Pap stain; High power
Larger sheet of cells with enlarged nuclei. Note the nuclei are more than 3X larger than the background normal intermediate cells
Note nuclear irregularity and hyperchromasia
Pap stain; Medium Power
The cells with LSIL on left show enlarged nuclei compared to normal intermediate cells on right
Note nuclear hyperchromasia and slight irregularity
Pap stain; High power
Group of superficial cells with LSIL
Note nuclear irregularity and hyperchromasia
Note normal intermediate cell on upper right
Pap stain; High power
Koilocytes
Note nuclear irregularity and sharply demarcated halo
Pap stain; High power
Koilocytic change in superficial cells
Note hyperchromatic nuclei, binucleation, sharply demarcated perinuclear halo and cytoplasmic condensation.
Presence of halo alone is NOT diagnostic of koilocytosis. Nuclear features are required.
Features
• Liquid based
• Cells involved: Superficial and intermediate cells
• Cell may or may not be enlarged
• Koilocytosis: Perinuclear halo with dense cytoplasm around periphery
• Nuclear enlargement (at least 3x size of nucleus of normal intermediate cell)
• Nuclear cytoplasmic ratio: Normal
• Chromatin: hyperchromasia
• Irregular nuclear membrane
• Nucleoli: absent
• Koilocytic nuclei: Wrinkling, hyperchromasia and binucleation
• LSIL may or may not be associated with HPV. The risk of progression is higher in HPV related
• Koilocytosis may or may not be seen with LSIL