Clinical Cytology

Cytology and microscopy in gynecology

In obstetrics and gynecology, cytologic methods are the basis of prepregnancy care and routine check-ups.

Key areas of investigation:

• Cervical screening: a smear from the surface of the cervix and the endocervical canal allows for the detection of cervical intraepithelial neoplasia. The conditions and frequency of the procedure depend on the woman's age, the time elapsed since the previous examination, and the presence of human papillomavirus infection.
• Evaluation of discharge: in the presence of pathological discharge, an imprint smear must be taken. As part of infectious screening, microscopy of the discharge is performed to detect gonococci (Neisseria gonorrhoeae), trichomonads (Trichomonas vaginalis), and yeast fungi.

Morphological diagnosis is complemented by laboratory tests. For example, a complete blood count (CBC) is necessary to assess the patient's condition dynamics, especially if empirical antibiotic therapy fails to produce an effect in the presence of hyperthermia lasting more than 24–48 hours. It is important to remember that there is no direct correlation between blood parameters and the absolute necessity of prescribing antibiotics—the decision is always made clinically.

Bone marrow examination: diagnosis of Gaucher disease

If Gaucher disease (GD) is suspected, a cytologic examination of the bone marrow is performed. The material used is a myelogram (smear) or trephine biopsy imprints.

The key morphological finding is Gaucher cells. These are specific macrophages whose cytoplasm is overloaded with uncleaved lipids. However, the method has critical limitations:

1. Not an absolute criterion: the presence or absence of these cells does not allow for a definitive confirmation or exclusion of the diagnosis.
2. «Pseudo-Gaucher cells»: macrophages with similar morphology can be found in other diseases accompanied by massive cell destruction (chronic myeloid leukemia, lymphoproliferative disorders). In this case, macrophage overload is associated with the phagocytosis of decay products from the leukemic clone.
3. False-negative results: Gaucher cells are extremely fragile. They are easily damaged during the technical preparation of the smear or accumulate at its periphery—in zones that the laboratory technician might miss.

For the precise verification of GD, enzyme diagnostics (assessment of beta-glucocerebrosidase activity) and the search for biallelic pathogenic mutations in the GBA gene are required.

Ophthalmologic cytology: differential diagnosis of conjunctivitis

Cytologic examination of conjunctival scrapings provides substantial assistance in distinguishing between viral and bacterial eye infections.

Adenoviral conjunctivitis The smear is dominated by a mononuclear reaction. The cellular composition is represented by lymphocytes and monocytes. Specific destructive changes in the conjunctival epithelium are characteristic: lysis, nuclear fragmentation, and the appearance of vacuoles in the cytoplasm. Frequently, destroyed nuclei are located extracellularly. Clinically, the process is accompanied by follicular reaction, upper respiratory tract involvement, and punctate epithelial corneal infiltrates that stain with fluorescein.

Bacterial conjunctivitis Most commonly caused by staphylococcal flora. Unlike viral infection, the smear reveals a colossal number of leukocytes and the microbial flora itself. Clinically, this is accompanied by abundant mucopurulent or purulent discharge, the absence of systemic manifestations (fever, malaise), and intact regional lymph nodes.

Class and exam questions

What else to study on this topic

• Molecular genetic diagnostics of GBA gene mutations
• Enzyme diagnostics of storage diseases
• Rapid diagnosis of adenoviral conjunctivitis by immunochromatography
• Serological infectious screening during pregnancy planning
• Clinical presentation of corneal involvement in viral infections

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