Cytology of mucosal inflammation

Objectives and methods of cytological examination

Cytology is used in the presence of ulcers, erosions, diseases of the oral mucosa, periodontium, and when tumors are suspected. The main objectives of the method:

• Precise establishment of the disease nature.
• Determination of the character and degree of inflammation activity.
• Prognostication and evaluation of the effectiveness of ongoing therapy.

Scrapings from ulcerated surfaces, impression smears, saliva (ductal and mixed), lavages, and the contents of gingival pockets are used as material. The obtained material is applied to a glass slide, air-dried, fixed, and stained. For a more in-depth analysis, the morphological method is used — the study of biopsy specimens from which sections are made. They are stained with hematoxylin and eosin, picrofuchsin according to van Gieson, or special techniques are used. For targeted tissue sampling from the lesion (especially in tumor processes), the diagnostic puncture method is used.

Subclinical inflammation and oncogenesis

The inflammatory process in the mucous membrane is often hidden. For example, in the intestinal wall, it can persist with mild symptoms or their complete absence (clinical remission without endoscopic or histological confirmation).

Persistent inflammation against the background of inadequate treatment is the main factor in carcinogenesis — the development of colorectal cancer. Against the background of ulcerative colitis (UC), this cancer proceeds particularly aggressively. The probability of tumor development can be reduced only under the condition of continuous anti-inflammatory therapy.

Morphology of cervical inflammation

In endocervicitis (often caused by gonococci and chlamydia), the acute stage manifests as edema, hyperemia of the mucosa of the external os, erosions, and purulent discharge.

Cytological picture: the smears reveal columnar and stratified squamous epithelial cells with no signs of atypia, as well as an active inflammatory leukocyte reaction. When becoming chronic, the process spreads to the muscular layer (developing cervicitis). The cervix becomes denser and hypertrophied, and Nabothian cysts (ovulae Nabothii) form within its thickness. Treatment in the acute phase is carried out with systemic antibiotics; local intervention is excluded.

In acquired ectropion, which occurs during the epithelization of true erosion, reserve cells form columnar epithelium. On colposcopy, this looks like a velvety surface with red papillae (blood vessels shining through a single layer of cells). An important marker is the transformation zone — the site of replacement of columnar epithelium by squamous epithelium, where metaplasied cells and gland ducts are visible.

Pathology of the uterine mucosa (endometritis)

Acute endometritis is inflammation of the uterine mucosa (affecting the functional and basal layers). Most often it occurs after intrauterine manipulations (abortions, IUD insertion) or childbirth.

With progression, the inflammation involves the muscular layer (endomyometritis), and in severe cases, the entire uterine wall (panmetritis). Diagnostics include:

1. Examination: enlarged, soft uterus, tender along large lymphatic vessels (in the rib region).
2. Blood test: leukocytosis, shift to the left, lymphopenia, increased ESR.
3. Ultrasound: blurred border between the endometrium and myometrium, change in echogenicity, expansion of the cavity with hypoechoic contents.

Instrumental diagnostics of inflammation

Additionally, hardware techniques are used to detect inflammatory foci:

• Electric pulp testing (EPT): evaluates the response of the dental pulp to current. The indicator for an intact tooth is 2–6 µA. With pulp inflammation, it rises to 10–100 µA, and in periodontitis, it exceeds 100 µA.
• Thermography: a method for detecting temperature asymmetry. Acute inflammation (traumatic osteomyelitis) and jaw fractures result in an increased temperature, whereas hemorrhage without suppuration results in a decrease.

Class and exam questions

What else to study on this topic

• Clinical presentation and complications of acute endometritis
• Principles of biopsy specimen staining (hematoxylin-eosin, van Gieson)
• Indications and methods of surgical treatment for cervical ectropion
• Features of performing electric pulp testing (EPT)

Other topics in the "Additional Topics" section

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.