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Cells of squamous, cylindrical, glandular epithelium in a smear: what does it mean?
Last reviewed: 05.07.2025
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The process of renewal of epithelial cells occurs constantly, therefore epithelium in a smear from the urethra, vagina, cervical canal is present even in the absence of urological and gynecological diseases.
The main question for diagnosis is what kind of epithelium is found in the smear and in what quantity, since this cytological examination is necessary to identify urogenital pathologies and determine their causes, and a smear from the nasal cavity helps to clarify the etiology of chronic rhinitis.
What are epithelial cells and types of epithelium in a smear?
Epithelial cells or epithelial cells are cells of the epithelial tissue that covers internal organs and lines their cavities. The epithelium is separated from the underlying tissue by a fibrous basement membrane and consists of several types of cells.
What does epithelium mean in a smear from the urethra, vagina, cervical canal, from the nose and what types of epithelium can there be in a smear?
When a patient consults a urologist with complaints of problems with urination, they undergo an examination to determine their causes; one of the diagnostic procedures is a smear from the urethra. As in women, the epithelium found in a smear in men is most often: a single-layer squamous, transitional or intermediate epithelium lining the urethra, as well as a multi-row single-layer epithelium with goblet cells, stratified (multi-layered) epithelium with signs of keratinization and glandular epithelium with glandulocytes (secretory cells). Increased superficial epithelium in a smear in men in most cases indicates chronic inflammation of the urethra, less often the cause is leukoplakia of the urethra. More information in the material - Analysis of smears from the urethra
Epithelium in a smear in women is detected during examination of the urogenital area and organs of the reproductive system, in particular, the vagina (vagina) and the cervical canal (cervical canal).
There is stratified squamous epithelium in a smear from the vaginal mucosa; it is often indicated in the analysis transcript as a single epithelium in a smear or superficial epithelium in a smear in the norm.
In addition, during cytological examination of vaginal discharge, columnar epithelial cells may be detected: single-layer columnar epithelium in the smear and single-layer prismatic epithelium in the smear, since these are the types of epithelium that line the vaginal walls.
What can a cervical canal smear show? First of all, the lining membrane of the cervical canal is determined by the cylindrical epithelium in the smear, as well as the transitional and glandular epithelium in the smear.
When metaplastic epithelium appears in a smear, this means that as a result of a pathological process (associated with infection, hormonal or endocrine disorders), differentiated epithelial cells of one type are replaced by cells of another type.
The epithelium in the nasal smear is mainly single-layer multi-row and cylindrical epithelium with goblet and intercalated cells. Squamous epithelium flakes in the smear, as well as cylindrical epithelium in the smear of a child, appear in large quantities if the mucous membrane of the nasal cavity is inflamed.
Normal amount of epithelium in a smear
There is a generally accepted norm for the amount of epithelium in a smear during cytological studies.
The established norm of squamous epithelium in a smear from the urethra in men is no more than 10 cells; in the transcript, this can be designated either as superficial epithelium in a smear is normal, or - the epithelium in the smear in the field of vision does not exceed the norm.
The normal amount of epithelium in a vaginal smear (stratified squamous) depends on the phase of the menstrual cycle. And the squamous epithelium flakes in the smear - exfoliated cells - in one field of view of the microscope should not normally exceed 15 units.
If this indicator is slightly higher, then the cytogram interpretation indicates that there is a moderate amount of epithelium in the smear, and when it is much higher, there is a large amount of epithelium in the smear. For a gynecologist, this information gives grounds to assume that the patient has an imbalance of female sex hormones or inflammation. In this case, the number of epithelial cells less than 5 in the field of view or their complete absence in the vaginal smear is evidence of atrophic processes in the vaginal mucosa.
It is considered normal for the epithelium in a smear during pregnancy to be up to 10 cells (in the field of view) in the urogenital area, and the normal level of leukocytes present in the vagina is no more than 15 units in the field of view.
The norm of leukocytes in a smear from the urethra in men and women does not exceed 5 units in one field of vision, and a larger number of leukocytes may be an indicator of urethritis. Large amounts of leukocytes and epithelium in the smear require bacterial culture and PCR blood analysis to determine the specific pathogen causing inflammation of the urethra.
For women, the presence of three to four dozen leukocytes in the field of view in a smear from the vagina and almost the same number in a smear from the cervical canal is acceptable (i.e. does not indicate pathology).
Reasons for the appearance of epithelium in a smear
Experts identify physiological and pathological reasons for the appearance of epithelium in a smear.
The physiological reasons for which a single epithelium is detected in a vaginal smear, i.e., there is normally epithelium in a smear in the field of view of a microscope (when studying a sample of biological material using microscopy), are changes in the stratified squamous epithelium of the uterine cavity and the vaginal part of its cervix associated with certain phases of the menstrual cycle.
Excessive squamous epithelium in a smear from the cervical canal can be caused by various inflammatory diseases of the uterus, for example, latent endometritis.
Due to insufficient production of estrogen in the body of women, transitional or intermediate epithelium is detected in the smear. To confirm hypoestrogenism, a biochemical blood test for the level of sex hormones is prescribed.
The main reasons for the presence of squamous epithelium in smears are discussed in detail in the article - Squamous epithelium in smears in women and men.
When a cytological examination of the cervical mucosa reveals excessive stratified squamous epithelium in the smear, as well as prismatic epithelium in the smear, then inflammation of the cervix (cervicitis) is considered among the causes first of all. In this case, the epithelium is visible in layers in the vaginal smear under the microscope.
In significant quantities, cylindrical epithelium in a vaginal smear most often appears as a result of vaginitis (colpitis) - inflammation of its mucous membrane, as well as true erosion of the cervix (ectopia). In the second case, that is, with erosion, significant dystrophy of the epithelium is noted in the smear.
If, in addition to the cylindrical epithelium, intermediate epithelium/transitional epithelium is detected in the smear, in the cells of which there are abnormalities in the cytoskeleton and shape of the nuclei (dyskaryosis), then among the most likely diagnoses are cervical dysplasia, which requires a biopsy to minimize the risk factors for the development of oncology.
In addition, the superficial epithelium in the smear with the presence of atypical cells is a serious cause for concern, since modified epithelial cells, especially koilocytes affected by the human papillomavirus, appear in cases of precancerous tissue transformations and squamous cell carcinoma of the cervix. Therefore, an immediate smear test is required to detect the oncogenic HPV 16 and HPV 18 viruses.
Dyskeratosis of squamous epithelium in a smear is associated with its keratinization, which in gynecology is diagnosed either as leukoplakia of the cervix or as atrophy (kraurosis) of the vulva in women during menopause.
Glandular epithelium in a smear from the cervical canal may indicate glandular hyperplasia of the cervix, as well as glandular hyperplasia of the endometrium. When metaplastic epithelium is detected in a smear taken from the cervix, this is often a consequence of an increased level of sex hormones (hyperestrogenism), cervical erosion and the presence of infection, as well as a change in the acidity level in the vagina. Any of the listed reasons can lead to the replacement of the columnar epithelium with flat - single-layer or multilayer. Also, the reason for such a smear result may be the development of squamous cell metaplasia of the cervix.
The conclusion formulated as reactive changes in the epithelium in a vaginal smear may indicate the presence of an inflammatory process in the mucous membrane of the cervix.
It is noteworthy that inflammation of the vaginal mucosa, for example, in bacterial vaginosis, is characterized by a practical absence of leukocytes in the smear, but the presence of squamous epithelium is revealed. These are exfoliated epithelial cells or squamous epithelium scales in the smear, to the surface of which pathogenic cocci have adhered (specialists call such cells key).
It should be borne in mind that numerous leukocytes and epithelium in a smear against the background of reactive changes in the epithelium often indicate an STD (a specific infectious agent is detected by bacterioscopy), the presence of inflammation of the vaginal mucosa, and in men, this is observed in the case of inflammation of the urethra. In this case, the presence of a bacterial infection leads to an increase in the number of neutrophils in the smear, and if the number of lymphocytes is increased, then the inflammation is of viral origin.
Detailed information in the material - Why are leukocytes elevated in a smear in women and men?
Also, read what this smear result can mean in pregnant women - Leukocytes in a smear during pregnancy
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Epithelium in a nasal smear
Normally, a nasal smear contains a small amount of squamous epithelial cells of the nasal mucosa and columnar epithelium in the form of ciliated cells (cilia) that provide mucociliary clearance of the nasal airways.
As a result of decoding the cytological examination of a smear from the nasal cavity, it is possible to differentiate rhinitis of infectious and allergic etiology, which is especially important in chronic rhinitis in adults (often vasomotor) and frequent rhinitis with nasal congestion in children prone to allergies.
Performing a rhino- or nasocytogram can reveal leukocytes and epithelium in the smear
In a child or an adult patient. In case of allergy, the number of granulocyte leukocytes - eosinophils increases in the nasal secretion, and with an increased level of lymphocytes in the smear, the cause of frequent runny nose is associated with an infection. If there are no leukocytes in the smear from the nose, then vasomotor rhinitis can be diagnosed, and if leukocytes and epithelium are completely absent in the smear from the nose, then atrophic rhinitis is determined.
Indicative of the acute stage of allergic rhinitis is flat epithelium in layers in a smear (at the level of 15 units in the field of vision), the amount of which decreases by 2-3 times during remission.
When allergic rhinitis accompanies bronchial asthma, more cylindrical epithelium and particles of exfoliated squamous epithelium are detected in the smear. And for acute sinusitis, the presence of metaplastic cylindrical epithelium in the smear is characteristic.
Read also – Nasal mucus analysis
Treatment
It should be understood that the test results - and the epithelium in a smear from the urethra, vagina, cervical canal, from the nose is precisely the result of a cytological study of the mucous epithelium of these localizations - do not treat.
Based on this study, as well as the results of other diagnostic methods - analyzing the anamnesis and complaints of patients and recording clinical symptoms, doctors of the relevant specialization determine the existing disease and prescribe its treatment, read - Flat epithelium in a smear: treatment of diseases
For example, suppositories for inflammation in gynecology are effective for colpitis (vaginitis) of any etiology, but to suppress the pathogens of the inflammatory process, doctors prescribe vaginal suppositories for infections. How to treat leukoplakia of the cervix, you can find out from the publication - Hyperkeratosis of the cervix
Treatment for cervical erosion is described in the publication – Treatment of cervical erosion.
Patients with bacterial inflammation of the urethra are prescribed systemic antibiotics. More information in the article - Antibiotics for urethritis.
If an allergy is diagnosed, then it is necessary to treat allergic rhinitis.