Educational Module for Anatomic Pathology Registrars

Year 2: Module No 3

Non-specific reactive changes

Benign non-infectious entities



This module covers a wide range of benign conditions which may be represented in cervical cytology samples. The aim of cervical screening is to identify pre-neoplastic and neoplastic lesions. It is useful to report some benign/reactive changes to clinicians but more commonly the importance of their accurate identification is to avoid over-diagnosis because of the potential to mimic pre-neoplastic or neoplastic disease.

There are three sections to this module. Please click on each link to access notes on these topics.

1. Non-specific reactive/reparative/degenerative changes in cervical cytology

2. Specific benign non-infectious entities

3. Organisms

These topics are discussed in all standard cytology texts, although the depth of discussion varies. For this reason, NCPTS notes are provided. The notes provided on organisms aim to emphasise clinical contexts.

Study recommendations


1. Read Chapter 2: Non-neoplastic Findings in The Bethesda Book for Reporting Cervical Cytology 2nd Edition    (Ed: Diane Solomon and Ritu Nayar).

      This provides a basic introduction.

2. Read the NCPTS notes provided with this module, listed above.

3. Read Pages 109 -120 in The Art and Science of Cytopathology. Volume 1: Exfoliative Cytology. Richard M. DeMay 2nd Edition (2011) ASCP Press.

    This provides a more in-depth discussion. This is a standard cytology text that will be available in most cytology laboratories.


Access on-line (free) educational websites:

i. Bethesda Web Atlas.

Some of the images are conventional smears (as well as LBC), but are still useful to view.

            Google: NCI Bethesda System Web Atlas

·         Click on Atlas Chapter

·         Click on 2. Non-neoplastic findings

o   120 images are provided. This is a mix of conventional and LBC images.

ii. Eurocytology Atlas

·         Click on English

·         Click on Training Package 1 (top menu strip)

·         Scroll down to Module 7 and click on Course Content (below photo)

All of the listed content is relevant to this topic

4. SurePath images are available at the BD Surepath™ Training Centre (commercial company) website. To register, sign in and access training documentation, visit  Once you have accessed the site,

·         Click on BD SurePath™ Web Atlas – Gynaecological Specimens

·         Look at the images for the first three topics – Atrophy, Organisms and Reactive Changes. Click to see the images.

5. ThinPrep images are available on the Hologic (commercial company) website.

There is written information as well as images in the Study section of the website.

·         Click on Study, then on Study now

·         Scroll down to Section Three: Negative for Intraepithelial lesion/Malignancy

Click on the images to enlarge

Other references


1. College of American Pathologists Practical Guide to Gynecologic Cytopathology.

    Morphology, Management and Molecular Methods.  Ed; David Wilbur, Michael Henry 2008

Journal references

1. Small Cells in Cervical-Vaginal Smears of Patients Treated with Tamoxifen. Opjorden SL et al. Cancer Cytopathology. 2001 Feb; 93 (1): 23-28

2. The Small Blue Cell Dilemma Associated with Tamoxifen Therapy. Yang YJ et al. Arch Pathol Lab Med. 2001 Aug; 1:1047-1050

3. The significance of psammoma bodies on cervical cytology smears. Nicklin et al. Gynecol Oncol 2001 Oct; 83(1):6-9

  Dr Margaret Sage
Cytopathologist, NCPTS