THE ART OF CYTOLOGY
by Suzanne L. Adams, CT (ASCP)
cytotechnologist and artist

Dedicated to Education and Research in Nutrition and Disease Prevention

Cytopathology Illustrations:

EXOGENOUS HORMONE EFFECT
(cervical Pap sample)

(color pencil illustration by Suzanne L. Adams, CT(ASCP), copyright)

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GENERAL DISCUSSION
   Exogenous hormones (contraceptive hormones, HRT, ERT) may effect the cervical epithelium of various individuals.  Doses with high levels of progesterone may limit maturation of squamous epithelium to the parabasal level (eg: Depo-Provera).  Pregnancy and post-partum may produce similar cell changes. Sometimes these cell changes may appear as dysplasia or glandular hyperplasia (Ljusa D, 2000, Valente PT, 1998, see also ASCP Tech Sample CY-5, 1997).  These worrisome changes (BCC, ASC-US or AGS) have been associated with hypomethylation of DNA within the nuclei of cells due to B vitamin deficiency, especially folic acid, and have been known to disappear or improve when these nutrients are increased or hormones are discontinued.  Antioxidant vitamin deficiencies may cause similar cell changes to those of folic acid deficiency (Li X, 1995, Harper JM, 1994, Ciavatti M, 1991,  Butterworth, 1982). 
         Starting in the 1960's significant use of and exposure to synthetic steroid hormones (estrogen and progesterone) began in women of developed countries starting with DES in-utero exposure, then birth control pills, and finally hormone replacement therapy. Various estrogen and/or progesterone combinations were also given to many of these women to stop lactation after child birth (estrogen) and for ovarian and menstrual disorders (The Pill). 

CYTOLOGICAL FEATURES

ENDOCERVICAL CELLS
*Enlarged nuclei exhibiting hypochromasia
*Some groups may appear reparative
*Occasionally worrisome nuclear hyperchromasia with slight crowding
*Bi or multinucleation
*Pseudoparakeratosis (degenerate endocervical cells in streaks of mucous)
*Hypersecretory appearing with distended vacuoles

SQUAMOUS CELLS
*May see predominant intermediate or parabasal cell pattern
*Parabasal cells with Arias-Stella or decidual-like appearance
*Navicular cells with glycogen

OTHER FEATURES
*Occasional “cockleburr” (radiating crystalline formation surrounded by histiocytes)

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The Art of Cytology:
With Micronutrient Discussions


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Oral Contraceptives and Abnormal Cervical Cytology
 


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Copyright, Suzanne Adams, 2007
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