CT CT Gynecologic Cytology 2 — Questions and Answers
Question 1: On a Pap test, small dark cells with scant cytoplasm and nuclear molding that are shed in sheets from the lower uterine segment are most consistent with which entity?
- Endometrial adenocarcinoma
- Small cell carcinoma
- Endometrial stromal cells from the lower uterine segment (Correct answer)
- Lymphocytes from chronic cervicitis
Correct answer: Endometrial stromal cells from the lower uterine segment
Lower uterine segment stromal cells appear as tight clusters of small dark cells with scant cytoplasm and may mimic high-grade lesions but lack atypia.
Question 2: Which cytomorphologic feature best distinguishes endocervical adenocarcinoma in situ (AIS) from reactive endocervical cells on a Pap test?
- Increased mucin production
- Nuclear feathering, pseudostratification, and apoptotic bodies (Correct answer)
- Ciliated cell borders
- Intracytoplasmic neutrophils
Correct answer: Nuclear feathering, pseudostratification, and apoptotic bodies
AIS characteristically shows nuclear feathering (cells projecting from sheet edges), pseudostratification, hyperchromasia, and apoptosis absent in reactive changes.
Question 3: A Pap test from a 55-year-old woman demonstrates large cells with abundant granular cytoplasm, prominent nucleoli, and nuclear enlargement in small clusters. What is the most likely diagnosis?
- HSIL
- Endometrial adenocarcinoma (Correct answer)
- Tubal metaplasia
- Squamous cell carcinoma
Correct answer: Endometrial adenocarcinoma
Endometrial adenocarcinoma cells typically appear in small clusters with nuclear enlargement, prominent nucleoli, and variable cytoplasm, often with vacuolization.
Question 4: According to the 2019 ASCCP guidelines, what is the preferred management for a patient with an ASC-H Pap result?
- Repeat Pap in 1 year
- Reflex HPV testing only
- Colposcopy (Correct answer)
- Immediate LEEP procedure
Correct answer: Colposcopy
ASC-H (atypical squamous cells, cannot exclude HSIL) carries a higher risk of underlying CIN 2/3 and therefore warrants immediate colposcopic evaluation.
Question 5: Which liquid-based cytology preparation method uses a density gradient centrifugation technique that results in a thin monolayer deposit?
- ThinPrep (Hologic)
- SurePath (BD) (Correct answer)
- Papanicolaou conventional smear
- CytoRich Red
Correct answer: SurePath (BD)
SurePath uses a density gradient sedimentation process that settles cells onto the slide in a monolayer, while ThinPrep uses a filter-transfer method.
Question 6: Trichomonas vaginalis on Pap cytology is best identified by which combination of features?
- Hyphae and pseudohyphae
- Pear-shaped organisms with eccentric nucleus and pale granular cytoplasm (Correct answer)
- Coccobacilli coating squamous cells
- Sulphur granules in clusters
Correct answer: Pear-shaped organisms with eccentric nucleus and pale granular cytoplasm
Trichomonas vaginalis appears as small pear- to oval-shaped organisms with a pale eccentric nucleus and eosinophilic granular cytoplasm on Pap-stained slides.
CT CT Gynecologic Cytology 2
On a Pap test, small dark cells with scant cytoplasm and nuclear molding that are shed in sheets from the lower uterine segment are most consistent with which entity?