{"id":6265,"date":"2023-04-20T08:22:13","date_gmt":"2023-04-20T08:22:13","guid":{"rendered":"https:\/\/www.eurocytology.eu\/course\/alteracoes-citologicas-reativas\/"},"modified":"2023-04-20T08:22:13","modified_gmt":"2023-04-20T08:22:13","slug":"alteracoes-citologicas-reativas","status":"publish","type":"course","link":"https:\/\/www.eurocytology.eu\/pt-pt\/course\/alteracoes-citologicas-reativas\/","title":{"rendered":"Altera\u00e7\u00f5es citol\u00f3gicas reativas"},"content":{"rendered":"
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Os efeitos da les\u00e3o epitelial <\/strong><\/h3>\n

A les\u00e3o do epit\u00e9lio cervical resulta em uma resposta inflamat\u00f3ria caracterizada por altera\u00e7\u00f5es localizadas e sist\u00eamicas no tecido. No local da les\u00e3o h\u00e1, obviamente, danos localizados nas c\u00e9lulas epiteliais que apresentam altera\u00e7\u00f5es degenerativas citoplasm\u00e1ticas e necrose coagulativa dos n\u00facleos.<\/p>\n

No estroma subjacente, veremos as mudan\u00e7as sist\u00eamicas que o corpo usa para remover a agress\u00e3o e reparar o dano. H\u00e1 hiperemia dos vasos papilares para aumentar o fluxo sangu\u00edneo para a \u00e1rea, exsuda\u00e7\u00e3o de plasma no tecido circundante, e assim, trazer produtos sangu\u00edneos, como a fibrina, e promover a migra\u00e7\u00e3o de polimorfos para o local de infec\u00e7\u00e3o ou les\u00e3o.<\/p>\n

Estas altera\u00e7\u00f5es ao tecido n\u00e3o s\u00e3o espec\u00edficas e ocorrem independentemente da causa da les\u00e3o.<\/p>\n

 <\/h4>\n

Altera\u00e7\u00f5es citol\u00f3gicas observadas nas les\u00f5es <\/strong><\/h4>\n

Se um esfrega\u00e7o cervical \u00e9 colhido em um colo lesado, precisamos considerar tanto as c\u00e9lulas que est\u00e3o degenerando ap\u00f3s a les\u00e3o, como c\u00e9lulas que est\u00e3o regenerando o epit\u00e9lio lesado.<\/p>\n

 <\/h4>\n

Altera\u00e7a\u00e7\u00f5es Degenerativas<\/h4>\n

O citoplasma das c\u00e9lulas submetidas a altera\u00e7\u00f5es degenerativas mostrar\u00e1 perda dos bordos definidos, o citoplasma \u00e9 fr\u00e1gil, rompe-se, levando a uma perda parcial ou completa do citoplasma, o esfrega\u00e7o conter\u00e1 ent\u00e3o, os n\u00facleos remanescentes. Halos perinucleares est\u00e3o presentes na maioria das infec\u00e7\u00f5es juntamente com vacuoliza\u00e7\u00e3o (apar\u00eancia de tecido acometido por tra\u00e7a). Polimorfos podem estar presentes nos vac\u00faolos.<\/p>\n

Os n\u00facleos das c\u00e9lulas degeneradas inicialmente mostrar\u00e3o incha\u00e7o ou retra\u00e7\u00e3o (devido a incapacidade de controlar a entrada e sa\u00edda de \u00e1gua atrav\u00e9s da membrana celular) levando eventualmente \u00e0 picnose. O n\u00facleo tem uma membrana opaca, borrada e cromatina agrupada. Eventualmente e finalmente ocorre a cariorrex (quebra nuclear) e a cari\u00f3lise (dissolu\u00e7\u00e3o nuclear). A resposta inflamat\u00f3ria tamb\u00e9m formar\u00e1 um exsudato rico em prote\u00ednas no qual numerosos polimorfos se tornar\u00e3o incorporados. Ocasionalmente, os polimorfos s\u00e3o t\u00e3o numerosos que obscurecem as c\u00e9lulas epiteliais no esfrega\u00e7o e tornam o esfrega\u00e7o inadequado para avalia\u00e7\u00e3o, os detritos celulares necr\u00f3ticos tamb\u00e9m podem ser vistos em segundo plano.<\/p>\n

 <\/h4>\n

Altera\u00e7\u00f5es Regenerativas<\/h4>\n

A cicatriza\u00e7\u00e3o do epit\u00e9lio ulcerado ou erosado \u00e9 realizada atrav\u00e9s da prolifera\u00e7\u00e3o da camada de c\u00e9lulas basais do epit\u00e9lio escamoso adjacente e pela expans\u00e3o das c\u00e9lulas de reserva do endot\u00e9lio local e das criptas. Inicialmente a \u00e1rea lesada \u00e9 coberta por c\u00e9lulas metapl\u00e1sicas imaturas que eventualmente se transformam em epit\u00e9lio escamoso ou colunar maduro.<\/p>\n

As altera\u00e7\u00f5es regenerativas s\u00e3o caracterizadas por arranjos de c\u00e9lulas metapl\u00e1sicas colunares e imaturas com n\u00facleos grandes e nucl\u00e9olos proeminentes ou cromocentros que refletem a atividade mit\u00f3tica recente.<\/p>\n

 <\/p>\n

\"\"<\/a>
Figure 9b-13b: Repair change at low power in a conventional smear showing prominent nucleoli and occasional mitoses<\/figcaption><\/figure>\n
\"\"<\/a>
Figure 9b-13b. High-power appearance in LBC preparation (reproduced from Figure 29 in Denton et al. 2008)<\/figcaption><\/figure>\n

 <\/p>\n

Outras condi\u00e7\u00f5es inflamat\u00f3rias da c\u00e9rvice<\/strong><\/h3>\n

Cervicite Atr\u00f3fica<\/span><\/p>\n

As c\u00e9rvices atr\u00f3ficas s\u00e3o particularmente suscept\u00edveis \u00e0 infec\u00e7\u00e3o. Um esfrega\u00e7o atr\u00f3fico raramente tem um fundo claro, pode conter numerosos polimorfos, \u00e1reas com a presen\u00e7a de muco e as c\u00e9lulas parabasais mostrar\u00e3o altera\u00e7\u00f5es degenerativas como a picnose nuclear e a cariorrex.<\/p>\n

Cervicite Cr\u00f4nica<\/h4>\n

Quando a les\u00e3o persiste, discretos linf\u00f3citos e as c\u00e9lulas plasm\u00e1ticas migram para a \u00e1rea inflamada e podem ser encontrados no esfrega\u00e7o em n\u00famero moderado por entre os polimorfos. Em uma cervicite de longa dura\u00e7\u00e3o, como a associada \u00e0 inser\u00e7\u00e3o de um pess\u00e1rio vaginal, utilizado no prolapso vaginal em uma mulher na p\u00f3s-menopausa, o epit\u00e9lio pode mostrar altera\u00e7\u00f5es reativas, como paraceratose e hiperceratose.<\/p>\n

A cervicite linfoc\u00edtica cr\u00f4nica \u00e9 caracterizada por uma mistura de polimorfos e linf\u00f3citos no esfrega\u00e7o. Algumas c\u00e9lulas epiteliais podem apresentar intensa colora\u00e7\u00e3o eosinof\u00edlica compat\u00edveis com altera\u00e7\u00f5es hipercerat\u00f3ticas.<\/p>\n

 <\/h4>\n

Follicular cervicitis<\/h4>\n

Follicular cervicitis is a condition characterised by the exposure of lymphoid follicles due to disruption of the overlying epithelium.  It can occur at any age but is most common in post-menopausal women whose lymphoid follicles are covered by thin, fragile, atrophic epithelium which is easily removed by the spatula. The smear contains bands of lymphoid cells, both mature and immature, in varying stages of differentiation. Tingible-body macrophages are also present. Marked non-specific inflammatory and repair changes may be seen in the overlying epithelial cells.<\/p>\n

Figure 9b-14. Cervicite Folicular: Notar linf\u00f3citos de tamanho vari\u00e1vel e macr\u00f3fagos de corpos ting\u00edveis ocasionais<\/strong><\/p>\n

\"\"<\/a>
Figure 9b-14. Follicular cervicitis: not lymphocytes of variable size and occasional tingible-body macrophages<\/figcaption><\/figure>\n

 <\/p>\n

Cervicites n\u00e3o Espec\u00edficas e Endocervicites<\/h4>\n

Inflama\u00e7\u00e3o n\u00e3o espec\u00edfica, endocervicite, reparo e cervicite atr\u00f3fica podem simular a neoplasia intraepitelial, e s\u00e3o discutidas e ilustradas na se\u00e7\u00e3o sobre “armadilhas”.<\/p>\n

 <\/p>\n

\"\"<\/a>
Figure 9b-15. Altera\u00e7\u00e3o regenerativa em caso de cervicite n\u00e3o espec\u00edfica com numerosos polimorfos: notar nucl\u00e9olos proeminentes, cromatina clara e membranas nucleares regulares. Mitoses ocasionais podem ser vistas.<\/figcaption><\/figure>\n

 <\/p>\n

 <\/p>\n

\"\"<\/a>
Figure 9b-16.  C\u00e9lulas endocervicais com perda de secre\u00e7\u00e3o de mucina e c\u00e9lulas metapl\u00e1sticas imaturas associadas a um p\u00f3lipo endocervical: observar aumento nuclear, nucl\u00e9olo rosa proeminente nas c\u00e9lulas metapl\u00e1sicas, membranas nucleares e hipercromasia uniformes<\/figcaption><\/figure>\n

 <\/p>\n\n\n\n
\n

Learning points from Chapter 9b<\/h3>\n
    \n
  1. Normal squamous cells, immature metaplastic cells and endocervical cells should be seen on a normal LBC or conventional cervical cytology slide.<\/li>\n
  2. Endometrial cells, histiocytes, lymphocytes may also be seen and must be distinguished from mature and immature squamous and endocervical cells.<\/li>\n
  3. Lactobacilli may be seen in normal cervical smears often in those showing cytolysis and bare nuclei.<\/li>\n
  4. Candida, Trichomomas, Herpesvirus and Actinomyces may be seen in otherwise normal cervical cytology slides.<\/li>\n
  5. Cytologists must recognise reactive and regenerative changes seen non-specific and specific infections as well as in atrophy and atrophic vaginitis.<\/li>\n<\/ol>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

     <\/p>\n","protected":false},"excerpt":{"rendered":"

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    Os efeitos da les\u00e3o epitelial A les\u00e3o do epit\u00e9lio cervical resulta em uma resposta inflamat\u00f3ria caracterizada por altera\u00e7\u00f5es localizadas e sist\u00eamicas no tecido. No local da les\u00e3o h\u00e1, obviamente, danos localizados nas c\u00e9lulas epiteliais que apresentam altera\u00e7\u00f5es degenerativas citoplasm\u00e1ticas e necrose coagulativa dos n\u00facleos. No estroma subjacente, veremos as mudan\u00e7as sist\u00eamicas que o corpo usa […]<\/p>\n","protected":false},"featured_media":0,"parent":0,"menu_order":0,"template":"","meta":[],"tags":[],"course_area":[],"authors":[],"class_list":["post-6265","course","type-course","status-publish","hentry"],"yoast_head":"\nAltera\u00e7\u00f5es citol\u00f3gicas reativas - Eurocytology<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.eurocytology.eu\/pt-pt\/course\/alteracoes-citologicas-reativas\/\" \/>\n<meta property=\"og:locale\" content=\"pt_PT\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Altera\u00e7\u00f5es citol\u00f3gicas reativas - Eurocytology\" \/>\n<meta property=\"og:description\" content=\"Os efeitos da les\u00e3o epitelial A les\u00e3o do epit\u00e9lio cervical resulta em uma resposta inflamat\u00f3ria caracterizada por altera\u00e7\u00f5es localizadas e sist\u00eamicas no tecido. 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