Cervical cytology: Radiation and other therapy effects

Abstract

The different treatment options for carcinoma cervix include radiation, chemotherapy, and surgical treatments. Cytological analysis of smears is crucial for patient follow-up to determine response to therapy and to diagnose the persistence or recurrence of malignancy. Anatomical alterations and changes in cell morphology following radiation or chemotherapy make collecting and interpreting cervical cytology samples difficult. These issues can be mitigated by liquid-based cytology. Ionizing radiation is used in radiotherapy (RT) to kill cells. It is important that cytologists are aware of alterations in morphology of the cells. Radiation can cause cytoplasmic and nuclear changes. Cellular enlargement, vacuolation, granularity loss, and other changes linked with cell death are examples of cytoplasmic alterations. Nuclear enlargement and multinucleation are the most frequent nuclear alterations. These changes are determined by the amount of time that has passed since radiation. It should be emphasized that no one characteristic is pathognomonic. Post-irradiation dysplasia is a condition described as abnormal cellular changes in non-neoplastic epithelial cells after RT. Chemotherapy causes comparable alterations as radiation but impacts fewer cells. Busulfan and other chemotherapeutic treatments may produce morphological alterations, which cytologists must be aware of and able to identify. Immunosuppressive treatments, hormonal therapy, and tamoxifen are some of the other drugs that might cause changes in cervical morphology. Surgical methods used in the detection and treatment of cervical cancer may potentially cause alterations as a result of thermal damage and healing. For the treatment of cervical lesions, electrocautery and the loop electrosurgical excisional procedure are available. These procedures employ electric current ablation leading to ischemic changes in the cervical smear. Cytological analysis of smears following treatment with these modalities necessitates a comprehensive history, kind of therapy, and duration of treatment.

Keywords: Cervical Smear; Cytology; Pap smear; Radiation; Uterine Cervical Neoplasms.

Figure 1:

(a) Conventional Pap smear and (b) liquid-based cytology (LBC) preparation showing acute radiation changes: Superficial and intermediate cells along with inflammation, necrotic debris in the background (×10). LBC smear shows a cleaner background.

Figure 2:

(a and b) Conventional smear showing multiple cytoplasmic vacuolation and LBC preparation showing a single large vacuole indenting the nucleus (×10).

Figure 3:

LBC preparation: Large cell size with maintained N: C ratio. Multiple cytoplasmic vacuoles (×40).

Figure 4:

(a-d) LBC preparation showing binucleation (a, ×40), multinucleation (b, ×10), nuclear smudging (c, ×10), cellular gigantism with bland nucleus (d, ×10).

Figure 5:

(a and b) Conventional smear showing pus balls, that is, invasion of epithelial cells by polymorphs (a-×10, b-×40).

Figure 6:

(a and b) Conventional Pap smear showing cytoplasmic vacuolation in malignant cells (a-×20, b-×40).

Figure 7:

Conventional smear (a and b) showing chronic radiation changes in the form of atrophy in LBC preparation (c): Atrophic smear pattern in 45-year-old women 18 months after radiation (×10).

Figure 8:

(a and b) Conventional smear from a patient with persistent carcinoma, malignant cells without radiotherapy effect (a-×10, b-×20).

Figure 9:

(a and b) Conventional smear: Recurrent squamous cell carcinoma 10 months after radiation therapy in a 45-year-old woman (×10).

Figure 10:

LBC preparation: Cells showing post-radiation dysplasia in the lower half of the field.

Figure 11:

Conventional smear: Granular background and disintegrating squamous and glandular cells showing features of ischemia after cautery (×10).