Colpocytologic study - Causes, Symptoms and Treatment .MF .

August 12, 2017 17:52 | In Gynecology

method is based on a clearly pronounced effect of ovarian steroid hormones on target organs, which include the vaginal epithelium.As a result of the cyclical changes of the epithelium occur during menstruation (vaginal rings), characterized by varying degrees of maturation of epithelial cells.Vaginal walls separated by three types of cells: the parabasal - small, with a diameter of about 15-25 mm, with a circular core, originating from the bottom (germinal) layer, the intermediate - larger, with diameters of 25-30 microns and vesicular nucleus with a diameter of about 9um originating from a middle layer of vaginal epithelial cells and surface, the largest, with the diameter of about 6 microns, polygonal cells which may or vesicular or pyknotic nucleus (diameter less than 6 microns).In the latter case, the cells represent the maximum degree of maturation of vaginal epithelium, which is observed by increasing the body's estrogen saturation.

quantitative analysis of cells in a smear ratio and morphologica

l characteristics are the basis of hormonal cytodiagnosis.

for cytology material is obtained by aspiration or by gently touching tool to the side wall of the vagina (do not scrape the mucosa!) To smear should get only those cells which are readily separated from the vaginal mucosa.Taken material is transferred onto a glass slide, fixed and stained.For coloring increasingly using polychromatic method Schorr (or modification), which allows cells to differentiate eosinophilic (red) and basophilic (blue) and monochrome methods (H & E stain or hematoxylin and magenta).

Painted smear examined under a microscope and count the cells (200-300 cells better smear of the center).When counting the cells is determined by three indicators (the index).

1. IP (numeric index, maturity index) represents the percentage of the three types of epithelial cells - the parabasal, intermediate and superficial.Is written as three numbers from left to right: left shift means the appearance of parabasal cells, indicative of ovarian failure, shift to the right - increase the number of superficial cells, which indicates a high estrogen saturation of the organism.

2. CI - the percentage of superficial cells with nuclei pycnotic to the total number of cells in the smear.The higher the index, the higher the saturation estrogenic organism.

3. EI - the percentage of stained eosinophilic superficial cells to the total number of smear cells.Just as the CI indicator is estrogenic effects.Normally, EI always lower IQ, otherwise eosinophilia is non-hormonal origin.

addition to these indices into account congestion cytoplasm (for a three-point system), the location of the cells - the presence of seams or crowding index, representing the ratio of cells found in clusters of 5 or more cells positioned separately.These two indicators characterize the effects of progesterone.

smears may be signs of inflammatory changes, in which the endocrinological treatment impossible, and cytolysis, which are subjected to intermediate cells as a result of exposure Dederleyna sticks.

In the study of vaginal smears can be indirectly judged not only on the ratio of estrogen and progestogen in the body, but also on hyperandrogenism.Androgenic types of stroke are characterized by shifts IS left, and the emergence of a few larger than parabasal, round cells, clean background just smear pale coloring of the cytoplasm (androgenic atrophic smear).Most androgenic effects combined with estrogen, which is also manifested IC shift to the left, but less than that in the first case, a decrease in CI values ​​and EI, curved edges intermediate cells (reminiscent of boat-shaped in pregnancy) often cytolytic changes.

At impossibility of colpocytologic studies (inflammatory changes of the vaginal walls, heavy uterine bleeding) used urotsitogrammu.In this case, the smear is obtained from urine sediment obtained by centrifugation.Coloring and evaluation strokes are the same as and vaginal.

colpocytologic performance in normal menstrual cycle (M ± m),%

study time (cycle days)

IP

CI

EI

parabasal cells

Intermediate cells

Superficial cells

4-9

Unit in the preparation or missing

80,2 ± 7,9

19,9± 2,4

15,3 ± 2,1

10,6 ± 1,9

10-13

0

60 ± 6,7

40 + 4,1

30 ± 3,6

25,5 + 4

14-15-th (ovulation)

0

15± 2,1

85 + 9,3

80,7 + 9,3

75,4 + 6

16-20

0

60,5 ± 6,2

39,5 + 5,3

30,8 + 3,9

25,6 ± 4,7

21-27

0

80 ± 9,3

20 + .2.9

10,6 ± 2

8,8 ± 1,9