
Trichomonas
Candida
Bacteria
Mites
 Methods of collecting endometrial
samples

Endometrial aspiration

Endometrial lavage

Endometrial scraping

Endometrial biopsy
 Cervical vaginal smears
Several possibilities

Cervical scrape taken from the

squamo-columnar junction; the

level of the SC junction varies with
sexual maturity

Posterior fornix aspiration

Lateral vaginal wall [upper third]

scrape
Squamo-Columnar Junction
Junction of pink cervical
skin and red endocervical
canal
Inherently unstable
Key portion of the cervix to
sample
Most likely site of dysplasia
Vaginal Speculum
Ayers Spatula
Concave end to fit the
cervix
Convex end for vaginal
wall and vaginal pool
scrapings
Cytobrush
Insert ~ 2 cm (until
brush is fully inside
canal)
Rotate only 180 degrees
(otherwise will cause
bleeding)
 Squamous epithelial cells
Keratinized type: skin, valva

Non-keratinized: vagina, ectocervix

- Basal cells: usually not seen unless there is sever ulceration with
destruction of whole thickness of epithelium: deep basophilic
- Parabasal cells
- Intermediate cells
- Superfacial cells
- Non-nucleated cells
 Differentiating feature of normal
squamous cells
Parabasal Intermediate Superficial
Cell formation Single cells or Single cells or Single cells or
sheet clump clump

Diameter 15 25 um 30 -55 um 33 55 um
Nucleus Vesicular with Vesicular with Pyknotic or absent
finely granular finely granular 4 6 um
chromatin 10 - chromatin 8
12um 10 um

Cytoplasm Oval, thick, and Thin, flat or Polyhydral, thin,

dark basophilic folded, flat, eosinophilic
polyhydral, pale
basophilic
 Feature of cell maturation

Nucleus Cytoplasm

Basal cells Reticular chromatin Greenish blue

(basophilic)

Parabasal and Granular chromatin Yellow

intermediate cells

Superficial cells Pyknotic chromatin Red (acidophilic)

Make Pap Smear
As thin as possible
Properly labeled
Spray with Fixative

Within 10-15 seconds

Allow to fully dry before

packaging

Cytologic Fixative
 Causes of unsatisfactory smear
Air drying smear before fixation ---- less differentiation

between cytoplasm and nucleus.

Inadequate fixation

Uncleaned slides

Incorrect staining time

Dryness during staining procedures

 Characters of unsatisfactory smear

Thick

Poorly spread

Blood smear with clotting

Thank you