citologia cervico-vaginală
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Citologie şi Histologie practică
Citologia cervico-vaginalăFrotiu normal, atrofic, metaplazic,
inflamatorLP 2
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• Produc o mare variabilitate nucleară şi citoplasmatică
• Aspectele citologice:– Prezenţa exudatului inflamator– Modificări degenerative ale
nucleilor celulelor epiteliale– Modificări degenerative ale
citoplasmelor celulelor epiteliale• Citologia este dominată de
exudatul inflamator:– Numeroase granulocite neutrofile– Histiomacrofage– Uneori: fibrină şi hematii– Modificări nucleare
• Anizonucleoză• Hipercromazie• Kariorexis, kariopicnoză
– Vacuolizări citoplasmatice, vacuolizare perinucleară
– Citoliză, necroze celulare
Citologia cervico-vaginală - inflamaţiile acute -
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• Infiltrat inflamator:– Limfocite– Plasmocite– Macrofage (adesea
multinucleate)
• Metaplazie scuamosă• Parakeratoză,
hiperkeratoză• Daca pe frotiu se
identifică prezenţa atât a infiltratului acut cât şi a celui cronic, atunci inflamaţia se numeşte: inflamaţie cronică activă
Citologia cervico-vaginală - inflamaţiile cronice -
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Citologia cervico-vaginală - infecţia cu HPV -
• HPV: un grup heterogen de viruşi (ADN virus)care cauzează o varietate de leziuni la nivelul epiteliului scuamos
• Modificări specifice – koilocitoza:– Nucleu hipercrom, contur
neregulat– Halou perinuclear (citoplasmă fără
glicogen, PAS -)– Membrană citoplasmatică
îngroşată• Citologic:
– Celule cu zonă perinucleară clară– Condensare citoplasmatică la
periferie– Binucleere sau multinucleere– Anizonucleoză– Prezente celule parakeratotice
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Falsă koilocitoză
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• Parazit din clasa Flagellata• Boală cu transmitere sexuală
– uneori şi pe alte căi• Prezentă la ambele sexe• Până la 20% dintre femei• Simptomatologie:
– scurgere galben-verzuie (spumoasă) urăt mirositoare,
– prurit– dureri la contact sexual
(dispareunie)– poate fi demonstrată şi în absenţa
simptomatologiei clinice• Pe frotiu:
– frotiul este de aspect “murdar”– parazitul are aspect piriform– citoplasma albastră-cenuşie– nucleu alungit
Citologia cervico-vaginală - infecţia cu Trichomonas -
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• Infecţie micotică (fungi)• Este prezent adesea în flora
vaginală normală, în proporţie redusă
• Infecţiile prezente la – persoanele gravide– secundar utilizării contraceptivelor– după tratamente cu antibiotice– diabet– apare ca urmare a creşterii pH-
ului vaginal (pH 5-7)• Simptomatologie: prurit, arsură,
dureri la raporturi sexuale• Pe frotiu:
– sub formă de filamente, uneori ramificate
– sporii: ovali, de dimensiuni mici
Citologia cervico-vaginală - infecţia cu Candida albicans -
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• Bacili de dimensiuni mici (Gardnerela vaginalis).
• Simptomatologie– infecţie uşoară – netratată poate persista ani de
zile!– secreţie cenuşie urât
mirositoare– prurit în 12% din cazuri– foarte sensibili la metronidazol
• Pe frotiu:– Infecţia este suspectată dacă
sunt numeroşi bacili; un număr mic nu indică infecţie
– aderă de celulele epiteliale (clue cells), aspect prăfos, murdar
– granulocite neutrofile puţine– dezvoltarea maximă la pH 5,5
Citologia cervico-vaginală - infecţia cu Haemophilus -
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