Cells of flat, cylindrical, glandular epithelium in the smear: what does it mean?
Last reviewed: 23.04.2024
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The process of renewal of epithelial cells occurs constantly, therefore the 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 which epithelium is found in the smear and in what quantity, as this cytological study is necessary to identify urogenital pathologies and determine their causes, and a swab from the nasal cavity helps to clarify the etiology of chronic rhinitis.
What are epithelial cells and the types of epithelium in the smear?
Epitheliocytes or epithelial cells are cells of epithelial tissue that covers the internal organs and lining their cavities. The epithelium is separated from the main tissue by the fibrous basal 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 kinds of epithelium can be in the smear?
Addressing to the urologist with complaints about problems with urination, the patient undergoes a survey to find out their causes; one of the diagnostic procedures is a smear from the urethra (urethra). As with women, the detectable epithelium in the smear in men is most often: the urethra lining the single-layered flat, transitional or intermediate epithelium, as well as the multilayer single-layered with goblet cells, stratified (multilayered) epithelium with signs of keratinization and glandular epithelium with glandulocytes (secret-producing cells) . Elevated superficial epithelium in the smear in men in most cases indicates a chronic inflammation of the urethra, less often the cause is the urethra leukoplakia. More information from the material - Analysis of smears from the urethra
Epithelium in a smear in women is revealed when examining the urogenital area and organs of the reproductive system, in particular, the vagina (vagina) and the cervical canal (cervical canal).
There is a multilayered flat epithelium in a smear from the mucous membrane of the vagina; often in the decoding of the analysis it is indicated as a single epithelium in the smear or superficial epithelium in the smear in the norm.
In addition, during cytological studies of vaginal discharge , columnar epithelial cells can be found: a single-layered cylindrical epithelium in the smear and a single-layer prismatic epithelium in the smear, since it is these types of epithelium lining the vaginal walls.
What can show a smear from the cervical canal ? First and foremost, the lining of the cervical canal is defined by the cylindrical epithelium in the smear, as well as the transitional and glandular epithelium in the smear.
When the metaplastic epithelium appears in the smear, it means that as a result of the pathological process (associated with infection, hormonal or endocrine disruptions), differentiated epithelial cells of the same species are replaced by cells of a different type.
Epithelium in a smear from the nose, mostly single-layered multi-row and epithelium cylindrical with goblet and intercalary cells. The scales of the flat epithelium in the smear, as well as the cylindrical epithelium in the smear in the child appears in large quantities if the mucosa of the nasal cavity is inflamed.
Norm of the amount of epithelium in the smear
There is a generally accepted norm of the amount of epithelium in the smear in cytological studies.
The established norm of a flat epithelium in a smear from a urethra at men - no more than 10 cells, in decoding can be designated or as a superficial epithelium in a smear in norm or, - the epithelium in a smear in the field of vision does not exceed norm.
The norm of the amount of epithelium in the smear from the vagina (multilayered flat) depends on the phase of the menstrual cycle. And scales of flat epithelium 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 in the decoding of the cytogram it is indicated that in the smear a moderate amount of epithelium in the smear, and when much higher - the epithelium in the smear in large quantities. For a gynecologist, this information gives reason to assume that the patient has a violation of the balance of female sex hormones or inflammation. In this case, the number of epithelial cells less than 5 in the field of vision or their complete absence in the vaginal smear is evidence of atrophic processes in the mucous membrane of the vagina.
It is considered the norm of the epithelium in the smear during pregnancy up to 10 cells (in the field of view) in the urogenital area, and the corresponding level of the leukocytes present in the vagina is no more than 15 units in n / z.
The norm of leukocytes in the smear from the urethra in men and women does not exceed 5 units in one field of vision, and a greater number of leukocytes may be a measure of urethritis. The large number of leukocytes and epithelium in the smear require bacteriosseous and PCR blood analysis to determine the specific pathogen of inflammation of the urethra.
For women, it is permissible (that is, does not speak of pathology) the presence of three to four dozen leukocytes in the p / z in a vaginal smear and almost the same in a swab from the cervical canal.
Causes of the appearance of the epithelium in the smear
Specialists identify the physiological and pathological causes of the appearance of the epithelium in the smear.
The physiological causes for which a single epithelium is detected in a vaginal smear, that is, normally there is an epithelium in the smear in the field of view of the microscope (in the study of a sample of biological material by the method of microscopy), consists of changes in the multilayer flat epithelium of the uterine cavity associated with certain phases of the menstrual cycle the vaginal part of her neck.
Exceeding the norm of the flat epithelium in the smear from the cervical canal can be caused by various inflammatory diseases of the uterus, for example, latent endometritis.
Because of the insufficient production of estrogen in the body of women, a transitional or intermediate epithelium is found in the smear. To confirm hypoestrogenism, a biochemical blood test is assigned to the level of sex hormones.
The main reasons for the presence of flat epithelium in smears are discussed in detail in the article - Flat epithelium in the smear in women and men.
When, as a result of cytological examination of the mucous membrane of the cervix, an excess multilayered squamous epithelium is detected in the smear, as well as prismatic epithelium in the smear, then among the causes, first of all, the inflammation of the cervix (cercivitis). In this case, the microscope shows the epithelium in layers in a vaginal smear.
In significant quantities, the cylindrical epithelium in the vaginal smear most often appears due to vaginitis (colpitis) - inflammation of its mucous membrane, as well as true erosion of the cervix (ectopia). In the second case, that is, with erosion, there is a significant degeneration of the epithelium in the smear.
If, in addition to the cylindrical one, an intermediate epithelium is found in the smear / transitional epithelium in the smear, in which cells there are disorders of the cytoskeleton and the shape of the nuclei (dyskaryosis), then among the most probable diagnoses are cervical dysplasia, which requires a biopsy to minimize risk factors for 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 those infected with the human papilloma virus koylocytes, appear in cases of precancerous transformation of tissues and squamous cell carcinoma of the cervix. Therefore, an immediate delivery of a smear to detect an oncogenic virus HPV 16 and HPV 18 is required.
Dyskeratosis of the flat epithelium in the smear is associated with its cornification, which in gynecology is diagnosed either as leukoplakia of the cervix, or as atrophy (scarletosis) of the vulva in women during menopause.
The glandular epithelium in the swab of the cervical canal can signify glandular hyperplasia of the cervix, as well as hyperplasia of the glandular endometrium. When a metaplastic epithelium is found in a smear taken from the cervix, it is often a consequence of increased levels of sex hormones (hyperestrogenia), neck erosion and infection, and changes in acidity in the vagina. Any of the above causes can lead to the replacement of the cylindrical epithelium by a flat one-layered or multilayered one. Also, the reason for this result of the smear may be the development of squamous cell metaplasia of the cervix.
The conclusion, formulated as reactive changes in the epithelium in a vaginal smear, can mean the presence of an inflammatory process in the mucous membrane of the cervix.
It is noteworthy that the inflammation of the vaginal mucosa, for example, with bacterial vaginosis, is characterized by the practical absence of leukocytes in the smear, but the presence of squamous epithelium is evident. These are desquamated epithelial cells or flakes of flat epithelium in the smear, to the surface of which the pathogenic cocci adhere (such cells are called key cells).
It should be borne in mind that the numerous leukocytes and epithelium in the smear against the background of reactive changes in the epithelium often indicate STDs (a particular infectious agent is detected by bacterioscopy), the presence of inflammation of the vaginal mucosa, and in men this is observed in case of inflammation of the urethra. In this case, the presence of bacterial infection leads to an increase in the number of neutrophils in the smear, and if the number of lymphocytes is increased, the inflammation has a viral origin.
Detailed information in the material - Why are leukocytes in smear in women and men increased?
In addition, read what the result of a smear in pregnant women can mean - Leukocytes in a smear during pregnancy
[Epithelium in a smear from the nose
Normally, in a smear from the nose, there is an insignificant number of cells of the flat epithelium of the nasal mucosa and cylindrical epithelium - in the form of ciliated cells (cilia), providing mucociliary clearance of the nasal airways.
As a result of deciphering the cytological examination of the smear from the nasal cavity, rhinitis of infectious and allergic etiology can be differentiated, which is especially important for chronic rhinitis in adults (often vasomotor) and frequent rhinitis with nasal congestion in children prone to allergies.
Carrying out a rhino or nazocytogram can reveal leukocytes and epithelium in a smear
in a child or an adult patient. With allergies in the nasal secretion, the number of granulocyte leukocytes-eosinophils-increases, and at an increased level of lymphocytes in the smear, the cause of frequent rhinitis is associated with infection. If there are no leukocytes in the smear from the nose, then vasomotor rhinitis can be diagnosed, and if the leukocytes and epithelium in the swab from the nose are completely absent, then atrophic rhinitis is determined.
Indicative for the acute stage of the allergic rhinitis is the flat epithelium in layers in the smear (at the level of 15 units in n / z), the amount of which decreases by 2-3 times during remission.
When an allergic rhinitis accompanies bronchial asthma, the smear reveals more cylindrical epithelium and particles of exfoliated flat epithelium. And for acute sinusitis is characterized by the presence of metaplastic cylindrical epithelium in the smear.
Read also - Analysis of mucus from the nose
Treatment
It should be understood that the results of the analyzes - and the epithelium in the smear from the urethra, vagina, cervical canal, from the nose is the result of the cytological examination of the mucous epithelium of these localizations - they do not treat.
On the basis of this study, as well as the results of other diagnostic methods - analyzing the patient's history and complaints and fixing clinical symptoms, the doctors of the corresponding specialization determine the existing disease and prescribe its treatment, read - Flat epithelium in the smear: treatment of diseases
For example, candles from inflammation in gynecology are effective in colpitis (vaginitis) of any etiology, but to suppress pathogens of the inflammatory process, doctors prescribe a vaginal suppository against infections. How to treat leukoplakia of the cervix, you can learn from the publication - Hyperkeratosis of the cervix
Therapy for erosion of the cervix is described in the publication - Treatment of cervical erosion.
Patients with bacterial inflammation of the urethra are assigned systemic antibiotics. More information in the article - Antibiotics for urethritis.
If an allergy is diagnosed, then allergic rhinitis should be treated.