Upper New York State Society of Cytology,Inc.

Submitted by: Sharon Leo, MS, CT(ASCP), CMIAC

University of Rochester Medical Center, Rochester, NY

History

A routine Pap smear was received on a 24 year old patient. The specimen was labeled vaginal scrape and the LMP was given as "?".

Cytologic Findings

The specimen was cellular with normal squamous cells scattered throughout. Single columnar cells with basal nuclei were numerous. Cytoplasm was indeterminate and granular.Some single goblet cells were also identified. Larger aggregates had the "Swiss cheese" appearance of intestinal metaplasia.

Diagnosis/Discussion

Negative for malignancy. Glandular epithelium with goblet cells identified consistent with intestinal mucosa.

The patient had a history Mayer Rokitansky Kuster Hauser Syndrome. This syndrome occurs in the fifth gestational week and affects about 1 in every 4000-5000 women(1). The patients are genetic females and are born with short or non-existent vaginas. Other reproductive abnormalities, i.e., lack of uterus, cervix, fallopian tubes, ovaries, external genitalia,etc., vary with each individual patient.

Treatment can be surgical(vaginoplasty) or "pressure dilation" to create a vagina(1). Pressure dilation is the preferred method of treatment(1). A dilator is used at the vaginal entrance to actually expand and push the squamous epithelium internally to create the vagina. The pressure can be applied in a sitting position on a chair and the appliance length can be adjusted as needed. It is a long and time consuming procedure. To be successful, patients must receive adequate emotional support and counseling early on. Several surgical techniques are available, including transplanting a length of intestine with its blood supply to form a vagina(1). Even after choosing surgery, patients may still need to use a dilator.

Our patient was born without an uterus, cervix, fallopian tubes, but did have ovaries. She also had kidney anomalies.

References

1.www.medhelp.org/www/ais/31 HPLASIA.HTM