Mild leukocyte infiltration in the smear. Leukocyte infiltration of the cervix

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If a leukocyte infiltration of the cervix is ​​found in the smear taken by the obstetrician-gynecologist, then this is a sign of pathology. It manifests itself, as a rule, with vaginitis and inflammation of the cervical canal.

What is leukocyte infiltration of the cervix?

A condition when there are a large number of leukocytes in the tissues is called leukocyte infiltration of the cervix. They are usually present when there is an inflammatory process. It is characteristic of vaginitis and cervicitis.

How to detect the state?

You can learn about the pathology after the results of a vaginal smear or from the cervix. It is taken with a Volkmann spoon.

A gynecologist examines a woman in a gynecological chair, introduces special mirrors. It is at this moment that the material is collected. After the results are sent to the laboratory, where they will determine whether there is a pathology.

To clarify the diagnosis, the doctor has the right to give a referral for liquid cytology. This type research is more informative. In this case, the material is taken with a special brush, which the doctor scrolls in the cervix. Thus, it is impossible to miss the disease.

Study preparation

Before the analysis, the woman needs to thoroughly wash the external genitalia and dress in clean clothes. No special events are required.

Scented soaps and intimate deodorants should not be used for personal hygiene.

Do not douche the day before, use vaginal suppositories, tablets, ointments, creams or injected tampons. It is advisable to give up sex two days before taking a smear. The procedure is not performed during critical days. The woman should be warned a few days before the procedure.

Methodology

The smear results give reliable result when the sampling technique was correct. The material is taken during examination in the gynecological chair using a mirror. The doctor conducts an examination beforehand, after which:

1. Removes all secretions from the mucosa.
2. Armed with a Volkmann spoon, the doctor takes a scraping. Usually, a cytological smear is taken from 3 areas (vaginal fornix, vaginal exocervix and cervical canal).
3. After that, the material is placed on a glass slide, which the laboratory assistants previously disinfected and degreased. All three samples can be applied to one slide. To prevent the material from drying out, it is covered ethyl alcohol. If there is a special aerosol, then use it.
4. Then a brush (endobash) is taken. It can be replaced by a stick with a swab, which has been previously treated with sodium chloride. The swab is taken from the desired area and is painless.
5. After manipulation collected materials transferred to the laboratory. With the help of a microscope, specialists examine smears and determine the pathologies present.

If you need to take a liquid cytology, then the material that the doctor has collected is mixed with a special solution and applied to the glass. Then comes the distribution of leukocytes and mucus.

After cytological smears, there may be bloody issues. This is not a deviation. They pass in 4-6 days and do not have bad smell. If any deviations from the norm appear, this is a clear reason for contacting a specialist.

What can the study show?

Analyzes make it possible to determine the presence or absence of infections, after seeing the results, the doctor can assess the hormonal background of the lady, in what condition is the vagina. If a woman is carrying a baby, according to the data, a miscarriage can be prevented.

When laboratory workers examine smears, they will definitely pay attention to white blood cell counts. Leukocytes protect the body from pathological microorganisms. If there are a lot of them, then there is an active inflammatory process. The more of them, the more severe the stage of the disease.

In the case of 25-30 leukocytes in the cervical canal, about 5 in the urethra, in the vagina - 8-10 - this is the norm. These indicators are present in all women who have regular sexual intercourse.

If the indicators are much higher than those indicated above, then there is a pathology. The main reason for the strong increase in leukocytes can only be established by a doctor. An accurate diagnosis is made after bacterial culture, PCR (polymerase chain reaction) and immunoassay.

Conclusion

Leukocyte infiltration of the cervix is ​​detected after smear results. What it is is already clear from the above information, and the doctor will tell you how to treat the pathology after the diagnosis is established. The essence of treatment will depend on the severity of the disease and the pathology itself. Self-medication is unacceptable, as it can lead to serious and irreversible consequences.

Cytology results

1. The quality of the drug:

2. Cytogram (description).

3. Additional clarifications.

Read comments 12:

added after 16 minutes

added after 1 minute

Nival, well, everything is fine!

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Cytology results

Good day! Help to decipher results of a cytology please. After 3 weeks, stimulation is planned, followed by insimination. All analyzes are excellent and the last one came like this:

Cytological examination of biomaterial from the cervix according to the Papanicolaou method (PAP test)

1. The quality of the drug:

Exocervix - the quality of the drug is adequate.

Endocervix - the quality of the drug is adequate.

2. Cytogram (description).

Exocervix - cells were found in the obtained material squamous epithelium superficial and intermediate

Weak, sometimes moderately expressed leukocytic infiltration.

Endocervix - elements of peripheral blood, squamous epithelium cells were found in the obtained material

superficial, intermediate layers and columnar epithelium.

Squamous metaplastic epithelium.

Moderate, locally pronounced leukocyte infiltration.

3. Additional clarifications.

No cells with signs of malignancy were found in the obtained material.

Read comments 12:

Exocervix and endocervix are adequate, which means that there is no malignant cells.

Well, and so like as not the big inflammation is available. I don't think it's scary. Treat and everything will be good!

added after 16 minutes

I will also add that I am not a doctor, so only a doctor can say more specifically.

With inflammation, they are unlikely to be taken for stimulation (

What could it possibly be? Everything was clean for infections

Nival, I can’t say for sure about the inflammation, but I was confused in places by the pronounced leukocyte infiltration. The girls will go to the blog, maybe they will say something.

Here is my analysis, the doctor said excellent and that everything is ok. But the truth is you have written more than I have.

added after 1 minute

And so, mild leukocentric infiltration is the norm

Thanks a lot for the replies! I signed up for a doctor tomorrow (lucky, the window appeared), then I'll tell you what they will tell me about it.

Nival, your question is about my work profile. smear is normal. What cycle day did you take it on? I don't think they will ban stimulation

Nival, well, everything is fine!

Hermione, good afternoon! On the 7th day of the cycle.

Nival, good afternoon. the number of leukocytes is a dynamic value, it can change during the cycle, many factors affect it. what did they say in the consultation?

Hermione, today she came to two doctors with this question - the first one says everything is fine and do nothing, the second one prescribed terzhinan suppositories. opinions differed

edited less than a minute ago

Nival, don’t worry, the first doctor didn’t prescribe anything, because you don’t have any complaints, and if you don’t, then there’s nothing to treat. And the second one was appointed by Terzhinan for safety net, it will not get worse from him, you can apply it. Do what makes you feel calmer, because the main thing is the mood.

Squamous metaplasia - defense mechanism arising in connection with the proliferation of stem cells that differentiate towards the squamous epithelium. A large amount of metaplastic epithelium can be associated with the human papillomavirus (HPV). Hyperkeratosis - keratinization of the cells of the surface layer. Clinical diagnosis simple leukoplakia in cytological smears manifests itself as accumulations (single or more) of squamous epithelium scales. In leukoplakia with atypia, cells with various cytopathic changes are identified, which can be associated with both HPV and cervical neoplasia. With hyperkeratosis, oncological alertness is necessary and an additional examination is recommended to exclude a malignant process. Parakeratosis - non-specific defensive reaction epithelium. Pathological keratinization of squamous cells may be indirect sign of HPV. Parakeratosis is also determined after trauma, childbirth, with leukoplakia of the cervix. Pseudoparakeratosis is noted in postmenopausal women, as it is associated with degenerative changes. In endocervical smears in women of childbearing age, it is observed in the second phase of the cycle. Dyskeratosis is a pathological keratinization of squamous epithelial cells, which is an indirect sign of HPV. Multinucleated cells - bi- and multinucleated cells, which are an indirect morphological sign of a viral infection: HPV, HSV (virus herpes simplex). In conclusion, they reflect other cytopathic signs and indicate their probable genesis: “ indirect signs HPV? Multinucleated cells may be associated with inflammatory and reactive processes. Koilocytes - squamous epithelial cells with certain cytopathic changes in the nucleus and cytoplasm - a specific cytological sign of HPV. Dystrophic and dysregenerative changes in cells are associated with malnutrition and metabolism. Degenerative changes in cells of both squamous and columnar epithelium are most often associated with the process of inflammation, but may be a manifestation of the effects of hormones. reparative changes. In the process of repair, an increase in cell nuclei, the appearance of cells with hyperchromic nuclei, increased cytoplasmic eosinophilia, and a decrease in mucin content are determined. These changes in the epithelium of the endocervix, as well as in the stratified squamous epithelium, have focal character and are located in areas with inflammatory phenomena. The process is accompanied by the development granulation tissue, the appearance on the surface, devoid of epithelium, of a layer of cylindrical or immature metaplastic cells, which, as they proliferate and differentiate, form a stratified squamous epithelium. Reparative changes can be caused by inflammation, cryo-, laser treatment, radiation therapy. Reactive changes. The cause of reactive changes can be inflammation, chronic infections, surgery, etc. Reserve cells are not normally visible. They are detected with reserve cell hyperplasia, squamous metaplasia, as well as during pregnancy, the use of oral contraceptives and in menopause.

Cytology smear: what shows, decoding, norm and pathology

A cytology smear or Pap test in women has a large diagnostic value, because it makes it possible to identify malignant process at the initial stage and timely prescribe therapy.

Cytological examination in gynecology

Cytological analysis in gynecology is understood as a microscopic study of the typical cellular composition of samples taken from the vagina and cervical canal. Such diagnostics gives physicians the opportunity to draw conclusions about the presence of inflammatory processes, before cancer or cancer in reproductive organs female patients.

Unlike histological examination the cytological method is non-invasive. That is, when taking biological material there is no need to perform a biopsy or puncture, and the integrity of the tissue is not compromised at all. The analysis is subjected to samples taken using a print or smear. To obtain accurate results, you must carefully follow the rules for preparing for the examination. It is also very important that the analysis be deciphered by the woman's attending physician, who will take into account her complaints and data from other diagnostic methods.

It usually takes no more than a day to perform a cytological analysis. If a precancerous condition was found at the same time or oncological process, to clarify the diagnosis, they resort to invasive diagnostic techniques - biopsies.

Cytology is especially important when biopsy is contraindicated and when examining a large number of patients (when it is necessary to identify women who are at risk for the development of malignant pathology).

A cytology smear (PAP test, Papanicolaou analysis) is a study under a microscope of a smear from the cervix in order to early detection cancerous diseases. Also, this analysis is also called a histological smear or a smear for oncocytology. Such an examination is easily tolerated by patients, since it is completely painless and does not take much time.

The cytological smear not only makes it possible timely diagnosis cellular abnormalities, but also helps to detect the presence of unwanted microflora in the vaginal environment. At the same time, the test does not provide accurate data on the identified pathologies, and in case of an unfavorable result, the patient is sent for an additional examination (a smear for the flora in women) and for analysis for STDs.

Using the cytological method, which is successfully used in gynecological practice for decades, it is possible to identify 5 types of changes in the cells of patients. At the same time, the study is very simple and affordable. Doctors advise all women aged 18 to 65 to undergo it at least once a year. Based on the results of the analysis, it is possible to reliably establish the presence or absence of any pathology.

Indications for a cytology smear

It is desirable to take a smear for cytology for all women. At the age of 40, it is enough to undergo such a diagnosis once a year. Senior representatives age groups should be checked every 6 months. Some cases are mandatory indications to the test. These include:

Inflammation in the cervical canal, cervix, especially if they are chronic.

Violations menstrual cycle.

reproductive problems.

Preparing for surgical interventions and other medical procedures.

Planning for pregnancy.

Preparing to install the coil.

Taking hormonal drugs.

Diabetes.

2nd and 3rd degree of obesity.

The presence in the body of certain viruses (human papillomavirus, genital herpes).

Frequent change of sexual partners.

Contraindications for cytological examination

A smear for cytology is not taken during menstruation. If you need to assess the presence of atypical cells, you should not analyze during inflammation of the vagina and cervix. The fact is that a large number of leukocytes will simply “close” the pathological cells, and it will be impossible to detect them by the cytological method.

Preparing for a smear for cervical cytology

To get the most exact result, you must follow a few simple rules:

Do not douche.

Do not use medicines local action (suppositories, ointments, etc.).

Wait until the end of the month.

Do not urinate three hours before taking a smear.

Refrain from sexual intercourse for two days before the study.

If there is an inflammatory process in which a lot of secretion is released, the disease must be treated and a control smear taken to confirm recovery. And only after that it makes sense to perform a cytological analysis.

Taking an oncological smear is performed by a gynecologist when examining a patient. First, using mirrors, the doctor examines the condition of the vagina, examines the entrance to the cervical canal and the mucous membrane of the cervix. Then, material is taken from three areas (vagina, cervical canal, cervical inlet) using a special brush for analysis. The procedure takes very little time and does not cause any pain to the patients.
The collected material is placed on a glass slide, evenly distributed and, after drying, transferred to a medical laboratory. There, the smear is stained with special substances and examined under a microscope.

At the same time, the following characteristics are evaluated:

Cell sizes and their structure.

The number of cells (per unit area).

Mutual arrangement.

shape of the epithelium.

Availability pathological changes in cells.

Structures of the stratified squamous epithelium of the vaginal mucosa

A - basal layer (a - basal cells, b - parabasal cells)
B - intermediate layer, C - surface layer; on the right, individual cells of the corresponding layers of the vaginal epithelium are shown.

After the sampling procedure, the patient can immediately return to her normal activities. There should not be any discomfort normally, since the brush cannot injure tissues. True, there is a possibility that a small blood vessel. Then, within 1-2 days after the analysis, slight spotting (streaks) will be observed. This phenomenon should not cause concern in a woman.

Cervix healthy woman covered with a cylindrical epithelium, and the vagina is flat. Concerning vaginal microflora, then it is not cocci, but sticks. Some indicators depend on the phase of the cycle - karyopyknotic and acidophilic indices, basal and parabasal cells, the number of leukocytes. They provide information about the work of the ovaries.

Pap test interpretation

Depending on the state of the epithelial cells, vaginal smears subjected to cytological examination are divided into five classes (Papanicolaou method):

Class 1. Absence of pathological changes in the studied material. Cells have normal sizes and shape, correctly positioned.

Class 2 The morphological norm of some cellular elements, which is a sign of inflammation or infection. Such a result may be a sign of vaginosis. In such cases, further diagnostics is indicated for an accurate diagnosis and selection of adequate therapy.

Class 3. The material contains single cells with disorders in the structure of the nucleus and cytoplasm (dysplasia or hyperplasia). The number of such pathological cells is small. The patient is sent for re-cytology.

Class 4. In the examined smear, cells with malignant changes in the nucleus, chromatin and cytoplasm are found. These pathological changes indicate that the patient has a precancerous condition.

Class 5. Presence in a smear a large number atypical cells (they are much more than normal). In this case, diagnose initial stage cancer.

Deciphering a smear for cytology according to the Betsed method

The decoding of the cytological analysis of the material taken from the cervical canal is performed according to the Betsed method. This takes into account the location of the cells and dyskaryosis (changes in the nucleus). The results of the study may be as follows:

Norm. The absence of pathology does not have any special designation.

Vaginosis, koilocytosis - HPV.

- Cervical dysplasia depending on the degree - CIN I, CIN II or CIN III.

Cervical cancer - Carcinoma (pax).

Terms in the diagnosis in the cytological analysis of a smear of the cervix

In gynecological practice, to describe the results of cytological studies, it is customary to use the following designations and terms:

CBO. Normal performance no pathological changes.

Cytogram of inflammation. Development indicators inflammatory process(cervicitis).

Leukocyte infiltration - increased number leukocytes. This is a sign of vaginosis, exocervitis or endocervitis.

Koilocytes - the presence of cells that speak of HPV.

Proliferation - Acceleration cell division. This condition is characteristic of the inflammatory process in the uterus. With strong proliferation, advanced inflammation occurs.

Leukoplakia - pathologically altered (but not cancerous) cells are present in the smear.

Metaplasia - one type of cell is replaced by another. It is considered the norm for patients who have been treated for non-oncological pathologies of the uterus in menopause. In addition, this condition is normal for women who have been in menopause for more than 6 years.

Dysplasia is a precancerous pathology.

The following abbreviations are used to describe the results of a smear containing abnormal cells:

-ASC US- the presence of altered squamous epithelial cells with unknown etiology. It occurs more often in patients older than 45 when estrogen production decreases.

-AGC- changes in cylindrical cells that may indicate vaginosis or any other diseases. This result requires additional clarifying diagnostics.

- L-SIL- the presence of a small number of atypical non-malignant cells. In this case, the patient is referred for further examination (biopsy and colposcopy).

-ASC-H- pathological changes in cells that indicate a precancerous pathology or an oncological process that begins.

- HSIL is oncocytology (altered flat cells). Such patients undergo immediate medical measures to prevent degeneration into a malignant tumor.

- AIS– This abbreviation indicates that cylindrical malignant cells have been identified. These results require urgent treatment.

If pathologically altered cells are detected in the smear, the laboratory assistant will definitely indicate this in a written opinion specifying the type of changes. If in the decoding of the analysis there are no special designations no, then, in all likelihood, the smear is normal. An accurate diagnosis cannot be made on the basis of this test alone. To determine the nature of the pathology, the gynecologist needs to compare the results of different examinations.

How many days is a smear analysis done for cytology

Cytological analysis of a smear usually takes from 1 to 5 days.

It is important to remember that the oncological process does not occur in a few days. Quite a lot of time passes from the first pathological changes to malignant degeneration. Therefore, the timely detection of atypical cells in a woman's body makes it possible to prevent the development of cervical cancer. For these purposes, an accessible and simple method was introduced everywhere. early diagnosis malignant cells - cytological examination smear.

CYTOLOGICAL SMEAR IS A METHOD OF MICROSCOPIC STUDY OF THE CERVICAL EPITHELIUM FOR THE PURPOSE OF PREVENTION AND EARLY DIAGNOSIS OF CERVICAL CANCER.

smear for cytology first of all carried out to detect atypical cells, which allows for early stages diagnose (CIN, LSIL, HSIL) or cervical cancer. It is an inexpensive and convenient method for the preventive coverage of a large number of women. Of course, the sensitivity of a single study is low, but the annual mass screening in developed countries has significantly reduced the mortality of women from cervical cancer.

Due to the fact that atypical cells can be located on a relatively small area of ​​​​the mucosa, it is very important that the material be obtained from the entire surface of the cervix, especially from the cervical canal! For this, special brushes have been created that allow you to obtain material from areas inaccessible to inspection.

Particular attention is paid to the transformation zone, the cells of which are most often subjected to tumor degeneration. It is in developing up to 80-90% of cervical cancer, the remaining 10-20% fall on the cervical canal.

When to take a smear for cytology? Taking a smear for cytology should be carried out starting from the 5th day of the menstrual cycle and 5 days before the expected start of menstruation. It is impossible to analyze within two days after sexual intercourse or the introduction of suppositories into the vagina. Failure to follow these rules may lead to erroneous interpretation of the results. Also, the presence of a pronounced inflammatory process in the cervix and vagina seriously complicates the diagnosis.

It should be noted that the collection of material is enough unpleasant procedure. The gynecologist must scrape off the epithelium from the surface of the cervix and enter the cervical canal. The more epithelium from different zones gets - the better the diagnosis. Sometimes bruising may remain after cytology, this is considered normal.

Thus, the main significance of a smear for cytology is the determination of qualitative changes in cells. To determine the infectious agent that caused the inflammation, it is better to use or bacteriological culture . However, during a cytological examination, the doctor may note the presence of any microorganisms. To normal microflora include rods (lactobacilli), single cocci, a small amount may be opportunistic flora. The presence of specific infectious agents (Trichomonas, amoeba, fungi, gonococci, gardnerella, leptothrix, chlamydia, an abundance of cocci) is considered a pathology that must be treated.

Smear processing. Timing of Cytology

After taking the material, the sample is transferred to a glass slide, fixed and stained. With direct transfer of a smear from a brush, partial loss of material and deformation of the cells are possible, which leads to a decrease in the sensitivity of the method and a large number of false results. The classical method was replaced by liquid cytology, which significantly increased the accuracy and quality of the study.

Liquid Cytology - this is new technology processing of smears, which consists in placing samples in a container with a special stabilizing solution. In this case, the entire resulting epithelium enters the solution, which is then centrifuged and cleaned of unwanted impurities (mucus, etc.). Today, liquid cytology is becoming the "gold standard" for the study of smears from the cervical mucosa. But even in this case, the sensitivity of a single study does not exceed 60-70%. AT reproductive age false-negative results are common, and in menopausal women, false-positive results. Only a triple cytological examination allows you to approach 100%.

Exist various methods staining of preparations: according to Papanicolau (Pap test), according to Romanovsky, according to Wright-Diemsa, according to Gram. All methods are aimed at staining certain cell structures, which makes it possible to differentiate different types epithelium, to distinguish cells with keratinization and tumor transformation. The Papanicolaou test is widely recognized and is now used as the main standardized test.

How long does the test take? Depending on the organization of the process, the result can be obtained within 2-3 days.

Cytogram without features - what does it mean?

Options for the cytological conclusion vary widely. As a variant of the norm, the following conclusions can be used: cytogram without features «, « cytogram within normal limits «, « cytogram without intraepithelial lesions «, « cytogram corresponds to age - atrophic type of smear «, « NILM— Negative for intraepithelial lesion or malignancy«, « proliferative type smear ". All this is NORMAL!

The mucous membrane of the cervix is ​​normally smooth, shiny, moist. The squamous epithelium is pale pink, the glandular epithelium is bright red. The cellular composition that can be found in normal cytology is presented in the table.

Atrophic type of smear - what does it mean?

In women in perimenopause and menopause due to a decrease in general level estrogen slows down many metabolic processes, resulting in atrophy of the squamous epithelium. These changes can be seen in the cytogram. The atrophic type of smear refers to a variant of a normal cytogram. You can often find the phrase “ cytogram corresponds to age " or " age-related changes nilm ". These are all variations of the norm!

It must be understood that in women in menopause, false positive cytogram results are very frequent - the case when it is difficult for a cytologist to distinguish between atrophic squamous epithelium and dysplasia. This must be understood, since no pathology is usually found during a subsequent biopsy of the cervix. In addition, older women may be prone to keratinization of the epithelium with the formation of hyperkeratosis (leukoplakia).

The mucous membrane of the cervix in menopause is thinned, easily injured and tints, which is a consequence of a decrease in estrogen.

Deciphering the cytogram

Terminology

A smear for cytology is the norm

dyskaryosis and discaryocytes- abnormal cells with hyperchromic (dense and dark) nuclei and irregular nuclear chromatin. Dyskaryosis will be followed by the development malignant neoplasm. Used as a synonym for dysplasia, but as a more general term.

Atypia- any difference in the structure of the cell from the norm. The meaning often depends on the context. But more often it is still used to describe precancerous and tumor changes.

Inflammatory atypia- a combination of degenerative, reactive, proliferative changes in cells during inflammation. These changes can lead to a false-positive diagnosis of dysplasia or cancer.

- the process of violation of the maturation of the squamous epithelium. It is a true precancerous process. Has 3 degrees. The first is usually viral defeat, to the second and third - a lesion with tumor potential.

Severe epithelial dysplasia

ASCUS- atypical cells that are difficult to differentiate from reactive atypia and the actual precancerous process. Atypia of unclear significance.

Dyskeratosis- violation of keratinization of individual cells of the squamous epithelium. It is a sign of HPV.

- violation of keratinization of the epithelial layer. surface cells squamous epithelium always have some degree of keratinization - this is a protective mechanism. Parakeratosis can be observed normally, with irritation of the mucous membrane of any cause, or with HPV damage.

(koilocytic atypia, koilocyte)- specific changes in the nuclei characteristic of the human papillomavirus.

koilocytes, multinucleated cell

(leukoplakia)- pronounced keratinization of the epithelial layer with the appearance of a protective unstructured layer of keratohyalin. it normal process for the skin, but in the mucous membranes is considered a pathology. It is observed with HPV infection, as well as with irritation of the mucous membrane, especially with prolapse of the pelvic organs, prolapse of the uterus.

- defense mechanism physiological process replacement of the delicate glandular epithelium with a more stable squamous epithelium. Metaplastic epithelium often becomes a source of dysplasia and cancer, as it is easily affected by the human papillomavirus.

- proliferation, active growth glandular epithelium. It is a reactive process during inflammation, erosion of the cervix. Often seen when using hormonal drugs.

Classification Bethesda (USA) - transcript of the cytogram

The classification of cytological changes according to Pap is somewhat simpler than Bethesda. However, the message remains the same. There is a section of benign reactive changes that do not threaten health, a class of precancerous pathology and cervical cancer itself. Each class is distinguished based on prognosis, risk of malignant transformation, and required medical intervention.