[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 (SurePath^TM) 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 ThinPrep^TM 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 Cytopathology	Review findings	Bx Negative	Bx HPV	Bx-CIN1	CIN2 & 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%0	112 (51%)
	HSIL cells with SAPK (59)	26 (12%)	1 (0.5%)	2 (1%)	30 (13.5%)
	SAPK only (0)	0	0	0	0

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