Increased Epithelial Cell Abnormalities in Lymphocytic Cervicitis: A Five-Year County Hospital Experience.
Wendy A Chamberlain, Laura Royer, Santhi Ganesan. MetroHealth Medical Center, Cleveland, OH
Background: In cervical Pap smears, lymphocytic cervicitis (LC) has a predominant finding of a polymorphic lymphoid population with tingible-body macrophages. LC has been shown to be associated with Chlamydia infection as well as atrophy. To date, no studies have been done to evaluate for associations with epithelial cell abnormalities (ECA) (i.e., dysplasia), or HPV or other infection.
Design: Records from a county hospital from 2005-2009 were searched for Pap smears with a diagnosis of LC. Pap smear reports were analyzed for additional findings such as ECA, atrophy, organisms, and hormonal status (premenopausal (PrM) vs. postmenopausal (PoM). Medical records were searched for concurrent HPV, GC, and Chlamydia testing. Results were analyzed by the study group as a whole, as well as by hormonal status group. Pap smear ECA, HPV, and Chlamydia rates for a female control population were evaluated as a whole, as well as by groups subdivided by age (<50 yrs, >50 yrs) as an estimate of hormonal status.
Results: Of the 143,158 Pap smears from 2005-2009, there were 283 (0.20%) cases of LC with 67 (23.7%) cases in PrM and 216 (76.3%) in PoM. An ECA was also present in 16.96% of cases, with a PrM ECA rate of 28.36% and a PoM ECA rate of 13.43%. The majority of ECAs were ASCUS (83.33%). The remaining ECAs included ASC-H, AGC, and LSIL, with LSIL more common in PreM than PoM. Of the 67 concurrent HPV tests performed, 11.94% were positive (PrM, 23.53%; PoM, 8.00%).
Of the 235 (83.04%) LC cases without an ECA, there were additional findings in 61 (16.0%). Of the 61 cases, 47 (77.1%) were atrophy and 14 (22.9%) were organisms. All cases of atrophy were in PoM. The 14 cases with organisms included Candida (71.4%), Trichomonas (21.3%), and Actinomyces (7.2%) species. Of the 101 concurrent GC/Chlamydia tests performed, 12 (11.88%) were positive for Chlamydia (PrM, 25.58%; PoM, 1.72%). All GC tests were negative.
The control group had an ECA rate of 19.13% (PrM, 21.22%; PoM, 10.39%). The control group HPV rate was 22.16% (PrM, 24.87%; PoM, 9.57%) and the Chlamydia rate was 5.51% (PrM, 5.78%; PoM, 0.44%).
Conclusions: Lymphocytic cervicitis is an uncommon finding in cervical Pap smears, more prevalent in postmenopausal women than premenopausal. Our study shows an increased incidence of concurrent epithelial cell abnormalities in Pap smears with LC, especially in premenopausal women (28.36%) when compared to control group premenopausal women (21.22%). Our findings also confirm the previously reported associations of LC with Chlamydia infection and atrophy.
Tuesday, March 1, 2011 9:30 AM
Poster Session III # 95, Tuesday Morning