Cell Abnormality in Pap Smear in Women with Postmenopausal Bleeding

ASKAR, GHADA; SAFE EL DEEN, FATMA EL ZAHRAA; Salah ElDeen, Eman; ABD EL GAFFAR, HAZEM

doi:10.21608/smj.2017.40058

Cell Abnormality in Pap Smear in Women with Postmenopausal Bleeding

Document Type : Original Article

Authors

¹ Department of pathology, Faculty of Medicine, Sohag University.

² Department of Gynecology and Obstetrics Faculty of Medicine, Sohag University.

10.21608/smj.2017.40058

Abstract

Cancer cervix is a preventable and curable disease due to effective screening methods. Uterine cervix is ideal for screening due to easy accessibility for inspection, palpation and exfoliative cytology. The Pap smear is a screening test for cervical cancer, and with appropriate follow-up it can reduce cervical cancer incidence by up to 80%. This study includes fifty peri and postmenopausal women, cervical smears were taken in the Out-patient Clinic of Gynecology and Obestetrics Department and Pap stain was used for each sample, and the criteria of Bethesda (2014) was used for the diagnosis of each case. Bleeding was the main complaint in 92% patient and the remaining 8% complained from vaginal discharge and itching. Thirty nine patients were negative for intraepithelial lesion or malignancy (non-neoplastic), eight showed neoplastic changes, and 3 samples were insufficient for cytological interpretation. Two out of the 8 cases showed neoplastic lesions were atypical squamous cells of undetermined significance (ASCUS), two diagnosed as atypical squamous cells cannot exclude HSIL (ASC-H), 3 were high grade squamous intraepithelial lesions (HSIL) and one cases had features of squamous cell carcinoma (SCC). Six out of 39 samples showed only pure atrophy, three showed follicular cervicitis, three had features suggestive of Tichomonas vaginalis infection, one diagnosed as HSV infection, one showed bacterial vaginosis and eleven cases showed nonspecific inflammation. Non-neoplastic cases included also six cases showed metaplastic changes and eight had normal cytological findings. Conclusion: cervical smears is important in early detection of cervical carcinoma and its precursors in Sohag community as an easy, costless, accessible, and reliable manner and Bethesda system (2014) is beneficial for accurate diagnosis.

References

Abdel-Hadi M, Khalaf A, Aboulkassem H, Naeem N, Abdel Baqy M, Sallam H (2015). Cervical intraepithelial lesions in females attending Women's Health Clinics in Alexandria, Egypt. CytoJournal; 12:13.
Ahlgren M, Ingemarsson I, Lindberg L, Nordqvist M, Mordqvist S (1975). Conization as treatment of carcinoma in situ of the uterine cervix. Obstet Gynecol; 46:135-140.
Arbyn M, Anttila A, Jordan J, Ronco G, Schenck U, Segnan N, Wiener H, Herbert A, von Karsa L (2010). "European Guidelines for Quality Assurance in Cervical Cancer Screening. Second Edition Summary Document". Annals of Oncology; 21: 448-458.
Bal MS, Goyal R, Suri AK, Mohi MK (2012). Detection of abnormal cervical cytology in Papanicolaou smears. J Cytol; 29: 45-47.
Banik U, Bhattacharjee P, Ahamad S.U, Rahman Z (2011). Pattern of epithelial cell abnormality in Pap smear: A clinic-pathological and demographic correlation. Cytojournal; 8: 8.
Bukhari MH, Saba K, Qamar S, Majeed MM, Niazi S, Naeem S (2012). Clinico-pathological importance of Papanicolaou smears for the diagnosis of premalignant and malignant lesions of the cervix. J Cytol; 29: 20-25.
Chivukula M. and Shidham V.B (2006). ASC-H in Pap test definitive categorization of cytomorphological spectrum. CytoJournal; 3: 14.
Clark S.B. and Dawson A.E. (2002). Invasive SCC in Thin Prep Specimens: Diagnostic Clues in the Cellular Pattern. Diagn. Cytopathol; 26: 1-4.
Collaço L.M and Zardo L (2008). Cytological Screening Programs. In: Comprehensive Cyopathology, third edition, Elsevier, China, p. 47-57.
DeMay M. (2007). Practical principles of cytopathology. Revised edition. Chicago, IL: American Society for Clinical Pathology Press.
Ferlay J, Soerjomataram I, Ervik M, et al. GLOBOCAN (2012), Cancer Incidence and Mortality Worldwide: IARC Cancer Base No. 11. Lyon, France: International Agency for Research on Cancer; 2013. Available from: http://globocan.iarc.fr(link is external), accessed December2013.
Gupta K, Malik NP, Sharma VK, Verma N, Gupta A (2013). Prevalence of cervical dysplasia in western Uttar Pradesh. J Cytol; 30: 257-262.
Howell L.P, Gurusinghe S, Tabnak F (2009). Impact of ASC-H terminology on the detection of HSILs in medically underserved California women. Diagn. Cytopathol; 37: 103-110.
ICO Information Centre on HPV and Cancer (2016). Egypt: Human Papillomavirus and Related Cancers, Fact Sheet (October 7, 2016).http://www.hpvcentre.net/statistics/reports/EGY_FS.pdf.
Kalir T, Simsir A, Demopoulos HB, Demopoulos RI (2005). Obstacles to the early detection of endocervical adenocarcinoma. Int J Gynecol Pathol; 24: 399-403.
Kaur J, Dey P, Saha S.C, Rajwanshi A, (2010). Cervical cytology in patients with postmenopausal bleeding. Diagn. Cytopathol; 38: 496-498.
Leung KM, Chan WY, Hui PK (1994). Invasive SCC and cervical intra-epithelial neoplasia III of the uterine cervix. Morphologic differences other than stromal invasion. Am J Clin Pathol; 101: 508-513.
McGrath CM (2002). ASCUS in Papanicolaou smears: problems, controversies, and potential future directions. Am J Clin Pathol; 11: 62-75.
Moss SF and Blaser MJ (2005). Mechanisms of Disease: Inflammation and origins of cancer. Nat Clin Pract Oncol; 2: 907.
Nayar R, Wilbur DC (2015). The Bethesda System for Reporting Cervical Cytology: Definitions, Criteria, and Explanatory Notes, ed 3. New York, Springer.
Pak S.C, Martens M, Bekkers R, Crandon A.J. (2007). Pap smear screening history of women with SCC and adenocarcinoma of the cervix. Australian and New Zealand Journal of Obstetrics and Gynaecology; 47: 504-507.
Rinku S, Vijayalakshmi B, Anupama J, Poonam C (2007). A prospective study of 86 cases of ASCUS over two years. J Obstet Gynecol India; 57:73.
Saad R.S., Kanbour-Shakir A, Lu E, Modery J and Kanbour A (2006). Cyto-morphological Analysis and Histological Correlation of HSIL in Postmenopausal Women. Diagn. Cytopathol; 34: 467-471.
Verma I, Jain V, Kaur T (2014). Bethesda System for Cervical Cytology in Unhealthy Cervix. Jcdr; 8: 26-30.
Williams ML, Rimm DL, Pedigo MA et al., (1997). ASCUS: correlative histological and follow up studies from an academic medical center. Diagn Cytopathol; 16: 1-7.