Australian Society of Cytology

CEC Resources

Normal and Benign Cervical Cytopathology

Deborah Reich BSc MEd CTASC CTIAC
Dorevitch Pathology
Melbourne, Victoria
and
Gabriele Medley AM MBBS FRCPA FIAC
and
Grant King BSc CTASC CFIAC
Institute of Medical and Veterinary Science
Adelaide, South Australia

A sample chapter from this CD-ROM

Non Cellular Components and Artefacts

Cockleburrs Crystals
Psammoma body
Inspissated mucus
Mucus spirals
Ferning effect
Feacal contamination
Alternaria
Mould
Dust mite and carpet beetle
Pollen Grains
Starch crystals
Suture material
Lubricant
Cornflake artefact
Formalin effect
Air drying

This section has been included to help identify some of the more commonly occurring non-cellular components and artefacts that are encountered when screening cervical smears.

Cockleburrs Crystals are radiate arrays of crystalline material often surrounded by macrophages. They consist of thick club-like spokes. Whilst not common, if present they are more likely to be seen in smears from pregnant women. Their presence has no significance. They should not be confused with haematoidin crystals which have much finer crystalline rays, or ‘sulphur granules’ associated with Actinomyces (De May, 1999).

Psammoma Bodies are considered to be formed from single degenerate cells that become encrusted with mineral deposits, predominantly calcium and small amounts of iron, magnesium and other salts. The laminations observed are due to the progressive deposition of salts (Cotran, 1995) Psammoma bodies are infrequently found in cervical smears. Their presence is associated with both benign and malignant conditions. Main benign conditions include IUCD, endosalpingosis, tuberculous endometritis and benign endometrial and ovarian lesions. The most common malignant association is with serous papillary carcinoma of the ovary or peritoneum and endometrial malignancies. (De May, 1995)

Inspissated mucus “Blue blobs” are commonly seen in postmenopausal smears. Some authors consider these ‘blobs” to be inspissated mucus, whilst others favour degenerate parabasal squamous cells. These ‘blobs’ are about the size of parabasal cells, stain with haematoxylin, appear rather amorphous and usually have a darker staining central core (Gray, 2003). It is important not to confuse these ‘blobs” with undifferentiated malignant cells.

Mucus spirals (Curschmann's spirals) can occasionally be seen in cervical smears. They are identical with those seen in sputum. Their formation is related to an intrinsic property of endocervical mucus ( De May, 1996).

Ferning effect refers to the fern like pattern of endocervical mucus which may be seen near the time of ovulation.

Faecal contamination may be due to poor hygiene. However a more significant cause that should be considered is the presence of a recto-vaginal fistul

Alternaria is a fungus. It is an aerial contaminant and generally floats onto the slide at the time of collection or processing.

Mould may be identified on smears. It is an aerial or water-borne contaminant and is usually seen above the focal plane of the cells in the smear. These fungi have true segmented , branching hyphae not the pseudohyphae of yeast as seen in Candida.

Dust Mite and Carpet beetle are contaminants which may have been introduced by tampons, cotton applicators or the old style cardboard slide mailers.

Pollen Grains are an aerial contaminant. They generally present with a thick refractile cell wall.

Diatoms are a water borne contaminant. The observed structures are the cell walls, made of silica, of unicellular algae.

Starch crystals in a cervical smear are due to contamination from the practitioner's gloves. If crystals are abundant cellular material may be obscured. When polarised a characteristic maltese-cross birefringence is observed.

Suture material can be seen in cervical smears following a surgical procedure.

Lubricant is a globular purple staining material which may obscure cellular material. Clinicians are advised not to use lubricant when inserting a speculum.

"Cornflake artefact" - this brown artefact is thought to occur when there is a delay between removing the slides from the last xylene and applying the mounting media. Gill considers the brown artefact to be air trapped within the surface grooves of mature squamous cells (Gill, 2000).

Formalin effect results from contamination with formalin in histopathology specimens being transported with the cervical smears. The formalin causes lack of chromatin detail and alteration of cytoplasmic staining when subsequently stained by Papanicolaou stain. This can be corrected by using the method detailed here.

Air drying of cells before fixation results in increased cell and nuclear size with loss of chromatin detail.