Cambios citolgicos por radiacin
Cambios citolgicos por iatrogeniaDr. Luis Humberto Cruz
Contreras
Cambios regenerativos / Reparativos
Cambios secundarios
DIU
Effects of intrauterine contraceptive devices (IUD). A,B.
Calcified debris characteristic of this condition. C. Calcified
debris with a foreign body giant cell. D. A very small calcified
fragment with concentric calcification, surrounded by macrophages,
shown under high magnification. This structure, although very
small, was similar to a psammoma body. There was no evidence of
neoplasm on careful examination7
Dx Diferencial DIU
Cambios por electrocauterio, calor-frio7 dias
6 semanas1 semana2 semanas4 semanasEffects of cryosurgery and
cautery. A. Overview of a smear obtained 6 weeks after cryosurgery
for carcinoma of the cervix. Marked inflammation, distortion of
squamous cells, and a few suspicious cells with hyperchromatic
nuclei (arrows) are seen. B. Nuclear and cellular enlargement and
nuclear haziness one week after cautery. C. Parabasal cells with
basophilic cytoplasm and somewhat enlarged nuclei showing repair 2
weeks after cautery. D. Smear obtained 4 weeks after cautery
showing markedly atypical metaplastic squamous cells. It is
impossible to determine from this smear pattern whether or not this
patient has been cured. Further follow-up is
essential12Quimioterapia
ThiothepaEffect of chemotherapy on cervical smears. A. Section
of the uterine cervix obtained in 1957 at postmortem examination of
a 12-year-old girl treated for acute leukemia with a variety of
drugs. The tissue pattern closely resembles the warty changes
observed in condylomas. Also note scattered nuclear abnormalities.
B. Effect of Thiothepa administered for a malignant tumor. A large
squamous cell resembling a koilocyte is shown in the cervical
smear15
BusulfanosFigure 18-8 Effects of Myeleran (busulfan) effect in
cervical smears. A. Cell changes very similar to
spontaneously-occurring koilocytosis were observed several years
after onset of busulfan treatment for chronic myelogenous leukemia.
B. Biopsy of cervix corresponding to A showing a warty lesion with
marked koilocytosis, suggestive of an active HPV infection. C.
Nuclear enlargement and hyperchromasia in an atrophic smear of a
woman treated with busulfan for chronic myelogenous leukemia. D.
Postmortem changes in the squamous epithelium of the uterine cervix
of the patient shown in C. The change is suggestive of human
papillomavirus activation.
16Anticonceptivos orales
A. Enlarged nuclei of endocervical cells in a 27-year-old woman,
a long-term user of contraceptive medication. B. The same patient 6
months after discontinuation of therapy. The endocervical cell
pattern was completely normal. C. A multinucleated endocervical
giant cell, strongly resembling the Arias-Stella phenomenon in a
patient on contraceptive medication. D. Biopsy of endocervix
corresponding to smear shown in C. The endocervical lining shows
several large cells with hyperchromatic nuclei. The abnormality
disappeared 6 months after discontinuation of medication17Cambios
citolgicos por radiacinradiacincronologaRADIOTERAPIA
Radiation effect in cervical smears. A. Huge, multinucleated
squamous cells after 60 Gy administered to the uterine cervix. B.
Radiation effect on endocervical cells. The cells are markedly
enlarged and contain huge cytoplasmic vacuoles. C. A huge
multinucleated giant cell after 60 Gy. D. Persisting radiation
effect 4 months after completion of treatment. Sheets of elongated
squamous cells with hazy nuclei may be observed.Persisting
radiation effect. A. Endocervical and squamous cells 5 months after
completion of radiotherapy. Persisting large cytoplasmic vacuoles
and distortion of cell configuration may be noted. B. Same case as
in A. There is a marked atypia of squamous cells with large nuclei
and nucleoli. It is difficult to determine from this smear whether
or not the patient had recurrent cancer. C. Obvious bizarre
squamous cancer cells 6 months after completion of radiation
treatment. In this case, the diagnosis of recurrent cancer was
secure. D. Malignant cells 4 months after completion of
radiotherapy for cervix cancer.
Dx Diferencial Radiacin
Displasia post radiacin
Postradiation carcinoma in situ (dysplasia). A. The original
pattern of invasive squamous carcinoma treated by radiotherapy in
1946. B. Cervical smear obtained 13 years later (in 1959) showing
large dyskaryotic (dysplastic) cells with markedly enlarged nuclei.
C. Classical carcinoma in situ in a biopsy obtained in 1959. D.
Another example of postradiation carcinoma in situ. The smear shows
large granular nuclei with prominent nucleoli and mitoses.29
Postradiation carcinoma of cervix. A. The original squamous
cancer treated by radiotherapy in 1958. B. Smear obtained in 1975
showing markedly abnormal cells corresponding to an intraepithelial
neoplastic lesion. Several of the cells resemble koilocytes,
suggestive of HPV infection. C. Another field of the smear shown in
B. D. Squamous carcinoma in the left external iliac node observed
in 1975, after the smear shown in B and C30
