SQUAMOUS ATYPIA IN THE ATROPHIC CERVICAL VAGINAL SMEAR - A NEW LOOK AT AN OLD PROBLEM

Citation
A. Abati et al., SQUAMOUS ATYPIA IN THE ATROPHIC CERVICAL VAGINAL SMEAR - A NEW LOOK AT AN OLD PROBLEM, CANCER CYTOPATHOLOGY, 84(4), 1998, pp. 218-225
Citations number
15
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Oncology
Journal title
CANCER CYTOPATHOLOGY
ISSN journal
0008-543X → ACNP
Volume
84
Issue
4
Year of publication
1998
Pages
218 - 225
Database
ISI
SICI code
0008-543X(1998)84:4<218:SAITAC>2.0.ZU;2-Z
Abstract
BACKGROUND. Squamous atypia in postmenopausal (PM) cervical vaginal sm ears (CVS) only rarely is associated with a biopsy-proven squamous int raepithelial lesion (SIL), and thus most commonly represents an atroph y-associated benign reactive change. METHODS. To distinguish atypical squamous cells of undetermined significance (ASCUS) and SIL from atrop hy-associated benign reactive changes, a review of atypical atrophic P M CVS was performed. Ninety CVS exhibiting an atrophic smear pattern w ere considered appropriate for study. Repeat smears and/or biopsy afte r local estrogen therapy were requested to distinguish atrophic/reacti ve from dysplastic changes. RESULTS. Generally, atrophic CVS exhibit u niform nuclear enlargement in the squamous cell population, which, usi ng the criterion of nuclear enlargement alone, would qualify the major ity of these cases to be classified as ASCUS. The nuclear enlargement associated with atrophy resolves with the local application of estroge n. Follow-up after local estrogen treatment was available for 84 of 90 patients and revealed 10 cases of SIL (12%) and 9 cases of ASCUS (11% ), 6 of which were favored to be of a reactive etiology. Nuclear featu res most commonly noted in the cases considered to be ASCUS (nonreacti ve) and SIL were nuclear hyperchromasia and nuclear contour irregulari ties. CONCLUSIONS. Nuclear enlargement alone is not sufficient for dia gnosing ASCUS or SIL in PM CVS. Nuclear enlargement in squamous cells is an expected normal reactive change present in PM CVS that resolves with the application of local estrogen. Nuclear hyperchromasia and irr egular nuclear contours remain the most reliable cellular characterist ics for diagnosing SIL in atrophic CVS. [See editorial on pages 200-1, this issue.] Cancer (Cancer Cytopathol) 1998;84:218-25. (C) 1998 Amer ican Cancer Society.