PAP Smear

The PAP-TEST (PAP smear, Papanicolaou test) is a screening test used in gynecology. Main purpose of the test is to detect pre-cancerous lesions called squamous intraepithelial lesion (SIL), which are often caused by sexually transmitted human papillomaviruses. The test may also detect infections and abnormalities in the endocervix and endometrium. Gynecologist/obstetrician collect cells from the uterine cervix and the endocervix using speculum/Ayre’s spatula. The cells are examined under a microscope to look for abnormalities. Changes can be treated, thus preventing cervical cancer.

Cytological report according to the Bethesda system:

 Negative for SIL

  • normal findings
  • non-specific reactive changes
  • inflammatory changes: Yeasts
  • Bacteria
  • Thrychomonas Vaginalis
  • Actinomyces
  • Herpes Virus

 Squamous cell abnormalities

  •  Atypical squamous cells of undetermined significance (ASCUS)
  • Atypical squamous cells – cannot exclude HSIL (ASCH)
  • Atypical Glandular Cells not otherwise specified (AGUS)
  • Low-grade squamous intraepithelial lesion (L-SIL)
  • High-grade squamous intraepithelial lesion (H-SIL)

 Malignant cells

  •  Squamous cell carcinoma
  • Adenocarcinoma  (if possible specify endocervical or endometrial origin)

Photo gallery

(click tumbnail to view high quality images)

Negative for SIL: normal findings

 superficial, intermediate & immature squamous cells

 glycogen rich intermediate cells


 endocervical cells – “palisading pattern”

 endocervical cells – “honeycomb pattern”

 endometrial cells

Negative for SIL: non-specific reactive changes

 metaplastic cells

 metaplastic cells


Negative for SIL: inflammatory changes

 Bacterial flora


 Budding Yeasts

 Trychomonas Vaginalis

Squamous cell abnormalities: ASCUS

Glandular cell abnormalities: AGUS

Squamous cell abnormalities: L-SIL



 CIN1 (Cervical intraepithelial Neoplasia – Mild Displasia)

Squamous cell abnormalities: H-SIL

 CIN2 (Cervical intraepithelial Neoplasia – Moderate Displasia)

 CIN3 (Cervical intraepithelial Neoplasia – Severe Displasia)

 CIS (Cervical Carcinoma in Situ)

Malignant cells: Squamous cell carcinoma

 Keratinizing Spindle Cell Carcinoma

 Keratinizing Spindle Cell Carcinoma

Malignant cells: Endocervical Adenocarcinoma

 Endocervical Adenocarcinoma (in Situ)

 Endocervical Adenocarcinoma (invasive)

Malignant cells:  Endometrial Adenocarcinoma

 Endometrial Adenocarcinoma

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  4. Excellent photos and job, i like to see them and learn more! I think that will be better if explain exactly the diagnostic points at every photo. 🙂


  5. Funny cytology !


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  7. awarif ahmed

    u don’t know how help me in my next exam by this pic so thanx


  8. Hai friend,
    Thanks for you are kind help . Its very helpful to me….
    If u dont mind , i need some more information about bethesda system of cytologic classification. If its u have pls send meeee…
    Thanking u…….


  9. Gopi Thangavelu

    Good posts Davide.. Helping a lot for learner.


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  11. nice pics, but each pic should be labeled. It should be told that how to distinguish bet
    1-endometrials and group of endocervicals,
    2- benign and malignant endometrial cells,
    3–squamous metaplastics from HSIL


  12. I am so grateful for finding your website. I can’t wait to see more. I am lecturer in Cytology at the Central University of Technology in South Africa. I will most definitely be sharing this website with my students.


    • My dear,
      I’m glad you appreciate my job. I’m busy at the moment and I don’t have too much time to put new content. I’m studying at university master in management of sanitary professions. Stay tuned.



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