Squamous cells were found. Epithelial tissue: structural features, functions and types

Women aged 18-40 years should regularly, once every six months, visit a gynecologist and have a smear for cytological examination. This is intended to assess the condition of the tissue cells of the squamous epithelium - the layer lining the vagina and cervix. The squamous epithelium in the smear gives an idea of ​​how successfully this tissue copes with its role as a shield for important female organs.

What is the essence of the analysis?

The epithelium is a layer that protects the tissues of the body cavities and mucous membranes. Analysis of the squamous epithelium of the cervix can show First stage development of cancer, as well as possible reasons infertility. A smear is taken from the external pharynx using a curved spatula. The fact is that cancer cells begin to form from below and gradually move to the top. Therefore, deep sampling of cytological material will give results only in the case of an already advanced disease.

In a smear, multilayered squamous epithelium shows the ratio of the types of cells it consists of, namely:

• superficial cells;
• intermediate;
• basal-parabasal.

The balance of these cells is determined by the phase menstrual cycle. Therefore, for the most accurate conclusions, it is recommended to take the test on days 5-7 of the cycle. Squamous epithelial cells in women of reproductive age are completely replaced with new ones every 4-5 days.

Qualitative characteristics of squamous epithelium

Multilayered squamous epithelium, as mentioned above, consists of several layers. Each of them performs a specific function, together providing immunological (responding to inflammation and infection) and mechanical (protecting the vagina and uterus from damage) functions. Thus, basal-parabasal cells help restore the lining of the cervix. However, they are visualized only in postmenopause. At reproductive age, visible cells of this layer indicate hormonal disorders or local inflammation. The layer of intermediate cells differentiates basal and superficial. The latter, in turn, are constantly exfoliated and provide renewal of the epithelium. The epithelium grows due to estrogen (the female sex hormone), but progesterone has a depressing effect on this growth, increasing desquamation.

Hyperkeratosis of squamous epithelium

Recently, women are increasingly being diagnosed with squamous epithelial hyperkeratosis. This means that the cells of the surface layer undergo exfoliation and keratinization too actively. As a rule, this disease occurs in women after 40 years of age, during menopause. But in last years hyperkeratosis (or leukoplakia) also appears in young girls. This suggests that the patient's body produces too much progesterone, and this may be the cause of infertility. The main danger of hyperkeratosis of squamous epithelium is that it creates a pathological environment in tissues that is favorable for the development of cancer tumors in the cervix.

Among the causes of leukoplakia are the following:

• violations in endocrine system- hormonal imbalance;
• problems in the immune system (frequent colds, sore throat);
• chronic form of human papilloma or chlamydia;
• injuries (for example, piercing of the intimate area).

Hyperkeratosis does not have external signs, so the woman does not know about it until she goes to the gynecologist and receives smear data for cytology. Moreover, upon examination, a specialist can already speak with 80% confidence about hyperkeratosis if he finds small white spots-plaques on the ectocervix. To confirm the diagnosis, a cytological analysis and colposcopy (examination of the patient with a colposcope - an illuminated binocular) are prescribed.

Treatment of hyperkeratosis is determined by the patient’s age and reproductive function. In some situations, surgical intervention is possible, in others, surgery is a last resort, as it creates scars on the uterus, causing complications during childbirth. In addition, the following applies:

• cryodisruption (cauterization of hyperkeratosis foci with liquid nitrogen);
• radiosurgical therapy;
• laser vaporization (exposure to leukoplakia plaques with a laser beam - to avoid scarring)

IN complex treatment hyperkeratosis, hormonal and antibacterial therapy is used. In this way, it is possible to prevent the transition of leukoplakia to the oncological stage.

Preparing for a smear test for squamous epithelium

So that the cytological examination data gives the most accurate results, you must follow certain recommendations for preparing for it.

1. Refrain from sexual intercourse one day before the test.
2. Do not take a couple of days before the smear test medications, as they may affect hormonal balance. Exception - oral contraceptives. A break in taking these medications, in addition to unwanted pregnancy, provokes hormonal stress.
3. Do not douche, as douching solutions can not only cause microcracks on the surface of the vagina (and then the smear will be painful), but also wash away part of the epithelium.
4. Do not go to the toilet 2.5 hours before collecting material.

Find out about cervical colposcopy, this procedure is as informative as a smear.

The value of the norm of epithelium in a smear

If the result of a smear on squamous epithelium is within 4-15 units, then this is considered normal. However, the value may fluctuate one way or the other. If a lot of squamous epithelium is found, then the woman has probably recently suffered inflammation or infection, so the protective layer begins to actively grow and renew itself. If there are few squamous epithelial cells, this indicates a lack of estrogen in the woman’s body and an excess of male estrogen.

When the results of a cytological analysis show the absence of squamous epithelium in the smear or there are atypical cells in it, this indicates the development of cancer. Then the patient is prescribed a biopsy to determine the stage of the disease in more detail.

A smear test can also reveal signs of chlamydia in women, so you should visit your gynecologist regularly.

Additional diagnostics of squamous epithelium

The squamous epithelium in a smear from the cervix allows one to draw the necessary initial conclusions about the woman’s health status. But when there is a suspicion of certain problems, including oncological ones, additional tests are prescribed for cytological examination:

• colposcopy (hormonal effects on the epithelium are assessed);
• iodine test according to Schiller (stains healthy epithelial cells in Brown color, and thinned cells become white);
• biopsy (detects atypical cells with an accuracy of 99%).

What is being studied?

A smear for oncocytology allows you to examine the epithelium of the cervix - that is, the cells that cover the cervix from the outside and line its canal from the inside.

Normally, the vaginal part of the cervix is ​​covered with stratified squamous epithelium, and the cervical canal (it runs inside the cervix and leads from the vagina to the uterus) is lined with columnar epithelium.

Why is a smear taken for oncocytology?

All over the world, the incidence of cancer is growing, and cervical cancer is one of the first places among cancer diseases in women.

A smear examination for oncocytology is primarily aimed at the early detection of cancer cells on the cervix, as well as precancerous processes - that is, conditions that can lead to the development of cervical cancer in the future.

In addition, certain changes in the smear for oncocytology are detected, for example, with inflammation, the presence of human papillomavirus (HPV) and other diseases. Many of them are successfully treated if detected in the early stages.

Smear for oncocytology during pregnancy

In a pregnant woman, it is important to promptly diagnose changes in the cervical epithelium at any stage, since high levels of hormones during this period can contribute to the rapid progression of a precancerous condition.

A smear for oncocytology is taken once without fail from all pregnant women when registering at the antenatal clinic. In some cases, when initial changes in the cervical epithelium are detected, the analysis is repeated in the second and third trimesters of pregnancy.

How to take a smear for oncocytology

The material is collected by an obstetrician-gynecologist during an examination. expectant mother on the gynecological chair. This procedure is most often completely painless, only some women report minor discomfort.

The epithelium is taken separately from the surface of the cervix and from cervical canal with a special soft brush or spatula. The material is applied to one or two glasses and sent to the laboratory.

The result is usually ready in 5-10 days.

Preparing for analysis

A smear for oncocytology should not be done if there is an inflammatory process in the vagina (colpitis) and on the cervix (cervicitis), since this condition causes changes in cells that can be regarded as an initial precancerous process.

Interpretation of results

The results of a smear for oncocytology are a description of the cells that are found in the material being studied. A normal smear for oncocytology is considered to be one in which all cells have the required size, shape and structure.

First, visible cells taken from the cervical canal and the surface of the cervix are described. During pregnancy, the cellular composition of smears from the cervix is ​​normally represented by stratified squamous epithelial cells, predominantly of the superficial or intermediate type.

Columnar epithelial cells are normally present in the cervical canal without changes.

The cytological report may contain the following data:

• cervical smear : columnar epithelial cells without any features were found in the obtained material. (Cells of metaplastic epithelium may be found - this is a normal variant and indicates that the smear was taken from the transition zone, where the columnar epithelium of the cervical canal passes into multilayered squamous epithelium covering the vaginal part of the cervix);
• smear from the vaginal part of the cervix : in the obtained material, cells of stratified squamous epithelium of the surface layers without any features are noted.

If any change in the structure or size of the cells is detected, the cytologist who did the study describes these changes in detail and gives a conclusion.

An abnormal smear for oncocytology does not always indicate that the patient has cervical cancer.

What a smear can reveal

Inflammation

With any inflammatory process in the vagina and cervical canal, changes are detected in a smear for oncocytology. Most often found a large number of leukocytes (white blood cells), cells of infectious agents - fungi, trichomonas, gardnerella.

Epithelial cells of the cervix and cervical canal may look abnormal in case of inflammation, but after anti-inflammatory therapy they return to normal.

Human papillomavirus infection

Quite often, signs of oncocytology are revealed in a smear papillomavirus infection.

Human papillomavirus (HPV) is a group of viruses that can infect the epithelium of the genital organs. HPV is common cause the appearance of condylomas (warts) in the external genital area, and is also considered a risk factor for the development of cervical cancer.

When infected with the human papillomavirus, the cells of the cervix decrease in size and acquire a light “rim”, which is why they appear empty. Such cells are called koilocytes. It is the detection of koilocytes in an oncocytology smear that allows a cytologist to make a diagnosis of HPV.

Hyperkeratosis

Hyperkeratosis is the appearance of squamous epithelial scales in an oncocytology smear. These cells are usually found in cervical leukoplakia. Leukoplakia is a benign lesion of the cervix, characterized by the presence of a white area on its surface, which is detected during colposcopy (examination of the cervix using a special microscope).

If a smear for oncocytology reveals single scales of squamous epithelium and upon examination no changes are detected on the cervix, then hyperkeratosis has no diagnostic value and such an analysis is considered normal.

Dysplasia, or cervical intraepithelial neoplasia (CIN)

When examining a smear for oncocytology, changes in cervical cells characteristic of dysplasia (the presence of atypical cells on the cervix) of varying degrees of severity can be detected.

Mild dysplasia is usually a sign of an inflammatory process and is treated with antibacterial and anti-inflammatory drugs.

Moderate and severe dysplasia is a precancerous process and requires a mandatory additional examination - a cervical biopsy, which involves taking a small piece of tissue from the affected area. This is necessary in order to conduct a thorough examination of the pathological process in the cervix and decide on the need for further treatment.

If moderate or severe dysplasia is confirmed, surgical methods are usually used (cauterization, removal of the affected part of the cervix) or the patient is referred to a gynecological oncologist to determine tactics for further observation.

In pregnant women, depending on the extent of the pathological process and the duration of pregnancy, the doctor decides on the need for a cervical biopsy and subsequent treatment before (or after) childbirth.

If a smear for oncocytology reveals pronounced inflammatory changes or mild dysplasia, then after anti-inflammatory treatment, the smear for oncocytology is taken again, usually 2–4 weeks after the end of therapy.

Cervical cancer

Detection of atypical cancer cells in an oncocytology smear indicates the presence of cervical cancer and requires urgent consultation of the pregnant woman with a gynecological oncologist.

If any changes are detected in the smear for oncocytology, in this case a colposcopy is required - this is a procedure for examining the cervix and vaginal walls at high magnification under a special microscope (colposcope).

At the same time, it becomes possible to see pathologically changed areas, assess their size, severity, location - after pre-treating them special solutions (acetic acid, Lugol's solution).

Colposcopy is an absolutely painless procedure and can be performed at any stage of pregnancy. Preparation for colposcopy is the same as for taking a smear for oncocytology: 24 hours before the examination, the patient should not douche, use vaginal gels or suppositories, ointments or tampons, because this may affect the accuracy of the examination.

Cervical cancer most often develops in the transformation zone, it is preceded by background processes and intraepithelial lesions (epithelial dysplasia), which can be located in small areas, so it is important that material is obtained from the entire surface of the cervix, especially from the junction of squamous and columnar epithelium . The number of altered cells in a smear varies, and if there are few of them, then the likelihood increases that pathological changes may be missed when viewing the specimen. For effective cytological examination it is necessary to consider:

• During preventive examinations, cytological smears should be taken from women, regardless of complaints, the presence or absence of changes in the mucous membrane. Cytological examination should be repeated at least once every three years;
• it is advisable to obtain smears no earlier than on the 5th day of the menstrual cycle and no later than 5 days before the expected start of menstruation;
• You cannot take material within 48 hours after sexual intercourse, use of lubricants, vinegar or Lugol’s solution, tampons or spermicides, douching, insertion of medications, suppositories, creams into the vagina, including creams for performing ultrasound examination;
• pregnancy is not best time for screening, since incorrect results are possible, but if you are not sure that the woman will come for examination after childbirth, it is better to take smears;
• for symptoms acute infection it is advisable to obtain smears for the purpose of examining and identifying pathological changes in the epithelium, the etiological agent; Cytological control is also necessary after treatment, but not earlier than 2 months. after completing the course.

Material from the cervix should be taken by a gynecologist or (during screening, preventive examination) a well-trained nurse(midwife).

It is important that the smear contains material from the transformation zone, since about 90% of tumors come from the junction of the squamous and columnar epithelium and the transformation zone, and only 10% from the columnar epithelium of the cervical canal.

For diagnostic purposes, material is obtained separately from the ectocervix (vaginal portion of the cervix) and endocervix (cervical canal) using a spatula and a special brush (such as Cytobrush). When conducting a preventive examination, Cervex-Brush, various modifications of the Eyre spatula and other devices are used to obtain material simultaneously from the vaginal part of the cervix, the junction (transformation) zone and the cervical canal.

Before obtaining the material, the cervix is ​​exposed in “mirrors”; no additional manipulations are performed (the cervix is ​​not lubricated, mucus is not removed; if there is a lot of mucus, it is carefully removed with a cotton swab without pressing on the cervix). A brush (Eyre spatula) is inserted into the external os of the cervix, carefully guiding the central part of the device along the axis of the cervical canal. Next, its tip is rotated 360° (clockwise), thereby obtaining a sufficient number of cells from the ectocervix and from the transformation zone. The instrument is inserted very carefully, trying not to damage the cervix. Then the brush (spatula) is removed from the canal.

Preparation of drugs

Transfer of the sample to a glass slide (traditional smear) should occur quickly, without drying out or losing mucus and cells adhering to the instrument. Be sure to transfer the material to the glass on both sides with a spatula or brush.

If it is intended to prepare a thin-layer preparation using the liquid-based cytology method, the brush head is disconnected from the handle and placed in a container with a stabilizing solution.

Fixation of strokes performed depending on the intended staining method.

Papanicolaou and hematoxylin-eosin staining are the most informative in assessing changes in the cervical epithelium; any modification of the Romanovsky method is somewhat inferior to these methods, however, with experience, it allows one to correctly assess the nature of the pathological processes in the epithelium and the microflora.

The cellular composition of smears is represented by desquamated cells located on the surface of the epithelial layer. When adequate material is obtained from the surface of the mucous membrane of the cervix and from the cervical canal, the cells of the vaginal portion of the cervix (stratified squamous non-keratinizing epithelium), the junction or transformation zone (cylindrical and, in the presence of squamous metaplasia, metaplastic epithelium) and cells of the cervical canal enter the smear. columnar epithelium). Conventionally, cells of multilayered squamous non-keratinizing epithelium are usually divided into four types: superficial, intermediate, parabasal, basal. The better the epithelium’s ability to mature, the more mature cells appear in the smear. With atrophic changes, less mature cells are located on the surface of the epithelial layer.

Interpretation of cytological examination results

The most common at present is the Bethesda classification (The Bethesda System), developed in the USA in 1988, to which several changes have been made. The classification was created to more effectively transfer information from the laboratory to clinical doctors and ensure standardization of treatment of diagnosed disorders, as well as follow-up of patients.

The Bethesda classification distinguishes squamous intraepithelial lesions of low grade and high grade (LSIL and HSIL) and invasive cancer. Low-grade squamous intraepithelial lesions include changes associated with human papillomavirus infection and mild dysplasia (CIN I), high-grade - moderate dysplasia (CIN II), severe dysplasia (CIN III) and intraepithelial carcinoma (cr in situ). This classification also contains indications of specific infectious agents, causing diseases sexually transmitted.

To designate cellular changes that are difficult to differentiate between reactive states and dysplasia, the term ASCUS - atypical squamous cells of undetermined significance (squamous epithelial cells with atypia of unclear significance) has been proposed. For a clinician, this term is not very informative, but it directs the doctor to the fact that this patient needs examination and/or dynamic monitoring. The Bethesda classification has now also introduced the term NILM – no intraepithelial lesion or malignancy, which combines normal, benign changes, and reactive changes.

Since these classifications are used in the practice of a cytologist, below are parallels between the Bethesda classification and the classification common in Russia (Table 22). Cytological standardized report on material from the cervix (form No. 446/u), approved by order of the Ministry of Health of Russia dated April 24, 2003 No. 174.

The reasons for receiving defective material are different, so the cytologist lists the types of cells found in the smears and, if possible, indicates the reason why the material was considered defective.

Cytological changes in the glandular epithelium

Bethesda Terminology developed in Bethesda (USA, 2001)	Terminology adopted in Russia
ASSESSMENT OF SWIM QUALITY
Full material	The material is adequate (a description of the cellular composition of the smear is given)
The material is not complete enough	The material is not adequate (a description of the cellular composition of the smear is given)
Unsatisfactory for evaluation	Cellular composition is not enough to confidently judge the nature of the process
Satisfactory to evaluate, but limited by something (identify reason)
Within normal limits Metaplasia (normal)	Cytogram without features (within normal limits) - for reproductive age Cytogram with age-related changes in the mucous membrane: - atrophic type of smear - atrophic type of smear with leukocyte reaction Estrogenic type of smear in a postmenopausal woman Atrophic type of smear in a woman of reproductive age
BENIGN CELL CHANGES
Infections
Trichomonas vaginalis	Trichomonas colpitis
Fungi morphologically similar to the genus Candida	Elements of Candida fungus detected
Cocci, gonococci	Diplococci located intracellularly were found
Predominance of coccobacillary flora	Flora coccobacillary, possibly bacterial vaginosis
Bacteria morphologically similar to Actinomyces	Flora of the Actinomycetes type
Other	Flora of the type Leptotrichia
	Flora – small sticks
	Flora – mixed
Cellular changes associated with Herpes simplex virus	Epithelium with changes associated with Herpes simplex
	Possibly chlamydial infection
Reactive Changes
Inflammatory (including reparative)	The changes found correspond to inflammation with reactive changes in the epithelium: degenerative, reparative changes, inflammatory atypia, squamous metaplasia, hyperkeratosis, parakeratosis, and/or others.
Atrophy with inflammation (atrophic	Atrophic colpitis Atrophic type of smear, leukocyte reaction Mucosal epithelium with hyperkeratosis Mucosal epithelium with parakeratosis Mucosal epithelium with dyskeratosis Reserve cell hyperplasia Squamous metaplasia Squamous metaplasia with atypia
Radiation changes	Mucosal epithelium with radiation changes
Changes due to use intrauterine contraceptives
PATHOLOGICAL CHANGES IN THE FLAT EPITHELIUM
Squamous epithelial cells with atypia of unknown significance (ASC-US*) Squamous epithelial cells with atypia of unknown significance not excluding HSIL (ASC-H)	The changes found are difficult to differentiate between reactive changes in the epithelium and dysplasia Cells were found that were difficult to interpret (with dyskaryosis, enlarged nuclei, hyperchromic nuclei, etc.)
Changes in squamous epithelium (non-tumor, but worthy of dynamic observation)
Low grade squamous intraepithelial lesion (LSIL): human papillomavirus infection, mild dysplasia (CIN I)	Mucosal epithelium with signs of papillomavirus infection The changes found may correspond to mild dysplasia.
High-grade squamous intraepithelial lesion (HSIL): moderate, severe dysplasia and intraepithelial carcinoma (CINII, CIN III)	The changes found correspond to moderate dysplasia. The changes found correspond to severe dysplasia. The changes found are suspicious for the presence of intraepithelial cancer.
Invasive cancer
Squamous cell carcinoma	Squamous cell carcinoma Squamous cell carcinoma with keratinization Small cell squamous cell carcinoma
	Glandular hyperplasia The changes found correspond to endocervicosis
Atypical glandular epithelial cells (possible assumptions): * whenever possible, ASCUS should be defined as similar to reactive, reparative or precancerous processes; ** changes associated with exposure to human papillomavirus, previously designated as koilocytosis, koilocytic atypia, condylomatous atypia, are included in the category of mild changes in squamous epithelial cells; *** If possible, it should be noted whether the changes relate to CIN II, CIN III, whether there are signs of cr in situ; ****hormonal assessment (performed only on vaginal smears): – the hormonal type of smear corresponds to age and clinical data; – the hormonal type of smear does not correspond to age and clinical data: (decipher); – hormonal assessment is impossible due to: (specify the reason). Interpretation of the cytological report The cytological conclusion “Cytogram within normal limits”, in the case of obtaining complete material, can be considered as an indication of the absence of pathological changes in the cervix. The conclusion about inflammatory lesions requires clarification of the etiological factor. If this cannot be done from cytological smears, microbiological or molecular testing is necessary. A cytological conclusion about reactive changes of unknown origin requires additional (clarifying) diagnostics. The conclusion of ASC-US or ASC-H also dictates the need for examination and/or dynamic monitoring of the patient. Almost all modern guidelines for the management of patients with cervical lesions contain these diagnostic categories. An algorithm for examining women has also been developed depending on the detected pathological changes. Integration of various laboratory methods In the diagnosis of cervical diseases, clinical data and microflora test results (classical microbiological (culture), ANC methods (PCR, RT-PCR, Hybrid Capture, NASBA, etc.) are important). If it is necessary to clarify the pathological process (ASC-US, ASC-H), cytological examination is, if possible, supplemented with molecular biological ones (p16, oncogenes, methylated DNA, etc.). HPV detection tests are low prognostic significance, especially in young women (under 30 years of age), due to the fact that in most patients in this age group, HPV infection is transient. However, despite the low specificity of the test for intraepithelial tumors and cancer, it can be used as a screening test in women under 30 years of age, followed by cytological examination. Sensitivity and specificity increase significantly with the combined use of the cytological method and research to detect HPV, especially in patients with questionable cytological data. This test is important in the management of patients with ASC-US, during follow-up to determine the risk of relapse or progression of the disease (CIN II, CIN III, carcinoma in situ, invasive cancer).

Normally, the vaginal part of the cervix is ​​covered with stratified squamous epithelium, and the cervical canal (it runs inside the cervix and leads from the vagina to the uterus) is lined with columnar epithelium.

What is oncocytology

Worldwide frequency oncological pathologies is growing, and one of the first places among cancer diseases in women is cervical cancer.

Study smear for oncocytology primarily aimed at the early detection of cancer cells on the cervix, as well as precancerous processes - i.e. conditions that may lead to the development of cervical cancer in the future.

In addition, certain changes in smear for oncocytology detected, for example, during inflammation, the presence of human papillomavirus (HPV) and other diseases. Many of them are successfully treated if detected in the early stages.

Smear for oncocytology: studies during pregnancy

In a pregnant woman, it is important to diagnose changes in the epithelium in a timely manner cervix at any stage, since high levels of hormones during this period can contribute to the rapid progression of a precancerous condition.

It is required to be taken once from all pregnant women upon registration at the antenatal clinic. In some cases, when initial changes in the cervical epithelium are detected, the analysis is repeated in the second and third trimesters of pregnancy.

Material collection performed by an obstetrician-gynecologist during an examination of the expectant mother in a gynecological chair. This procedure is most often completely painless, only some women report minor discomfort.

The epithelium is taken separately from the surface of the cervix and from the cervical canal with a special soft brush or spatula. The material is applied to 1 or 2 glasses and sent to the laboratory. The result is usually ready in 5–10 days.

Preparing for analysis

You should not take the test if you have an inflammatory process in the vagina (colpitis) or on the cervix (cervicitis), since this condition causes changes in the cells that can be regarded as an initial precancerous process.

During the day before taking a smear It is not recommended to have sexual intercourse, use spermicidal creams and suppositories, vaginal douches, douching and tampons, because all this can interfere with obtaining reliable research results.

Oncocytology smear: interpretation of results

results smear for oncocytology represent a description of the cells that are found in the material under study. A normal smear for oncocytology is considered to be one in which all cells have the required size, shape and structure.

First of all, visible cells taken from the cervical canal and from the surface of the cervix are described. During pregnancy The cellular composition of cervical smears is normally represented by stratified squamous epithelial cells, predominantly of the superficial or intermediate type. Columnar epithelial cells are normally present in the cervical canal without changes.

The cytological report may contain the following data:

Cervical smear: columnar epithelial cells without any features were found in the obtained material. Cells of metaplastic epithelium may be found - this is a normal variant and indicates that the smear was taken from the transition zone, where the columnar epithelium of the cervical canal passes into multilayered squamous epithelium covering the vaginal part of the cervix.

Smear from the vaginal part of the cervix: in the obtained material, cells of stratified squamous epithelium of the surface layers without any features are noted. If any changes in the structure or size of cells are detected, the cytologist who conducted the study describes these changes in detail and gives a conclusion. Abnormal smear for oncocytology does not always indicate that the patient has cervical cancer.

What a smear can reveal

Inflammation. With any inflammatory process in the vagina and cervical canal, changes are detected in a smear for oncocytology. Most often, a large number of leukocytes (white blood cells), cells of infectious agents - fungi, trichomonas, gardnerella - are detected. Epithelial cells of the cervix and cervical canal may look abnormal in case of inflammation, but after anti-inflammatory therapy they return to normal.

Human papillomavirus infection. Quite often, a smear for oncocytology reveals signs of papillomavirus infection. The name human papillomavirus (HPV) refers to a group of viruses that can infect the epithelium of the genital organs. HPV is a common cause of condylomas (warts) in the external genital area and is also considered a risk factor for the development of cervical cancer. When infected papillomavirus human cervical cells decrease in size and acquire a light rim, which is why they appear empty. Such cells are called koilocytes. It is the detection of koilocytes in an oncocytology smear that allows a cytologist to make a diagnosis of HPV.

Hyperkeratosis. Hyperkeratosis is the appearance of squamous epithelial scales in an oncocytology smear. These cells are usually found in cervical leukoplakia. Leukoplakia is a benign lesion of the cervix, characterized by the presence of a white area on its surface, which is detected during colposcopy (examination of the cervix using a special microscope).
If a smear for oncocytology reveals single scales of squamous epithelium and upon examination no changes are detected on the cervix, then hyperkeratosis has no diagnostic value and such an analysis is considered normal.

Dysplasia, or cervical intraepithelial neoplasia(CIN). When examining a smear for oncocytology, changes in cervical cells characteristic of dysplasia (the presence of atypical cells on the cervix) of varying degrees of severity can be detected. Mild dysplasia is usually a sign of an inflammatory process and is treated with antibacterial and anti-inflammatory drugs. Moderate and severe dysplasia are a precancerous process and require a mandatory additional examination - a cervical biopsy, which involves taking a small piece of tissue from the affected area. This is necessary in order to conduct a thorough examination of the pathological process in the cervix and decide on the need for further treatment.

With confirmed moderate or severe dysplasia, surgical methods are usually used (cauterization, removal of the affected part of the cervix) or the patient is referred to a doctor gynecological oncologist to determine further treatment tactics.

When researching smear for oncocytology in pregnant women, the decision on the need for a cervical biopsy and subsequent treatment - before or after childbirth - is made by the doctor, taking into account the extent of the pathological process and the duration of pregnancy.

If in smear for oncocytology If pronounced inflammatory changes or mild dysplasia are detected, then after anti-inflammatory treatment, a smear for oncocytology is taken again, usually 2–4 weeks after the end of therapy.

Cervical cancer. Detection of atypical cancer cells in an oncocytology smear indicates the presence of cervical cancer and requires urgent consultation pregnant woman from a gynecological oncologist. If any changes are detected in a smear for oncology, a colposcopy is required - this is a procedure for examining the cervix and vaginal walls at high magnification under a special microscope (colposcope).

At the same time, it becomes possible to see pathologically changed areas, evaluate their size, severity, location - after pre-treating them with special solutions (acetic acid, Lugol's solution).

Colposcopy- This is an absolutely painless procedure, and it can be performed at any stage of pregnancy. Preparation for colposcopy is the same as for taking a smear for oncocytology: 24 hours before the examination, the patient should not douche, use vaginal gels or suppositories, ointments or tampons, because this may affect the accuracy of the examination.

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The squamous epithelium in the smear provides very important information about the condition of the vaginal mucosa and the hormonal background of the woman.

Squamous epithelium is several layers of cells that line the inner surface of the vagina. The life of cells is not long-lasting; the inner membrane constantly renews itself by exfoliating old cells and replacing them with young ones. Thanks to this process, squamous epithelial cells are found in smears even in healthy women.

The thickness of the stratified squamous epithelium of the vagina ranges from 150-200 microns. Epithelial cells often contain keratohyalin, similar to that found in stratified keratinizing epithelial cells (skin cells). At the same time, keratinization processes do not occur in the squamous epithelium of the vagina.

Cells of the squamous epithelium of the vagina are capable of accumulating large amounts of glycogen, which, in the process of renewal of the layers of squamous epithelium, enters the vaginal lumen.

Mature squamous epithelium contains several types of cells: basal, parabasal, cells that make up the intermediate layer and cells containing keratogealin grains.

IMPORTANT! Predispose to the development of vaginitis: poor personal hygiene, endocrine disorders, decreased immune status, erratic sex life, insertion of various objects into the vagina for the purpose of obtaining sexual satisfaction.

Treatment of specific vaginitis consists of eliminating the pathogen from the body by prescribing appropriate antibacterial drugs, not only locally, but also systemically. The sexual partner also needs to undergo examination and treatment to prevent re-infection.

It should be noted that there is a type of vaginitis that is not associated with the presence of any infectious agent. They can be caused by the use of “aggressive” soap, thermal effects, injury, or too zealous douching. In this case, treatment comes down to eliminating the action of the factor that provoked the development of inflammation, as well as sitz baths with chamomile decoction, douching with a solution of Chlorhexidine, Dioxidine, Miramistin, and washing with a slightly pink solution of potassium permanganate.

IT IS IMPORTANT TO REMEMBER that prolonged douching can harm the microflora of the vagina and disrupt its acidity. The duration of douching should not be more than 4-3 days, and the frequency of the procedure should not be more than 2 times per day.

At the final stage of treatment, drugs are prescribed to restore the vaginal microflora (Bifidumbacterin, Vagilak, Biovestin, Lactobacterin).

After adequate treatment, the squamous epithelium in the smear decreases to normal levels.

Reduced number of squamous epithelial cells in the smear

A sharp decrease in the number of squamous epithelial cells or their complete absence the smear indicates an unfavorable hormonal background, or rather estrogen deficiency.

This condition is more typical for women during menopause.

Estrogens perform very important functions in a woman’s body.

1. They support the division of epithelial cells, which ensures an optimal rate of renewal of the epithelial layer of the vagina.
2. Create conditions for the formation normal microflora vagina. A sufficient amount of estrogen helps maintain the acidic environment of the vagina, as it is necessary for normal life and the proliferation of lactobacilli. Moreover, the acidic environment of the vagina inhibits the proliferation of opportunistic bacteria.
3. Maintains normal blood circulation in the walls of the vagina.

With the onset of menopause, the female body begins to experience a lack of estrogen, which negatively affects the condition of the vaginal mucosa. It becomes thinner, and the rate of renewal of squamous epithelium gradually decreases. The acidic environment of the vagina becomes alkalized, which serves as a favorable environment for the activity of pathogenic bacteria. The inner vaginal wall becomes dry. Another type of vaginitis develops - atrophic (senile) vaginitis. It is present in almost all women, 7-5 years after the onset of menopause.

When this type of vaginitis occurs, the woman begins to be bothered by the following symptoms.

• Burning, dryness, itching in the vagina. During sexual intercourse, these symptoms are aggravated by an insufficient amount of vaginal lubrication, which is normally abundantly produced by the glands of the genital organs during sexual arousal.
• There may be the appearance of spotting bloody discharge from the vagina. In this case, it is necessary to additionally submit smears from the vagina for cytological examination, since bloody discharge from the vagina, especially after sexual intercourse, can signal the presence of a neoplasm. carried out to detect atypical cells, which confirms the presence malignant tumor. In the absence of such cells, the cause of bleeding can be polyps of the inner surface of the vagina.
• Increased urge to urinate. The urge to urinate does not always indicate a full bladder.

With such a disease, the squamous epithelium is not detected in the smear or its reduced amount is observed.

During an examination by a gynecologist of the inner surface of the vagina using mirrors, a smoothed mucous membrane is revealed.

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Additionally, pH testing is performed to determine the acidity of the vaginal contents.

Treatment of senile vaginitis is aimed at correcting insufficient estrogen levels hormonal drugs local action (Ovestin) in the form of vaginal suppositories and ointments. During sexual intercourse, additional use of lubricants is recommended to prevent injury to the vaginal mucosa.

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