Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Camperdown, Australia.
Pathology. 2010 Feb;42(2):113-8. doi: 10.3109/00313020903494110.
Transitional cell metaplasia (TCM) of the cervix and vaginal vault is rarely reported. We sought to describe the clinical and cytological features and cytological differential diagnosis of TCM.
Cervical and vaginal vault smears reported as TCM or smears from patients with histologically confirmed TCM were examined for the following features: cellularity, architecture, background cell population, cell group thickness, cell shape, nuclear features (shape, chromatin, nucleoli, outline), perinuclear haloes, the presence in cell groups of a surface layer of cuboidal cells, and associated pathology. The cases of TCM were compared with smears of conventional atrophy and high grade squamous intraepithelial lesion (HSIL).
Six cases (five cervical, one vaginal vault) of TCM were identified from six patients (age range 34-80 years, median 60 years). The smears showed three-dimensional cell groups (2-5 cells in thickness) composed of oval-shaped cells with small amounts of cytoplasm and spindle/oval-shaped nuclei, with the impression of 'streaming' in some groups. The nuclei showed mild membrane irregularities, evenly distributed chromatin, and small nucleoli. Nuclear grooves were identified in at least occasional cells in four cases. A surface layer of cuboidal cells was identified in two cases. The background contained dysplastic squamous cells in three cases. Atrophic changes were present and in one case some cell groups exhibited transition from TCM at one end to more conventional atrophic parabasal cells at the other.
Awareness of the cytological features of TCM is critical to avoid a false-positive diagnosis of HSIL, and the consequent ramifications for patients. TCM should always be considered in the differential diagnosis of multilayered cell groups in cervicovaginal smears, particularly in peri- and post-menopausal women and in atrophic conditions.
宫颈和阴道穹窿的移行细胞化生（TCM）很少见报道。我们旨在描述 TCM 的临床和细胞学特征及细胞学鉴别诊断。
我们对报告为 TCM 的宫颈和阴道穹窿涂片，以及经组织学证实为 TCM 的患者的涂片，进行了细胞学检查，观察以下特征：细胞密度、结构、背景细胞群、细胞群厚度、细胞形状、核特征（形状、染色质、核仁、轮廓）、核周晕、细胞群表面是否有一层立方细胞，以及相关的病理学特征。将 TCM 病例与常规萎缩和高级别鳞状上皮内病变（HSIL）的涂片进行了比较。
从 6 名患者（年龄 34-80 岁，中位年龄 60 岁）中发现了 6 例（5 例宫颈，1 例阴道穹窿）TCM。涂片显示出三维细胞群（厚度 2-5 个细胞），由具有少量细胞质和梭形/椭圆形核的椭圆形细胞组成，在一些细胞群中呈现出“流动”的印象。细胞核显示出轻微的膜不规则、均匀分布的染色质和小核仁。在至少 4 例中，偶尔可以看到核沟。在 2 例中可以看到表面有一层立方细胞。在 3 例中背景中存在发育不良的鳞状细胞。存在萎缩性改变，在 1 例中，一些细胞群的一端从 TCM 过渡到另一端更为传统的萎缩性基底细胞。
认识 TCM 的细胞学特征对于避免将 HSIL 误诊为假阳性诊断以及对患者的后续影响至关重要。在宫颈阴道涂片的多层细胞群的鉴别诊断中，特别是在绝经前后和萎缩性病变中，应始终考虑 TCM。
