Cytology Quik-Pics: #1-Low grade squamous intraepithelial lesion (LSIL)

Low grade squamous intraepithelial lesion (LSIL): 

LSIL: Koilocytes-"koilocytotic atypia"

Sample Type: Liquid-based preparation: SurePath™

TBS Category: Epithelial Cell Abnormality

Interpretation: Low grade squamous intraepithelial lesion (LSIL)

Encompasses: HPV/mild dysplasia/CIN 1

Cytologic Criteria:

1. koilocytes-hallmark of HPV cytopathic effect, perinuclear cytoplasmic halo; single cells or sheets of dysplastic cells, with or without koilocytotic atypia. Dense peripheral rim of cytoplasm borders optically clear, perinuclear halo.
2. nuclear enlargement 4-6x the size of a normal intermediate cell nucleus
3. nuclear hyperchromasia
4. irregular nuclear membranes
5. frequent binucleation or multinucleation
6. finely granular, evenly distributed chromatin; infrequent nucleoli
7. occasionally, the nuclei are degenerated and pyknotic, with “raisinoid” changes

Cytology Quik-Pics: #1 Quiz

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Question 1

The nomenclature system utilized that uses the term LSIL is The Bethesda System. True or False.

A	True.
B	False.

Question 1 Explanation: 

The Bethesda System (TBS) for reporting of cervical-vaginal cytology was initially developed by the NCI in 1988, with revisions in 1991 and 2001.

Question 2

Select from the options below, the term best used to describe a cell with nuclear enlargement, perinuclear halos with a dense rim of bordering cytoplasm.

Cytology Quik-Pics: #1 Quiz

A	Dysplastic cell
B	Pyknotic cell
C	Koilocyte
D	Dyskeratotic cell

Question 2 Explanation: 

A koilocyte is the hallmark for HPV cytopathic effect.

Question 3

The nuclear changes seen in LSIL on conventional compared to liquid-based cytology (LBC) are:

A	identical regardless of the methodology used.
B	completely different.
C	the same for all LBC preps, but different for conventional smears.
D	essentially the same, although LBC preps, may show normochromic or hypochromic nuclear features.

Question 3 Explanation: 

These changes are perhaps more often noticed on SurePathTM samples.

Question 4

An interpretation of LSIL also encompasses HPV, mild dysplasia and CIN 2. True or False.

A	True
B	False

Question 4 Explanation: 

Didn't fool you!

Question 5

Cytologic criteria for LSIL include all of the following except:

A	nuclear enlargement 2-3x the size of a normal intermediate cell nucleus
B	finely granular, evenly distributed chromatin; infrequent nucleoli
C	occasionally, the nuclei are degenerated and pyknotic, with "raisinoid" changes
D	frequent binucleation or multinucleation

Question 5 Explanation: 

The nuclear enlargement is 4-6x the size of a normal intermediate cell nucleus.

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