Upper New York State Society of Cytology, Inc.

Interesting Case 1

Submitted by: Douglas Minot, BS, CT(ASCP)

University of Rochester Medical Center-Strong Memorial Hospital, Rochester, NY

 

History:

Routine Pap smear on a 31-year-old female. Last three Pap smears have all been WNL with no known history of atypias.

Cytologic Findings:

This Pap smear was in our general Pap workload. The Pap smear has many of the "normal" elements, superficial squamous cells, intermediate squamous cells, and a healthy number of benign endocervical cells. However, some cells that were glandular appearing had what appeared to be viral changes. I counted about 10-12 of them. They had single, very prominent, reddish macro inclusions. They appeared to totally replace the nucleus with a halo-like effect around the inclusions. There were no other viral changes identified.

Diagnosis/Discussion:

Viral inclusions present consistent Cytomegalovirus.

Cytomegalovirus(CMV) is a common DNA virus belonging to the herpes virus group. More than 50% of the adult female population can be demonstrated to have antibodies to this agent(1). It produces characteristic cytomorphologic alterations including karyo and cytomegaly, prominent intranuclear inclusions, and basophilic or eosinophilic round intracytoplasmic inclusions(2). The cytologic changes of CMV infection can be found in both immunocompetent and immunocompromised hosts. CMV changes can be found in various organ systems including pulmonary, gastrointestinal, and the females genital tract.

Identificiation in cytologic specimens from the female genital tract is unusual with the infected cells appearing to be of endocervical glandular origin. Transmission of CMV can occur through sexual contact, and this infection may coexist in the cervix with other sexually transmitted diseases(3). A discussion has been ongoing for some time regarding the significance of this finding. There appears to be a well-recognized association of CMV with AIDS, leading some to conclude that CMV infection may be the result of AIDS, or another immunocompromising condition(3). However, it has not been established that an otherwise healthy-appearing woman should be tested for HIV based on the CMV diagnosis. Also, if undetected, active infection may result in congential infection in children of CMV-infected mothers, but the actual risk of vertical transmission is not known.

References:

1. Bonfiglio T, Erozan Y, Gynecologic Cytopathology, 1997; Lippincott-Raven Publishers; 40-41.

2. Hunt J, Baloc Z, Judkins A, LiVolsi V, Montone K, Gupta PK. Unique Cytomegalovirus Intracytoplasmic Inclusions in Ectocervical Cells on a Cervical/Endocervical Smear. Diagnostic Cytopathology 1998; 18: 110-112.

3. Henry-Stanley MJ, Stanley MW, Buton LG, Samuelson J. Cytologic Diagnosis of Cytomegalovirus in Cervical Smears. Diagnostic Cytopathology 1993; 9: 364-365.