[376] Cyanophilic Small Atypical Parakeratotic Cells in ThinPrep Cervical Cytology: A Pitfall Leading to HSIL or ASC-H Misinterpretation.

Tamar Giorgadze, Joseph Thompson, Inderpreet Dhillon, Pamela Archuletta, Lili Geng, Sudeshna Bandyophadhyay, Jining Feng, Shashi Madan, Dongping Shi, Paul Tranhida, Seema Sethi, Muhammad Faisal, Vinod B Shidham. Wayne State University Hospitals & Karmanos Cancer Institute, Detroit, MI

Background: We previously reported significance of small atypical parakeratotic (SAPK) cells in liquid-based cytology (SurePathTM) smears. A subset of SAPK cells may be misinterpreted as HSIL or as “Atypical squamous cells, rule out high grade squamous intraepithleial lesion (ASC-H)”. However, follow-up biopsies reveal frequent association with negative results or cytopathic effect of Human Papilloma Virus (HPV) without dysplasia. The goal of this study is to evaluate SAPK cells [both orangeophilic (SAPK-O) and cyanophilic (SAPK-C)] in ThinPrepTM smears (TP) with follow-up biopsy specimens.
Design: Out of 89138 TP (during the year 2009), 45 ASC-H and 242 HSIL cases with availability of follow-up biopsies were included.
TP were studied for association with SAPK cells. SAPK cells showed: a. Relatively cohesive hyperchromatic crowded groups of small parakeratotic cells with atypical nuclei (vs non-cohesive checker board pattern in CIN2); b. Recognizable intercellular cytoplasmic borders (vs syncitial pattern in CIN3); c. Cyanophilic cytoplasm with slightly angulated and sharp straight peripheral margins (with variable focal acido-orangeophilia); d. High N/C ratio with ill-defined spaces around nuclei reminiscent of koilocyte.
Results: The correlation of biopsy results with cytopathologic findings is shown in table 1. Out of 16 SAPK with or without ASC-H, 9 revealed SAPK-C, 4 SAPK-O, and 3-both SAPK-O and SAPK-C.

Correlation of cytopathology findings with biopsy results
Initial CytopathologyReview findingsBx NegativeBx HPVBx-CIN1CIN2 & above
ASC-H (54)ASC-H cells only (38)21 (38%)1 (2%)8 (15%)8 (15%)
 ASC-H cells with SAPK (10)3 (6%)0 (0%)0 (0%)7 (13%)
 SAPK only (6)4 (7%)1 (2%)1 (2%)0 (0%)
HSIL (218)HSIL cells only (159)26 (12%)0 (0%)21 (10%0112 (51%)
 HSIL cells with SAPK (59)26 (12%)1 (0.5%)2 (1%)30 (13.5%)
 SAPK only (0)0000
Bx, Biopsy; SAPK, small atypical parakeratotic cells

Conclusions: Study demonstrated that SAPK cells are also pitfall in TP with tendency for ASC-H and even HSIL interpretation. This is more often with completely cyanophilic SAPK cells. Familiarity with the cytomorphologic spectrum of SAPK cells may prevent their potential misinterpretation as HSIL or ASC-H cells.
Category: Cytopathology

Tuesday, March 1, 2011 1:30 PM

Platform Session: Section D, Tuesday Afternoon


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