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ASCP CT practice questions

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Question 1Gynecologic Cytology

Which finding in a cervical cytology specimen is reported under the Bethesda category NILM?

  1. Endocervical adenocarcinoma in situ
  2. Atypical squamous cells, cannot exclude HSIL
  3. Low-grade squamous intraepithelial lesion
  4. Clue cells of bacterial vaginosis Correct answer.

Explanation

NILM includes reactive and inflammatory changes as well as organisms such as those of bacterial vaginosis, Candida, and Trichomonas. Squamous intraepithelial lesions, ASC-H, and adenocarcinoma in situ are epithelial cell abnormalities that are reported separately.

Question 2Gynecologic Cytology

Cervical cytology shows squamous cells with nuclear enlargement about three times the area of an intermediate cell nucleus, finely granular chromatin, and no perinuclear halo. No cells suspicious for HSIL are seen. What is the most appropriate Bethesda interpretation?

  1. ASC-H
  2. ASC-US Correct answer.
  3. LSIL
  4. NILM

Explanation

ASC-US denotes squamous atypia with nuclear enlargement of roughly 2.5 to 3 times normal but without the koilocytic halo of LSIL or the features of HSIL. The absence of a halo and of cells suspicious for HSIL excludes the other categories.

Question 3Gynecologic Cytology

Which cytologic feature is the hallmark of LSIL?

  1. Enlarged cells with abundant orangeophilic cytoplasm and pyknotic nuclei
  2. Nuclei with a sharply defined perinuclear halo and atypia Correct answer.
  3. Syncytial groups with high N/C ratio and irregular nuclear membranes
  4. Small cells with nuclear molding and salt-and-pepper chromatin

Explanation

LSIL is defined by koilocytosis: enlarged, hyperchromatic nuclei surrounded by a sharply demarcated perinuclear halo with relatively abundant cytoplasm. Syncytial high-N/C groups suggest HSIL, and small molded cells suggest a small cell carcinoma.

Question 4Gynecologic Cytology

According to the Bethesda System, a conventional (not liquid-based) cervical smear is satisfactory for evaluation when at least how many well-visualized squamous cells are present?

  1. 8,000 Correct answer.
  2. 5,000
  3. 2,000
  4. 500

Explanation

A conventional smear is considered adequate when approximately 8,000 to 12,000 well-visualized squamous cells are present. Liquid-based preparations require approximately 5,000 cells.

Question 5Gynecologic Cytology

Which organism is identified by small pear-shaped flagellates with pale gray-green cytoplasm and a small eosinophilic nucleus?

  1. Trichomonas vaginalis Correct answer.
  2. Actinomyces israelii
  3. Candida albicans
  4. Leptothrix

Explanation

Trichomonas vaginalis appears as pear-shaped organisms with pale gray-green cytoplasm, a small red (eosinophilic) nucleus, and sometimes visible flagella. It is commonly accompanied by neutrophils and a granular background.

Question 6Gynecologic Cytology

Branching pseudohyphae and budding yeast forms arranged perpendicular to squamous cells ('shish kebab' pattern) are characteristic of which organism?

  1. Candida species Correct answer.
  2. Trichomonas vaginalis
  3. Leptothrix
  4. Chlamydia trachomatis

Explanation

Candida species produce pseudohyphae and spores that may align perpendicularly along squamous cell borders, producing the shish kebab appearance. Candida glabrata typically shows only budding yeast without pseudohyphae.

Question 7Gynecologic Cytology

Clue cells in a cervical smear are best described as:

  1. Squamous cells coated with short rod-shaped bacteria and having a normal nucleus
  2. Squamous cells whose borders are obscured by adherent coccobacilli Correct answer.
  3. Parabasal cells with enlarged nuclei and dense orange cytoplasm
  4. Endocervical cells with multiple intracytoplasmic vacuoles

Explanation

Clue cells are squamous cells covered by adherent coccobacilli that obscure the cell border while the nucleus remains visible. They are the cytologic marker of bacterial vaginosis.

Question 8Gynecologic Cytology

The presence of endocervical glandular cells in a cervical cytology specimen is most useful for documenting:

  1. Absence of endometrial pathology
  2. Ovulation and progesterone effect
  3. HPV infection of the glandular epithelium
  4. Sampling of the transformation zone Correct answer.

Explanation

Endocervical cells indicate that the sampling device reached the transformation zone, where squamous and glandular epithelium meet. Although not required for adequacy under the Bethesda System, their presence documents adequate transformation zone sampling.

Question 9Gynecologic Cytology

Which finding best distinguishes ASC-H from ASC-US?

  1. Numerous neutrophils obscuring the borders of squamous cells
  2. Abundant orangeophilic cytoplasm in superficial squamous cells
  3. Nuclear enlargement accompanied by a perinuclear halo
  4. Hyperchromatic crowded groups with equivocal HSIL features Correct answer.

Explanation

ASC-H is used when atypical squamous cells raise concern for HSIL, typically as small hyperchromatic crowded groups with a high N/C ratio, but the features fall short of a definite HSIL diagnosis. ASC-US shows lesser atypia without features suggesting HSIL.

Question 10Gynecologic Cytology

A smear contains fragments of crowded cells with marked nuclear hyperchromasia, irregular nuclear membranes, and scant cytoplasm; the edges of the groups are smooth and well demarcated. These features most favor:

  1. Reactive squamous metaplasia
  2. LSIL
  3. ASC-US
  4. HSIL Correct answer.

Explanation

HSIL shows hyperchromatic crowded groups with high N/C ratios, irregular nuclear membranes, and loss of polarity, often with smoothly contoured group borders. LSIL instead shows koilocytes with abundant cytoplasm and sharply defined halos.

Question 11Gynecologic Cytology

A smear shows a small group of endocervical-type glandular cells with nuclear enlargement and mild stratification; there is no feathering, rosette formation, or significant nuclear atypia. What is the most appropriate Bethesda interpretation?

  1. Endometrial cells in a woman aged 45 years
  2. AGC, favor neoplastic
  3. AIS
  4. AGC, not otherwise specified Correct answer.

Explanation

AGC, not otherwise specified is used when glandular atypia exceeds reactive change but lacks sufficient features to suggest AIS or invasive carcinoma. Feathering, rosettes, and marked nuclear atypia would push the interpretation toward AGC favor neoplastic or AIS.

Question 12Gynecologic Cytology

Which feature is most characteristic of endocervical adenocarcinoma in situ on cytology?

  1. Single cells with dense orange cytoplasm and pyknotic nuclei
  2. Clusters with abundant vacuolated cytoplasm and signet-ring forms
  3. Multinucleated cells with ground-glass chromatin
  4. Palisading strips with nuclear crowding and rosettes Correct answer.

Explanation

AIS produces pseudostratified strips of columnar cells with nuclear palisading, rosette formation, feathering at the edges, and apoptotic debris. Signet-ring cells and marked vacuolation suggest invasive adenocarcinoma.

Question 13Gynecologic Cytology

Endometrial cells are reported on a Pap test from a 54-year-old postmenopausal woman who is not taking hormone therapy. This finding should be interpreted as:

  1. Abnormal, requiring endometrial evaluation Correct answer.
  2. Evidence of cervical adenocarcinoma in situ
  3. A benign artifact of the sampling device
  4. A normal finding reflecting cyclic shedding

Explanation

In a postmenopausal woman not on hormone therapy, exfoliated endometrial cells are abnormal and raise concern for endometrial hyperplasia or carcinoma, so endometrial sampling is indicated. In premenopausal women under 45, endometrial cells during the first half of the cycle are considered physiologic.

Question 14Gynecologic Cytology

Which cytologic feature is characteristic of herpes simplex virus infection?

  1. Perinuclear halos with enlarged, wrinkled nuclei
  2. Multinucleated cells with nuclear molding and marginated chromatin Correct answer.
  3. Intranuclear inclusions surrounded by a clear halo in glandular cells
  4. Cytoplasmic vacuoles containing magenta inclusions

Explanation

HSV produces multinucleated cells with nuclear molding, chromatin margination, and ground-glass nuclei, sometimes with Cowdry A inclusions. These changes reflect viral cytopathic effect in squamous or metaplastic cells.

Question 15Gynecologic Cytology

A woman with a copper intrauterine device has a smear showing tangled colonies of filamentous bacteria with sulfur granules. The most likely organism is:

  1. Leptothrix
  2. Trichomonas vaginalis
  3. Actinomyces species Correct answer.
  4. Candida glabrata

Explanation

Actinomyces forms tangled filamentous colonies, often with sulfur granules, and is associated with intrauterine devices. Its presence warrants clinical correlation and consideration of device removal.

Question 16Gynecologic Cytology

Which cytologic change is typical of prior pelvic radiation therapy?

  1. Enlarged multinucleated cells with vacuolated cytoplasm Correct answer.
  2. Endocervical cells showing apical feathering and crowding
  3. Small cells with nuclear molding and crushed chromatin
  4. Koilocytes with sharply defined perinuclear halos and nuclear atypia

Explanation

Radiation effect produces cell enlargement, multinucleation, cytoplasmic vacuolation, nuclear smudging, and prominent nucleoli in a clean background. These changes can mimic malignancy but the nuclei remain relatively bland.

Question 17Gynecologic Cytology

A postmenopausal woman not taking hormones has a smear showing sheets of small parabasal cells with a high N/C ratio but uniform, evenly spaced nuclei. What is the most appropriate interpretation?

  1. HSIL
  2. AIS
  3. Atrophic changes Correct answer.
  4. LSIL

Explanation

Atrophic smears are dominated by parabasal cells with high N/C ratios, but the nuclei are uniform and evenly spaced without hyperchromasia or membrane irregularities. This pattern can mimic HSIL and is resolved with a course of estrogen or by recognizing the bland nuclear features.

Question 18Gynecologic Cytology

Tubal metaplasia of the endocervix can mimic AIS. Which feature favors tubal metaplasia?

  1. Ciliated cells among mixed glandular and reserve cells Correct answer.
  2. Marked nuclear enlargement with coarse, irregular chromatin and nucleoli
  3. Feathering of cells at the edges of the groups
  4. Nuclear palisading with rosette formation and crowding

Explanation

Tubal metaplasia contains a mixture of ciliated columnar cells, secretory cells, and reserve cells, and lacks the monotonous atypical population of AIS. Cilia are the most reliable feature separating it from glandular neoplasia.

Question 19Gynecologic Cytology

In cervical cancer screening, a negative high-risk HPV test is most useful because it:

  1. Confirms the presence of koilocytes
  2. Has high negative predictive value for high-grade disease Correct answer.
  3. Detects only HPV types 16 and 18
  4. Replaces the need for cytology in every age group and setting

Explanation

A negative high-risk HPV test has a very high negative predictive value for CIN 3 and cancer, which allows screening intervals to be extended. It does not replace cytology in all settings and does not identify koilocytes.

Question 20Gynecologic Cytology

Strong, continuous block-like p16 immunostaining in a cervical cytology sample is best interpreted as:

  1. Marker of transforming high-risk HPV infection Correct answer.
  2. A marker of endometrial glandular origin
  3. A normal finding in benign endocervical cells
  4. Evidence of a benign reactive squamous change

Explanation

Block-positive p16 reflects accumulation of the protein after high-risk HPV E7 inactivates Rb, and it serves as a surrogate marker of a transforming HPV infection. Patchy or weak staining is nonspecific and can occur in reactive and metaplastic cells.

Question 21Gynecologic Cytology

A cervical smear shows sheets of small cells with scant cytoplasm, nuclear molding, 'salt-and-pepper' chromatin, and crush artifact. The most likely diagnosis is:

  1. HSIL involving endocervical glands
  2. Lymphocytic cervicitis
  3. Endometrial adenocarcinoma
  4. Small cell carcinoma of the cervix Correct answer.

Explanation

Small cell carcinoma shows small cells with scant cytoplasm, nuclear molding, finely granular chromatin, and prominent crush artifact, often in a necrotic background. The differential includes lymphoma and HSIL, but molding and salt-and-pepper chromatin are typical of neuroendocrine carcinoma.

Question 22Gynecologic Cytology

Which finding in a cervical smear most favors metastatic adenocarcinoma over a primary endocervical lesion?

  1. Necrotic background in a patient with breast cancer Correct answer.
  2. Koilocytes adjacent to the abnormal glandular cell groups
  3. Feathering at the edges of the glandular groups
  4. Nuclear palisading in strips of columnar epithelial cells

Explanation

Metastatic adenocarcinoma is suggested by a compatible clinical history, tumor diathesis with necrosis, and cells that do not fit an endocervical origin. Primary endocervical adenocarcinoma can also show necrosis, so the clinical context is essential.

Question 23Gynecologic Cytology

In a cervical smear, psammoma bodies raise greatest concern for which condition?

  1. Follicular cervicitis with germinal centers
  2. Trichomonas vaginalis infection
  3. Serous ovarian carcinoma Correct answer.
  4. Bacterial vaginosis with clue cells

Explanation

Psammoma bodies in cervical cytology raise concern for metastatic serous carcinoma, most often of ovarian or endometrial origin. They can occasionally occur in benign glandular conditions, so the finding requires correlation with the clinical picture.

Question 24Gynecologic Cytology

Follicular cervicitis is characterized by:

  1. Clusters of histiocytes containing psammoma bodies
  2. Sheets of parabasal cells with nuclear atypia
  3. Multinucleated giant cells with viral inclusions
  4. Lymphocytes with tingible-body macrophages Correct answer.

Explanation

Follicular cervicitis shows a polymorphous lymphoid population with tingible-body macrophages, reflecting a germinal center reaction. The mixed population distinguishes it from lymphoma, which shows a monomorphic population.

Question 25Gynecologic Cytology

A pregnant woman's cervical smear shows enlarged glandular cells with hyperchromatic, smudged nuclei and vacuolated cytoplasm; no feathering is seen. These changes most likely represent:

  1. Endocervical adenocarcinoma in situ
  2. Radiation effect
  3. HSIL
  4. Arias-Stella reaction Correct answer.

Explanation

The Arias-Stella reaction occurs in glandular epithelium under hormonal stimulation, especially in pregnancy, and produces enlarged cells with hyperchromatic smudged nuclei and vacuolated cytoplasm. The absence of feathering, rosettes, and mitotic activity helps separate it from AIS.

Question 26Gynecologic Cytology

A normal superficial squamous cell in a cervical smear is best characterized by which feature?

  1. Scant basophilic cytoplasm with a vesicular nucleus
  2. Clear cytoplasm with a large central nucleolus
  3. Abundant eosinophilic cytoplasm with a pyknotic nucleus Correct answer.
  4. Columnar shape with apical mucin vacuoles

Explanation

Superficial squamous cells are mature, glycogen-rich cells with abundant cytoplasm and a small, dense pyknotic nucleus. Their appearance reflects normal squamous maturation at the surface of the cervix or vagina.

Question 27Gynecologic Cytology

Which finding is most typical of a normal Lactobacillus-dominated cervical smear?

  1. Long bacilli with cytolysis of squamous cells Correct answer.
  2. Budding yeast with pseudohyphae
  3. Tangled filamentous bacteria with sulfur granules
  4. Short gram-negative rods covering squamous cells

Explanation

Lactobacilli are long bacilli that produce lactic acid and are part of the normal vaginal flora. Heavy colonization often causes cytolysis of glycogen-rich squamous cells, producing bare nuclei and cytoplasmic fragments.

Question 28Gynecologic Cytology

Which cytologic finding best identifies squamous metaplasia?

  1. Multinucleated cells with nuclear molding
  2. Columnar cells with apical mucin vacuoles
  3. Cohesive sheets of round cells with dense cytoplasm Correct answer.
  4. Isolated cells with high N/C ratio and coarse chromatin

Explanation

Squamous metaplasia appears as cohesive sheets of round-to-oval cells with dense cytoplasm and distinct cell borders. The nuclei are uniform and lack the high N/C ratio and irregular contours of a high-grade lesion.

Question 29Gynecologic Cytology

Koilocytosis is best described as which change?

  1. Parabasal cells with enlarged nuclei and no halo
  2. Multinucleated giant cells with ground-glass inclusions
  3. Endocervical cells with large mucin vacuoles
  4. Squamous cells with a perinuclear halo and nuclear enlargement Correct answer.

Explanation

Koilocytes show a sharply defined perinuclear halo together with nuclear enlargement, hyperchromasia, and irregular nuclear contours. These changes reflect human papillomavirus cytopathic effect and are a hallmark of low-grade squamous intraepithelial lesion.

Question 30Gynecologic Cytology

Trichomonas vaginalis trophozoites in a cervical smear typically appear as which structure?

  1. Long filamentous bacilli
  2. Large cells with intranuclear inclusions
  3. Budding yeast with pseudohyphae
  4. Pear-shaped organisms with eosinophilic granules and a small nucleus Correct answer.

Explanation

Trichomonas trophozoites are pear-shaped organisms with eosinophilic cytoplasmic granules and a small, pale nucleus. Flagella are often difficult to see on routine cervical cytology.

Question 31Gynecologic Cytology

A vaginal vault smear obtained after total hysterectomy typically contains which cell type?

  1. Endometrial glandular cells
  2. Superficial squamous cells Correct answer.
  3. Endocervical glandular cells
  4. Tubal metaplastic cells

Explanation

After total hysterectomy, the cervix and uterus are absent, but vaginal squamous epithelium remains. The smear therefore typically contains superficial and intermediate squamous cells without endocervical or endometrial glandular cells.

Question 32Gynecologic Cytology

Which human papillomavirus types are responsible for most cervical cancers?

  1. Types 42 and 44
  2. Types 6 and 11
  3. Types 16 and 18 Correct answer.
  4. Types 53 and 66

Explanation

High-risk HPV types 16 and 18 account for the majority of cervical cancers worldwide. Types 6 and 11 are low-risk types associated with condylomata rather than invasive cancer.

Question 33Gynecologic Cytology

A cervical cytology report of NILM indicates which finding?

  1. Atypical squamous cells of undetermined significance
  2. Low-grade squamous intraepithelial lesion
  3. No intraepithelial lesion or malignancy Correct answer.
  4. Unsatisfactory for evaluation

Explanation

NILM is the Bethesda category for a negative smear showing no intraepithelial lesion or malignancy. It may still include reactive, inflammatory, or organism-related changes that are not neoplastic.

Question 34Gynecologic Cytology

ASC-US is best defined as which diagnosis?

  1. Definitive koilocytic change
  2. High-grade cells in syncytial fragments
  3. Squamous atypia that does not meet criteria for LSIL or HSIL Correct answer.
  4. Glandular atypia favoring neoplasia

Explanation

ASC-US is a category of uncertainty in which squamous cells show atypia but lack sufficient features for LSIL or HSIL. It is not a definitive diagnosis of a squamous intraepithelial lesion.

Question 35Gynecologic Cytology

Which finding is sufficient for a Bethesda category of LSIL?

  1. Atypical squamous cells with no definite lesion
  2. Koilocytes involving superficial or intermediate cells Correct answer.
  3. Parabasal cells with high N/C ratio and irregular nuclear membranes
  4. Endocervical cells with nuclear stratification and mitoses

Explanation

LSIL encompasses human papillomavirus cytopathic effect, including koilocytosis, and mild dysplasia, usually involving mature superficial or intermediate squamous cells. High-grade features in small cells indicate HSIL rather than LSIL.

Question 36Gynecologic Cytology

Which feature favors HSIL over LSIL?

  1. High N/C ratio with irregular nuclear membranes in small cells Correct answer.
  2. Binucleation
  3. Perinuclear halo
  4. Abundant cytoplasm

Explanation

HSIL is characterized by small cells with a high N/C ratio, irregular nuclear contours, hyperchromasia, and loss of polarity. Perinuclear halos and binucleation are more typical of HPV cytopathic effect in LSIL.

Question 37Gynecologic Cytology

The Bethesda category AGC indicates which finding?

  1. Normal endometrial cells
  2. Squamous cell carcinoma
  3. Glandular cell atypia that may be reactive or neoplastic Correct answer.
  4. Definite endocervical adenocarcinoma in situ

Explanation

AGC is a category of glandular cell atypia that cannot be classified as benign, adenocarcinoma in situ, or invasive cancer. It requires further evaluation because it may represent a reactive or neoplastic process.

Question 38Gynecologic Cytology

Which cytologic finding in a postmenopausal woman raises concern for endometrial adenocarcinoma?

  1. Superficial squamous cells with perinuclear halos
  2. Numerous lactobacilli with cytolysis
  3. Flat sheets of uniform endocervical cells with a honeycomb pattern
  4. Atypical glandular clusters with prominent nucleoli and debris Correct answer.

Explanation

Endometrial adenocarcinoma often sheds three-dimensional atypical glandular clusters with prominent nucleoli, irregular nuclear contours, and necrotic debris. Benign endocervical cells form flat honeycomb sheets, and lactobacilli are normal flora.

Question 39Gynecologic Cytology

Tumor diathesis in a cervical smear refers to which background finding?

  1. Multinucleation of endocervical cells
  2. Necrotic debris, blood, and inflammation with invasive carcinoma Correct answer.
  3. Sharply defined perinuclear halos around atypical squamous cells
  4. Psammoma bodies within glandular clusters

Explanation

Tumor diathesis is a background of necrotic debris, blood, and inflammatory cells that accompanies invasive carcinoma. It helps distinguish invasive cancer from an intraepithelial lesion.

Question 40Gynecologic Cytology

Which feature favors a benign repair reaction over carcinoma?

  1. Cohesive flat sheets with uniform nuclei and prominent nucleoli Correct answer.
  2. Three-dimensional clusters with marked nuclear pleomorphism
  3. Single cells with high N/C ratio
  4. Tumor diathesis

Explanation

Repairing epithelium typically forms cohesive flat sheets with uniform nuclei, prominent nucleoli, and smooth community borders. Carcinoma shows three-dimensional clusters, marked pleomorphism, single cells, and tumor diathesis.

Question 41Gynecologic Cytology

Cytomegalovirus infection in a cervical smear is suggested by which finding?

  1. Budding yeast with pseudohyphae
  2. Pear-shaped flagellated organisms
  3. Multinucleated cells with ground-glass nuclei
  4. Enlarged cells with intranuclear and intracytoplasmic inclusions Correct answer.

Explanation

Cytomegalovirus produces enlarged cells with a large intranuclear inclusion surrounded by a halo and smaller intracytoplasmic inclusions. Ground-glass nuclei suggest herpes simplex virus rather than cytomegalovirus.

Question 42Gynecologic Cytology

Decidual cells in a cervical smear during pregnancy are best described as which type of cell?

  1. Large polygonal cells with abundant cytoplasm Correct answer.
  2. Small cells with scant cytoplasm and nuclear molding
  3. Squamous cells with perinuclear halos
  4. Columnar cells with apical mucin vacuoles

Explanation

Decidual cells are large polygonal cells with abundant eosinophilic cytoplasm and prominent nucleoli. They can mimic glandular neoplasia but lack the crowded, hyperchromatic clusters of adenocarcinoma.

Question 43Gynecologic Cytology

Which change is commonly associated with an intrauterine device on cervical cytology?

  1. Koilocytes with perinuclear halos
  2. Psammoma bodies
  3. Multinucleated giant cells with ground-glass inclusions
  4. Vacuolated endocervical cells with nuclear enlargement Correct answer.

Explanation

Intrauterine devices can cause reactive glandular changes, including cytoplasmic vacuolation, nuclear enlargement, and prominent nucleoli. These changes may mimic adenocarcinoma in situ and must be interpreted in the clinical context.

Question 44Gynecologic Cytology

Endometrial cells on a cervical smear from a menstruating woman are generally interpreted how?

  1. Expected during the first half of the menstrual cycle Correct answer.
  2. Diagnostic of endocervical adenocarcinoma in situ
  3. Always indicative of endometrial carcinoma
  4. A feature of herpes simplex infection

Explanation

Endometrial cells can normally exfoliate during the first half of the menstrual cycle, especially during menses. In a premenopausal woman they are not abnormal by themselves, but in a postmenopausal woman they require evaluation.

Question 45Gynecologic Cytology

Cytologic LSIL most often corresponds to which histologic finding?

  1. Invasive carcinoma
  2. Normal tissue
  3. CIN 3
  4. CIN 1 Correct answer.

Explanation

LSIL corresponds to HPV cytopathic effect or mild dysplasia, which is histologically CIN 1. CIN 2 and CIN 3 correspond to HSIL.

Question 46Gynecologic Cytology

Which feature best favors adenocarcinoma in situ over invasive adenocarcinoma on cervical cytology?

  1. Smooth borders and no tumor diathesis Correct answer.
  2. Koilocytes
  3. Prominent nucleoli and tumor diathesis
  4. Psammoma bodies

Explanation

Adenocarcinoma in situ shows crowded, hyperchromatic glandular clusters with smooth borders and lacks tumor diathesis. Invasive adenocarcinoma more often shows irregular cluster borders, prominent nucleoli, and necrotic background debris.

Question 47Gynecologic Cytology

Which finding favors an endometrial rather than an endocervical origin for atypical glandular cells?

  1. Prominent apical vacuoles in columnar cells
  2. Small cells in tight three-dimensional clusters Correct answer.
  3. Columnar cells with apical mucin vacuoles
  4. Honeycomb sheets with distinct cell borders and mucin

Explanation

Endometrial glandular cells are smaller, have scant cytoplasm, and form tight three-dimensional clusters. Endocervical cells are columnar, contain mucin, and often form flat honeycomb sheets.

Question 48Gynecologic Cytology

Which feature most strongly suggests a high-grade glandular lesion rather than reactive endocervical cells?

  1. Abundant mucin vacuoles
  2. Honeycomb arrangement of cells
  3. Prominent nucleoli in cohesive sheets
  4. Nuclear stratification, hyperchromasia, and apoptotic bodies Correct answer.

Explanation

High-grade glandular lesions show nuclear stratification, hyperchromasia, mitoses, and apoptotic bodies with loss of the normal honeycomb pattern. Reactive endocervical cells may have nucleoli but retain orderly cohesion and mucin production.

Question 49Gynecologic Cytology

Which finding most strongly favors HSIL over squamous metaplasia?

  1. Irregular nuclei with high N/C ratio Correct answer.
  2. Uniform nuclei with smooth nuclear contours
  3. Intercellular bridges between cohesive cells
  4. Distinct cell borders with dense cytoplasm

Explanation

HSIL shows irregular nuclear contours, high N/C ratio, hyperchromasia, and loss of polarity. Squamous metaplasia has uniform nuclei, distinct cell borders, and intercellular bridges.

Question 50Gynecologic Cytology

Which finding favors ASC-H over LSIL?

  1. Cytolysis with lactobacilli
  2. Small cells with high N/C ratio Correct answer.
  3. Perinuclear halos with nuclear enlargement
  4. Binucleation with abundant cytoplasm

Explanation

ASC-H is used when a high-grade squamous lesion is suspected but criteria for HSIL are not fully met. Small cells with a high N/C ratio raise this concern, whereas koilocytic halos favor LSIL.