What is the most likely diagnosis of this cervical Papanicolaou preparation?

  • Incorrect. These cells are not atypical enough for SCC, which also tends to show abnormal forms such as “tadpole cells” and dense cytoplasm.

  • Incorrect. The cells of HSIL have a high N/C ratio with smaller cell size than found in LSIL. They are hyperchromatic and have irregular nuclear contours. The cells shown here are too large for HSIL, and HSIL does not typically show koilocytic change on cytology.

  • Incorrect. Reactive atypia shows a more pronounced streaming effect than seen here, less coarse chromatin, decreased N/C ratios, and more regular nuclear contours.

  • Correct. Koilocytes and nuclear enlargement > 3 x the size of an intermediate cell nucleus indicate LSIL. These cells also have “raisinoid” nuclei (nuclei look like raisins).

  • Incorrect. Endocervical adenocarcinoma shows malignant features such as more irregular nuclear contours and a greater degree of pleomorphism. Other hints include squamous dysplasia, a history of dysplasia (LSIL/HSIL) and a relatively young age, which can also help to distinguish the lesion from endometrial adenocarcinoma, which tends to occur in older patients.