ThinPrep® Pap Test Diagnostic Challenges and Differential

1. ThinPrep® Pap Test Diagnostic Challenges and Differential Diagnoses

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2.

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3. ThinPrep® Characteristics

• Wet Fixation
– enhanced cytoplasmic and nuclear detail
– variability in nuclear staining
• Cell Size
– proportionately smaller
– single cells more prominent
– cells may round up in solution e.g.. adenocarcinoma
• Smear Pattern
– Cellular material not pulled out in mucous
– Mechanical artifacts eliminated
• Specimen Background
– Cellular debris may appear clumped
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4. Differential Diagnoses

• Endocervical Adenocarcinoma vs. Poorly Differentiated Squamous
Cell Carcinoma (SCC)
• Endocervical Adenocarcinoma vs. Endometrial Adenocarcinoma
• Endometrial Adenocarcinoma vs. Small Cell Squamous Carcinoma
• Adenocarcinoma-in-situ vs. Tubal Metaplasia
• HSIL vs. Single Endometrial Cells
• HSIL vs. Immature Squamous Metaplasia
• Poorly Differentiated Squamous Cell Carcinoma vs. Repair
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5. Poorly Differentiated Squamous Cell Carcinoma vs. Endocervical Adenocarcinoma

Poorly Differentiated SCC
Endocervical Adenocarcinoma
• 2D sheets and single cells
• Ragged group edges
• Dense, homogenous
cytoplasm
• Pleomorphism, irregular
nuclear shapes and sizes
• Irregular chromatin clumping
• Nucleoli variable in shape,
size, number and position
3D cell groupings
Common group borders
Delicate, foamy cytoplasm
Enlarged nuclei, commonly
round/oval
• Parachromatin clearing
• Round, central, single or multiple
macronucleoli
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6.

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7.

20x
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8.

40x
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9.

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10.

60x
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11.

60x
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12.

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13.

60x
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14. Endocervical Adenocarcinoma vs. Endometrial Adenocarcinoma

Endocervical Adenocarcinoma
Endometrial Adenocarcinoma
• Abundant abnormal material
– directly scraped
• Well preserved material
• Cells and cell groupings generally
larger in size
• Abundant, foamy cytoplasm,
occasionally columnar shaped
• AIS precursor with endocervical
architecture may be seen
• Isolated abnormal groups
– cell shedding
• Variable preservation of cells
• Cells and cell groupings generally
smaller in size
• Scant, cyanophilic cytoplasm with
occasional conspicuous vacuoles
• Mature hormonal pattern, watery
transudate may be seen
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15.

20x
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16.

60x
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17.

40x
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18.

60x
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19.

40x
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20.

60x
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21.

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22.

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23.

60x
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24.

40x
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25. Endometrial Adenocarcinoma vs. Small Cell SCC

Endometrial Adenocarcinoma
Small Cell SCC
Isolated abnormal groups
cell shedding
Occasional clusters, fewer single cells
Scant, vacuolated cytoplasm
Eccentrically located nuclei
Parachromatin clearing
Round, central, single or multiple
macronucleoli
Abundant abnormal material
directly scraped
++ Single cells, clusters
Dense, homogenous cytoplasm
Centrally located nuclei
Irregular chromatin clumping
Prominent, irregular nucleoli
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26.

40x
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27.

40x
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28.

60x
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29.

40x
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30.

40x
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31.

20x
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32. Adenocarcinoma In Situ vs. Tubal Metaplasia

Adenocarcinoma In Situ
Tubal Metaplasia
Cilia and/or terminal bars reliably
identified
Crowding without overlap, lacking depth
of focus
Evenly distributed chromatin
Cytoplasm dense and cuboidal
Nucleoli absent
Nuclear membrane irregularities and
thickening absent
Occasional elongate nuclear forms
Crowded sheets & strips
Feathering & pseudostratification
Relative hyperchromasia
Uniformly stippled chromatin
Nuclear size and shape variation
Block-like nucleoli
Mitoses and apoptotic bodies
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33.

40x
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34.

40x
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35.

40x
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36.

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37.

60x
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38.

40x
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39.

40x
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40.

40x
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41.

40x
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42.

40x
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43. HSIL vs. Endometrial Cells

HSIL
Endometrial Cells
Sheets, syncitia; thick plaques rather
than 3D ball-like clusters
Hyperchromasia
Irregular nuclear membranes
Single cells have centrally located
nuclei
Dense homogenous cytoplasm
3D ball-like clusters and small, single
cells
Relative hyperchromasia
Regular nuclear membranes
Single cells with eccentrically located
nuclei
Scant basophilic cytoplasm with
cytoplasmic “blebs”
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44.

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45.

40x
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46.

40x
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47.

40x
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48.

40x
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49.

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50.

40x
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51. HSIL vs. Immature Squamous Metaplasia

HSIL
Immature Squamous Metaplasia
Single cells, clusters, and thickened
plaques
Variable hyperchromasia
Irregular nuclear membranes
Coarse clumped chromatin
Variation in nuclear size within a cluster
Single cells & cobblestone sheets
Normochromatic
Regular nuclear membranes
Evenly distributed chromatin with
pinpoint chromocenters
Nuclear size & shape consistent
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52.

60x
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53.

40x
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54.

40x
40x
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55.

40x
40x
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56.

40x
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57.

40x
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58. Repair vs. Poorly Differentiated SCC

Repair (typical)
Poorly Differentiated SCC
Poorly cohesive sheets and single cells
Cohesive sheets
Irregular nuclear shapes & sizes
Significant nuclear size variation but
Thickened nuclear membranes
typically round/oval in shape
Irregular chromatin clumping
Nucleoli variable in shape, size, number
Thin, well defined nuclear membranes
and position
More open chromatin pattern with minimal
Some nuclei display nucleoli, some nuclei
variability
do not
Centrally located macronucleoli with
smooth, round contours
Virtually all nuclei display nucleoli
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59.

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60.

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61.

40x
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62.

40x
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63.

40x
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64.

60x
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65. Trademark Statement

CytoLyt, Hologic, PreservCyt, ThinPrep, and
UroCyte are registered trademarks of
Hologic, Inc. and/or its subsidiaries in the
United States. CytoLyt, Hologic, PreservCyt,
ThinPrep, UroCyte and associated logos are
trademarks of Hologic, Inc. and/or its
subsidiaries in other countries.
All other trademarks are the property of their
respective owners.
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66. Any Questions?

Part No. 86798-001 Rev. 001
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