Image 1: Cytopathology (AKA: cytology) in medicine studies the features of cells, and is a field of pathology with special sample preparations and sample evaluatory processes. These cellular preparations have very few (low or high power) architectural features representative of their in-situ appearance - they have been scraped or suctioned from their in-situ location and architectural qualities are generally lost.

This specimen at low power shows individual cells and small cell clusters relatively evenly distributed over the slide. Even at this power one can appreciate a mixture of bluish and reddish cells; cytology preparations are not stained with H/E, and the more red the cytoplasm in this particular preparation, the more cytokeratin that is being produced. This specimen is a typical pap smear, showing a predominance of exfoliated squamous cells that have been lightly scraped from the ectocervix, smeared on a slide, and then stained for microscopic evaluation. Scraping helps to disrupt cell junctions.

Question: What type (including descriptors) of epithelium line the ectocervix and vagina? The endocervix?

Question: What type of cell junction does keratin help anchor in the cytoskeleton?

On higher power, note that the squamous cells have voluminous cytoplasm compared to their fairly small, distinct nucleus. Cells with bluer cytoplasm came from a location closer to the basal layer, have slightly larger nuclei, and would normally be producing less cytokeratin; cells with redder cytoplasm came from a more superficial location, have smaller nuclei, and produce more intracellular cytokeratin. Particularly prominent, a greyish haze is seen surrounding/covering most of the squamous cells. These are clusters and mats of bacteria, which are producing the typical pap smear appearance of bacterial vaginosis - a relative overgrowth of the normal cervical bacterial flora. Clinical features may include a foul-smelling discharge, burning with urination or possibly pruritis. Also note the features and presence of interspersed inflammatory cells among the squamous cells. They will have similar, but somewhat different features than what would be seen on H/E slide preparations.

Image 2: The intrapelvic genital organs are partially covered by a hemorrhagic mass that obscure bilateral tubes and the right ovary. The hemorragic material is shiny and slightly stringy. A lack of clearly definitive suppuration (pus) is present in this image, and further gross and/or histological evaluation would be needed to better define the gross pathology (i.e., circulatory/hemorrhagic, inflammatory, etc.) in this image. The remaining visible surfaces of the uterus and left ovary are relatively unremarkable.

Question: Given the stringy quality of the hemorrhagic material, what component(s) would be expected histologically?

Image 3: Dissection into the hemorrhagic mass reveals the right fallopian tube. It is markedly expanded and its surface is covered by hemorrhage and suppurative exudate. Breadloafing of the tube reveals it's distended by exudate, consisting of pale yellow, creamy fluid. Several small peritubal abscesses are also identified, and small abscesses are found around the right colon and appendix.

Question: Histologically, suppurative/purulent exudate is composed of what components?

Question: Suppurative/purulent exudate is what type of necrosis?

Image 4: The tubal epithelium is heavily infiiltrated by a neutrophilic infiltrate. Pus is seen within the lumen, consisting of abundant neutrophils, necrotic cellular debris (dead/dying neutrophils and tubal epithelium), dead/dying bacteria, and proteinaceous edema fluid.

Image 5: This tissue section highlights the pathology in patient's left fallopian tube. On low power, the tubal epithelium appears basophilic. The basophilia extends into the adjacent soft tissue in an almost concentric fashion. The peritubal soft tissue appears thickened, and hemorrhage and/or congested vessels can be appreciated where tubal surface is present (lower portion of image).

At higher power, the tubal epithelium is infiltrated by a mixed inflammatory infiltrate, implying both mononuclear and polynuclear inflammatory cells are present. Neutrophils can be seen in the lumen, in and around the epithelium, and populating the lamina propria. As one moves into the muscular subserosa, the infiltrate becomes much more mononuclear in quality, consisting of mostly lymphocytes. The subserosa and serosa also show marked thickening, as abundant lymphocytes and loose connective tissue now expand this histologic region. At the serosal surface, features of granulation tissue can be appreciated - angiogenesis, extravasated red blood cells, mixed inflammation, and new collagen are evident.

Question: Contrast the changes involving the left and right fallopian tubes.

Question: Describe a temporal relationship between the changes involving the fallopian tubes.