Gynecological and Breast Cytopathology Board Review and Self-Assessment

Gynecological and Breast Cytopathology Board Review and Self-Assessment

Walid E. Khalbuss Marilee Means Editors Gynecological and Breast Cytopathology Board Review and Self-Assessment

Editors Walid E. Khalbuss, MD, PhD, FIAC Director of Cytology and Cytopathology Fellowship Program University of Pittsburgh Medical Center Shadyside Hospital Pittsburgh, Pennsylvania, USA Marilee Means, PhD, SCT(ASCP) School of Health Professions University of Kansas Medical Center Kansas City, Kansas, USA ISBN 978-1-4614-7269-8 ISBN 978-1-4614-7270-4 (ebook) DOI 10.1007/978-1-4614-7270-4 Springer New York Heidelberg Dordrecht London Library of Congress Control Number: 2013941370 Springer Science+Business Media New York 2013 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, speci fi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on micro fi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. Exempted from this legal reservation are brief excerpts in connection with reviews or scholarly analysis or material supplied speci fi cally for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work. Duplication of this publication or parts thereof is permitted only under the provisions of the Copyright Law of the Publisher s location, in its current version, and permission for use must always be obtained from Springer. Permissions for use may be obtained through RightsLink at the Copyright Clearance Center. Violations are liable to prosecution under the respective Copyright Law. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a speci fi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com)

I dedicate this book to my beloved family, my teachers, mentors, and trainees. Walid E. Khalbuss I dedicate this book to my parents, my children, and my supportive husband as well as the many great pathologists who have shared both their knowledge and their friendship with me. Marilee Means

Preface This book provides a comprehensive in-depth systems-based review of gynecological cytology including cytomorphology, pitfalls, and ancillary testing presented in a high-yield review followed by board-type questions and discussions. It is an excellent review and self-assessment for pathologists, cytopathologists, and cytologists, as well as cytology trainees (e.g., pathology residents, cytopathology fellows, and cytotechnology students). The book includes ten chapters covering technique, cytomorphology, ancillary testing, management, legal, and QA topics. Each chapter contains introductory high-yield review on the subject with tables and key points emphasizing useful criteria and concepts needed to make diagnoses in common and uncommon cases and to avoid diagnostic pitfalls. The book contains 64 summary tables, a wealth of full high-quality color photomicrographs of over 784 images, and review questions of 736 text-based and image-based multiplechoice questions (MCQs) that focus on practical diagnostic knowledge that will be useful to cytology trainees seeking basic information and also those with more experience who would like to fi ne-tune their skills. The book also features chapters dedicated to breast FNA, Pap test clinical management, laboratory management, and quality assurance as related to gynecological cytology. Pittsburgh, PA, USA Kansas City, KS, USA Walid E. Khalbuss Marilee Means vii

Acknowledgement We are indebted to Dr. Laura Z. Tabatabai for her meticulous review of this entire book and for sharing her pearls of wisdom with us. ix

Contents 1 The Pap Test: Technique and Reporting................................ 1 Marilee Means and Walid E. Khalbuss 2 Human Papillomavirus (HPV) Infection and Cervical Lesions............. 49 Chengquan Zhao, Huaitao Yang, Marilee Means, and Walid E. Khalbuss 3 Normal, Infectious, and Reactive Changes in the Pap Test................. 95 Marilee Means and Walid E. Khalbuss 4 Squamous Lesions in the Pap Test..................................... 177 Marilee Means and Walid E. Khalbuss 5 Glandular Lesions in the Pap Test..................................... 263 Walid E. Khalbuss and Marilee Means 6 Hyperchromatic Crowded Groups (HCGs) in the Pap Test................ 311 Marilee Means and Walid E. Khalbuss 7 Challenging and Uncommon Lesions in the Pap Test..................... 357 Jing Yu, Pamela Michelow, and Walid E. Khalbuss 8 Management Issues and Quality Assurance (QA) in the Pap Test........... 401 Asif Loya, Noreen Akhtar, Marilee Means, and Walid E. Khalbuss 9 Pelvic Washings for Gynecological Lesions............................. 425 Marilee Means and Walid E. Khalbuss 10 Breast FNA: Cytomorphology and Diagnostic Pitfalls.................... 477 Reda S. Saad, Walid E. Khalbuss, and Marilee Means Index................................................................. 559 xi

Contributors Walid E. Khalbuss, MD, PhD, FIAC Director of Cytology and Cytopathology Fellowship Program, University of Pittsburgh Medical Center Shadyside Hospital, Pittsburgh, PA, USA Marilee Means, PhD, SCT(ASCP) School of Health Professions, University of Kansas Medical Center, Kansas City, KS, USA Reda S. Saad, MD, PhD, FRCPC Department of Pathology, Hotel Dieu Grace Hospital, Windsor, ON, Canada Huaitoa Yang, MD, PhD Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA Jing Yu, MD, PhD Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA Chengquan Zhao, MD Department of Pathology, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA, USA Noreen Akhtar, FCPS, MBBS Department of Pathology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Punjab, Pakistan Asif Loya, MD, MBBS Department of Pathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Punjab, Pakistan Pamela Michelow, MBBCh, MSc Cytology Unit, Department of Anatomical Pathology, National Health Laboratory Service, University of Witwatersrand, Johannesburg, Gauteng South Africa xiii