23 yr old female with regular menstrual cycles. Cervix hypertrophied , discharge present Diagnosis ?



Respected madam, Thanks for posting the slides, PAP FINDINGS : 2014 BETHESDA SYSTEM FOR REPORTING CERVICAL CYTOLOGY 1. Nature of specimen : Conventional Pap smear. 2. Specimen adequacy : Satisfactory for evaluation. Endocervical and transformation zone components present. 3. General categorization and description : a) Normal Components : Intermediate squamous cells seen. b) Back Ground : Mild neutrophilic inflammatory infiltrates. c) Reactive Changes : Nil. d) Epithelial Cell Abnormality : Few of the intermediate squamous cells show mild nuclear changes which include nucleomegaly with koilocytosis, increase in NC ratio, hyperchromasia and irregularity of nuclei membrane. Occasional to few metaplastic squamous cells exhibit nucleomegaly, high NC ratio, hyperchromasia & irregularity of nuclear membrane. INTERPRETATION/ RESULT : HIGH GRADE SQUAMOUS INTRAEPITHELIAL LESION (HSIL). Suggestion: Advised colposcopic biopsy for confirmation before institution of any radical surgical procedure. Please note : 1] In the event of finding of occasional to few cells with HSIL changes the impression has been given as HSIL, although there are many cells in the background showing features of LSIL. 2] The opinion given is based on the quality of the slides provided and can never replace the original microscopic findings. Thanks madam, Best regards.

Great explaination as always.

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Revered madam, thanks for your reply. If apologize to state my opinion again. After repeated and careful observations, i have pondered to the following points : 1. Endocervical clusters appreciated in all the 7 slides show typical honey comb pattern, with the nuclei appearing bland and cytoplasm abundant. The cell pointed by you among the cluster appears more likely to be "benign" and is a lone cell that might be showing slightly enlarged nucleus but is bland. 2. The koilocytes seen in the smears are pathological and are a part of LSIL. 3. If you carefully see few scattered cells slide 2,3,4,5 they appear to be showing features of HSIL in immature squamous metaplastic cells. 4. Lines exactly picked from a highly valued referenced source : "Koilocytes are considered as a feature of LSIL in TBS (Nayar & Solomon 2004; Wilburet al. 2015) and the UK system (Dentonet al.2008) since the distinction between HPV infection and CIN1 cannot be made reproducibly. Koilocytes are most often seen with LSIL but may also be seen in HSIL". This is my professional opinion. Thank you very much madam. Comments are welcome from all the fraternity. Best regards.

smear is adequately cellular,shows superficial,intermediate squamous cells and endocervical cells are also seen.few epithelial cells show koilocytic change,hyperchromatic nucleus,nuclear enlargement with irregular nuclear margins.Neutrophils are also seen in b/g,-features are suggestive of LSIL

low grade squamous intraepithelial lesion. smear is satisfactory for evaluation of epithelial cells. transformation zone component is present. epithelial cell abnormality:L-SIL.

madam what is final opinion

Moderate to severe dysplatic changes . atplaces reactive changes and koilocytic changes. F//S/O. HSL Colposcopic biopsy for further evaluation.

correction.Intraepithelial Hsil.

Intraepithelial neoplasia Hail Thank you

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