CT CT Gynecologic Cytology 1 — Questions and Answers
Question 1: According to The Bethesda System, which category is used for Pap test results that cannot be clearly classified as normal or abnormal?
- Atypical squamous cells of undetermined significance (ASC-US) (Correct answer)
- Low-grade squamous intraepithelial lesion (LSIL)
- High-grade squamous intraepithelial lesion (HSIL)
- Squamous cell carcinoma
Correct answer: Atypical squamous cells of undetermined significance (ASC-US)
ASC-US is the Bethesda category for atypical squamous cells that cannot be definitively classified and represent the most common abnormal Pap result.
Question 2: Which cellular feature is the hallmark of koilocytic atypia, indicating HPV cytopathic effect in cervical specimens?
- Nuclear hyperchromasia with dense cytoplasm
- Perinuclear cytoplasmic clearing (halo) with nuclear irregularity (Correct answer)
- Single cell necrosis with karyorrhexis
- Intracytoplasmic mucin vacuoles
Correct answer: Perinuclear cytoplasmic clearing (halo) with nuclear irregularity
Koilocytes are characterized by a perinuclear cytoplasmic halo combined with nuclear enlargement and membrane irregularity, which are pathognomonic of HPV infection.
Question 3: A ThinPrep Pap test from a 35-year-old woman shows cells with a high nuclear-to-cytoplasmic ratio, hyperchromatic nuclei, irregular nuclear membranes, and coarse chromatin. What is the most appropriate Bethesda diagnosis?
- ASC-US
- LSIL
- HSIL (Correct answer)
- Atypical glandular cells (AGC)
Correct answer: HSIL
HSIL is characterized by cells with high N:C ratios, hyperchromatic irregular nuclei, and coarse chromatin, reflecting CIN 2 or CIN 3 lesions.
Question 4: Which transformation zone component must be present for a cervical Pap test to be considered adequate for evaluation by The Bethesda System?
- Parabasal cells
- Endocervical or squamous metaplastic cells (Correct answer)
- Histiocytes
- Endometrial cells
Correct answer: Endocervical or squamous metaplastic cells
The Bethesda System requires at least 10 well-preserved endocervical or squamous metaplastic cells to document sampling of the transformation zone.
Question 5: In postmenopausal women, the presence of which finding on a Pap test typically warrants clinical correlation due to potential endometrial pathology?
- Lactobacillus-dominant flora
- Atrophic epithelial cells
- Exfoliated endometrial cells after day 12 (Correct answer)
- Navicular cells
Correct answer: Exfoliated endometrial cells after day 12
Endometrial cells appearing in a postmenopausal woman's Pap test should prompt clinical investigation to exclude endometrial carcinoma or hyperplasia.
Question 6: Which organism, identified on Pap testing, presents as 'shift in flora' and is associated with bacterial vaginosis (BV)?
- Trichomonas vaginalis
- Candida species
- Gardnerella/Mobiluncus causing 'clue cells' (Correct answer)
- Actinomyces-like organisms
Correct answer: Gardnerella/Mobiluncus causing 'clue cells'
Bacterial vaginosis produces clue cells—squamous cells coated with coccobacilli (Gardnerella/Mobiluncus)—along with a shift from lactobacilli-dominant to mixed flora.
CT CT Gynecologic Cytology 1
According to The Bethesda System, which category is used for Pap test results that cannot be clearly classified as normal or abnormal?