65 year old woman PAP smear
65 year old woman screening PAP.
This is 65 year old female with no previous history, who had gynecological exam for a post menopausal bleeding. She never had a PAP smears done in the past because she "has been always healthy and does not like doctors". She is married and in monogamous relationship with her husband. She has 2 grown up kids. She is non-drinker, non-smoker. Upon examination there is small blood clot in the posterior vagina and a raised lesion in the exocervix. PAP smear was performed as well as biopsy. HPV PCR was also requested and returned positive for high risk HPV.
View the CASE.
Diagnosis: Poorly differentiated, squamous cell carcinoma, non-keratinizing.
How to handle such case:
1. Call the physician. This is urgent result, plus you can squeeze out more history.
2. You can show that to a colleague for second signature.
3. Make sure that the specimen comes from this patient .
4. Types of signing out this case:
- Positive for malignant cells, favor squamous cell carcinoma.
- Positive for malignant cells. Squamous cell carcinoma.
- Positive for malignant cells. Poorly differentiated neoplasm with squamous features.
NOTES: This is SSC because:
- These are flat and rare 3D clusters of cells with no common community border, marked variation in size and shape.
- No acini, glands, rosetting or columnar differentiation.
- N:C ratio is close to that of moderate dysplasia.
- Ratty, bloody background.
DIAGNOSIS1. Call the physician. This is urgent result, plus you can squeeze out more history.
2. You can show that to a colleague for second signature.
3. Make sure that the specimen comes from this patient .
4. Types of signing out this case:
- Positive for malignant cells, favor squamous cell carcinoma.
- Positive for malignant cells. Squamous cell carcinoma.
- Positive for malignant cells. Poorly differentiated neoplasm with squamous features.
NOTES: This is SSC because:
- These are flat and rare 3D clusters of cells with no common community border, marked variation in size and shape.
- No acini, glands, rosetting or columnar differentiation.
- N:C ratio is close to that of moderate dysplasia.
- Ratty, bloody background.
