Page 888 - Atlas of Histology with Functional Correlations

lead to cervical cancer.

FIGURE 21.32 | Vaginal Exfoliate Cytology

(Vaginal Smear) During Different Reproductive

Phases

Vaginal exfoliate cytology (vaginal smear) is correlated with the ovarian cycle.
The presence of certain cell types in the smear permits the recognition of the
follicular activity during normal menstrual phases or after hormonal therapy.

Also, exfoliate cytology together with cells from the endocervix provides
information for the early detection of cervical or vaginal cancers.

This figure illustrates cells in vaginal smears during different menstrual
cycles, early pregnancy, and menopause. A combination of hematoxylin, orange

G, and eosin azure facilitates the recognition of different cell types. In most
phases, the surface squamous cells show small, dark-staining pyknotic nuclei and
an increased amount of cytoplasm.

Figure (a) illustrates vaginal cells collected during the postmenstrual phase
(5th day of the menstrual cycle). The intermediate cells (1) from the

intermediate cell layers (precornified superficial vaginal cells) predominate
including a few superficial acidophilic (2) cells and leukocytes.

Figure (b) represents a vaginal smear during the ovulatory phase (14th day)
of the menstrual cycle. There is a scarcity of intermediate cells (8) and an

absence of leukocytes, and the large superficial acidophilic cells (9) characterize
this phase. This smear characterizes the high estrogenic stimulation prior to
ovulation. The superficial acidophilic cells (8) mature during increased estrogen
levels and become acidophilic. A similar type of smear is seen when a
menopausal woman is treated with high estrogen doses.

Figure (c) represents a vaginal smear during the luteal (secretory) phase
and represents the effects of increased progesterone. The large intermediate
cells (3) with folded borders aggregate into clumps and characterize the smear.
Superficial acidophilic cells (4) and leukocytes are scarce.

Figure (d) represents a vaginal smear during the premenstrual phase. This
stage is characterized by a predominance of grouped intermediate cells (10)
with folded borders, an increase in neutrophils (11), a scarcity of the superficial
acidophilic cells (12), and an abundance of mucus.

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