Cytopathology Conference

12/01/2005

Case 2

• Pap test from a 32-year-old female.

Diagnosis?

Differential Diagnosis

• AGUS• Reactive change associated with intrauterine device.

• Adenocarcinoma (endometrial, endocervical or ovarian)• Metastatic carcinoma• Radiation/chemo effect

NILM; reactive changes associated with IUD

IUD Changes

• Three types of atypical cells with IUD changes:

– Endocervical– Metaplastic cells– Endometrial cells

IUD Change -Endocervical

• Clusters

• Large, hypervacuolated, columnar cells

• May have neutrophils phagocytosed in cytoplasm

• Vacuoles are degenerative in nature

IUD Change – Metaplastic cells

• Vacuolated with nuclei pushed to the periphery

• Bland chromatin, nonsecretory nature of vacuoles, absence of a tumor diathesis

IUD Change – Endometrial cells

• May shed singly or in clusters

• Scant cytoplasm, uniform nuclear size and shape, slight hyperchromasia (if any)

• May have evidence of endometritis

IUD Effect - Actinomyces• Clusters of branching

filamentous organisms

• Usually found in patients with IUD

• Helpful for diagnosis if found

IUD Effect

• Cockleburrs are usually associated with pregnancy but can be with IUD or birth control pills

• Cockleburrs are probably from cellular debris. Not immunoglobulin, Not hematoidin.