Abnormal Pap and Cervical Dysplasia

Condyloma acuminatum of the penis. Raised, circumscribed, cauliflower-like lesions are seen on the shaft of the penis.

Normal cervical Papanicolaou (Pap) smear. Large squamous cells from the superficial, and intermediate layers of the epithelium are illustrated. The cells have abundant cytoplasm, which varies in staining from pink to blue. The nuclei are small, and the nuclear-cytoplasmic ratio is low. The most superficial cells have pyknotic nuclei (arrows).

FIG. 3.85. Recurrent cervical carcinoma with vesicovaginal fistula. Fat-suppressed, gadolinium-enhanced T1-weighted image of pelvis demonstrates enhancing infiltrating pelvic tumor (<italic>arrow</bold>) and wide communication between bladder and vagina (<italic>arrowhead</bold>) allowing passage of high signal intensity gadolinium.

FIGURE 28.50. Trichomonas vaginalis in urine. Note the flagella and the spherical character of this parasite. These organisms are easily misdiagnosed as white blood cells. (Bright-field microscopy, 3400.)

<bold>Figure 6.2 Condyloma acuminatum.</bold> Squamous epithelium with spikelike projections and koilocytosis (perinuclear halo, nuclear enlargement, and hyperchromasia).

<bold>Figure 6.3 Mild squamous dysplasia and condyloma.</bold> The dysplastic changes are confined to the lower third of the epithelium, and the upper portion shows koilocytosis (condyloma).

<bold>Figure 6.15 Atypical squamous cells of undetermined significance (ASC-US).</bold> This Pap smear shows superficial-type squamous cells with mild nuclear enlargement and hyperchromasia. These features are suggestive but not diagnostic of a low-grade squamous intraepithelial lesion.

<bold>Figure 6.16 Low-grade squamous intraepithelial lesion (Pap smear).</bold> These lesions show mildly dysplastic squamous cells with nuclear enlargement, hyperchromasia, and irregular nuclear contours that are more pronounced than in Figure 6.15.

<bold>Figure 6.17 High-grade squamous intraepithelial lesion (Pap smear).</bold> The dysplastic cells seen in the center show a high nuclear-to-cytoplasmic ratio.

<bold>Figure 6.18 High-grade squamous intraepithelial lesion (Pap smear).</bold> A cluster of overlapping, markedly dysplastic cells forms a sheet. Note single, severely dysplastic cells.

<bold>Figure 6.25 Warty vulvar intraepithelial neoplasia.</bold> This lesion is characterized by a condylomatous-appearing squamous epithelium with full-thickness epithelial atypia.

Strawberry cervix associated with trichomoniasis.

<bold><italic>Figure 3.4.</bold></bold> Condyloma acuminata of the vulva. Note the exophytic, cauliflower-like papule located on the labia majora, labia minora, vaginal introitus and fourchette. Due to human papilloma virus infection.

<bold>Figure 28.6.</bold> Condyloma acuminata.

Pap smear 1. Close up view of cross section of upper vagina and cervix with applicator inserted into the endocervical canal. Arrows indicate a clockwise rotation to obtain sample.

Pap smear 2. Close up view of cross section of upper vagina and cervix with wooden or plastic spatula pressed against cervix, longer end introduced slightly into os. Arrow indicates rotation to obtain ectocervical sample.

<bold><italic>Figure 21-12</bold> Pap smears. A:</bold> Normal. Large, flat cells with small nuclei. <bold>B:</bold> Dysplasia. Large, dark nuclei indicate damaged DNA; cytoplasmic halo indicates human papillomavirus (HPV) effect. <bold>C:</bold> Malignant. Compact cells with huge, irregular, dark nuclei indicate malignancy.

<bold><italic>Figure 6-16</bold> Pap smear of the cervix.</bold> Many normal cells are present, which have small, uniform nuclei. Also present are clumps of malignant cells, which have large, dark nuclei.

Figure 28.6. Condyloma acuminata.

Spectrum of cervical intraepithelial neoplasia (CIN) in cervical smears. (A) CIN grade I (mild dysplasia). The dysplastic cell (arrow) has abundant cytoplasm. The nucleus is enlarged and hyperchromatic. The chromatin is evenly dispersed, and a nucleolus is not evident. Compare this cell with the other two normal squamous cells. (B) CIN grade II (moderate dysplasia). The dysplastic cells (center) are more numerous and have a higher nuclear-to-cytoplasmic ratio than do mildly dysplastic cells...

Spectrum of cervical intraepithelial neoplasia (CIN) in cervical smears. (C) CIN grade III (severe dysplasia/carcinoma in situ). Multiple dysplastic squamous cells with scant cytoplasm and very high nuclear-cytoplasmic ratios are seen. Note the normal superficial squamous cell (arrow).

Spectrum of cervical intraepithelial neoplasia (CIN) in cervical smears. (A) CIN grade I (mild dysplasia). The dysplastic cell (arrow) has abundant cytoplasm. The nucleus is enlarged and hyperchromatic. The chromatin is evenly dispersed, and a nucleolus is not evident. Compare this cell with the other two normal squamous cells. (B) CIN grade II (moderate dysplasia). The dysplastic cells (center) are more numerous and have a higher nuclear-to-cytoplasmic ratio than do mildly dysplastic cells...

Genital warts (condyloma acuminatum).

Large condylomata of the penis