Cytopathological Changes of Cervical Smears in Patients with Uterine Prolapse: A Major Pitfall for Sqaumous Intraepithelial Neoplasia (Cervical Dysplasia)
HA Abu-Farsakh, MA Al-Jalad. First Medical Lab, Amman, Jordan; Specialty Hospital, Amman, Jordan
Background: Pitfall of cervical cytology is of utmost importance to be recognized due to its medicolegal consequences. Cytology of cervical smears from uterine prolapse patients can cause changes that may mimic dysplasia changes. Pathologists are likely to mistake these cases if encountered for the first time as dysplasia changes with Human papilloma virus (HPV)- like changes.
Design: Twenty cases of cervical swab from patients with uterine prolapse were studied. All patients had consequent simple hysterectomy due to prolapse symptoms. The patients' age ranged from 35-72 years of age with parity ranged from 4-14 kids.
Results: Cervicovaginal smears showed changes that are seen in cervical dysplasia: increased nuclear cytoplasmic ratio, nuclear membrane irregularities and perinuclear halos in 20/20 cases; discohesiveness of cells in 15/20 cases, cell hugging in 14/20 cases; nuclear hyperchromasia in 11/20 cases.
The followings changes are not seen in cervical dysplasia (but are seen in this entity): frayed cytoplasmic borders, neutrophilic debri in the background and the presence of vesicular nuclei (at least focally) in 20/20, and prominent nucleoli in 4/20 cases. Screening by PCR for Human papilloma virus (HPV) from cervical swab was performed on all these cases and proved to be negative.
Conclusions: Cytopathological changes of cervical smears in patients with uterine prolapse can be abnormal and may mimic cervical dysplasia. The cytological criteria that help in differentiating this diagnosis from dysplasia are: frayed cytoplasmic borders, neutrophilic debri in the background, vesicular nuclei in many of the atypical cells and occasionally prominent nucleoli. Awareness of these changes by the pathologists is very important to avoid falling into a mistake with its consequent medicolegal litigations.
Wednesday, March 11, 2009 9:30 AM
Poster Session V # 33, Wednesday Morning