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.
|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|