Cervicovaginal Smears Research Articles

Incidental detection of psammoma bodies in cervico-vaginal smears

Incidental detection of psammoma bodies in cervico-vaginal smears

Concomitant aspergillus species infection and squamous cell carcinoma diagnosed on pap smear

Concomitant infection with Aspergillus species and cervical squamous cell carcinoma in the female genital tract is a rare occurrence and attributed to the opportunistic nature of infection in the immunocompromised state due to the underlying malignancy. The contamination of smears with Aspergillus species should be excluded. The diagnosis of Aspergillus species infection along with squamous cell carcinoma was established on cervicovaginal pap smears in a 62-year-old female presented to gynecological clinic with complaints of stress urinary incontinence. Speculum examination revealed first-degree cervical descent. Smears showed features of squamous cell carcinoma along with fungal spores and fruiting body with hyphae of Aspergillus species. The presence of fruiting bodies and hyphae of Aspergillus species with coexisting squamous cell carcinoma is rare in routine pap smears. True infection needs to be distinguished from contamination by Aspergillus species. Early diagnosis can be established on routine cervicovaginal Pap smear examination.

Pregnant and Postpartum Women with Atypical Glandular Cells: Follow-up and Evaluation for High-Risk HPV

Objectives: The study was an attempt: to find out the prevalence of atypical glandular cells of undetermined significance (AGC) in cervicovaginal smears of pregnant and postpartum women in Duhok-Iraq; follow up these women to investigate the underlying pathology and to test for high-risk HPV (HR-HPV). Methods: From May 2005 to June 2013, all Pap smears of pregnant and postpartum women were analyzed and women with AGC cytology were enrolled in the study. One hundred and fifty two women, for whom follow up was possible, were subjected to colposcopic directed cytology and/or histology for at least 48 months from the initial reading. Their results were comprehensively evaluated, and HR-HPV DNA testing was performed by conventional PCR in 56 cases. Results: Overall, AGC cytology formed 6.7% of all pregnant and postpartum women’s Pap smears and 29.6% were at risk for neoplastic epithelial lesions (AGC and premalignant lesions). The diagnosis of ≥ low squamous intraepithelial lesion (LSIL) was observed in 14.5% of cases among whom significantly high frequency of HR-HPV DNA was noted compared with those having persistent AGC or negative atypia (NILM). Conclusions: Identical to non-pregnant women, pregnant and postpartum women with AGC cytology are at risk of harboring premalignant and malignant (squamous or glandular) lesions, and testing of AGC cytologic specimens for HR-HPV might help predict neoplastic cases but not to distinguish malignant from premalignant lesions.

Mansonelliasis identified by a cervicovaginal smear at the university hospital center of Bobo-Dioulasso (Burkina Faso)

Mansonella perstans is a genus of filaria that is often asymptomatic or responsible for unspecific symptoms. M. perstans microfilariae are uncommon on cervicovaginal smears. We report the case of a woman with pruritis and eosinophilia. Microfilariae of M. perstans were observed on both cervicovaginal and blood smears. The patient was successfully treated with a combined single dose of 400 mg of albendazole and ivermectin (150 μg/kg). We described here an atypical and rare localization of M. perstans. The routine examination of cervicovaginal smears of women admitted to Bobo-Dioulasso Hospital for screening of cervical neoplasia should allow us to determine the frequency of this parasitosis and propose appropriate treatment.

The Significance of Hyperkeratosis in Pap Smears with Squamous Intraepithelial Lesion

Objective: It was the aim of this study to evaluate the significance of reporting hyperkeratosis in cervical smears. Study Design: Cervicovaginal smears with low-grade (LSIL) and high-grade squamous intraepithelial lesions (HSIL), prepared from 2004 to 2007, were retrospectively reviewed. Anucleated squamous cells were counted. The smears were classified into two groups, based on the presence of <2 or ≥2 clusters of anucleated cells, and then compared. Results: Sixty Pap smears showing SILs (34 LSILs and 26 HSILs) as well as 120 random satisfactory smears without squamous or glandular abnormalities were selected. A statistically significant difference was found between the SIL group and the control group regarding the mean number of hyperkeratotic clusters (2.8 in the SIL and 1.9 in the control group; p = 0.012). Moreover, the mean number of hyperkeratotic clusters (3.3 in the LSIL and 2.2 in the HSIL group) had a statistically significant correlation with the diagnosis of the lesion as LSIL or HSIL (p = 0.0006). Conclusion: Our findings suggest that hyperkeratosis in the form of ≥2 clusters of anucleated squamous cells could be an indicator of underlying LSIL.

Detection of High-Grade Lesions on Cell Blocks from Residual Fluids of Pap Smears Diagnosed as Low-Grade Abnormalities: A Preliminary Pilot Study

Objective: To investigate the feasibility of the technique of cell blocks (CBs) from residual fluids of Papanicolaou (Pap) smears diagnosed as low-grade abnormalities in the detection of high-grade lesions on biopsies. Study Design: In the present pilot study, we evaluated the sensitivity and specificity of 70 CBs from liquid-based cervicovaginal smears of women with atypical squamous cells (ASCs) of undetermined significance (ASCUS; n = 39), ASCs that cannot exclude high-grade squamous intraepithelial lesion (ASC-H; n = 17) and low-grade squamous intraepithelial lesions (LSILs; n = 14) in the detection of cervical intraepithelial neoplasia (CIN) type 2+ lesions. Results: Of the 70 CBs, 22 were diagnosed as negative, 27 as CIN1 and 21 as CIN2+. The sensitivity and specificity of CB preparation for the diagnosis of CIN2+ lesions were 50 and 100%, respectively, in ASCUS, 92 and 100%, respectively, in ASC-H, 100 and 100%, respectively, in LSILs. Conclusions: Our study confirms that CB preparation is a simple and reproducible technique with a good specificity that could be added advantageously to Pap smears to detect CIN2+ lesions in women with ASCs and LSILs.

Epitel hücre anormalliği saptanan servikal smear olgularında sitolojik tanı dağılımı ve sito-histopatolojik korelasyon

Ozet Amac. Anabilim Dali’mizda incelenen ve epitel hucre anormalligi saptanan servikovajinal smear sonuclarinin degerlendirilmesi ve histopatolojik incelemesi bulunan olgularda sito-histopatolojik korelasyonun arastirilmasi. Yontem. Ocak 2008-Mayis 2011 tarihleri arasinda Cumhuriyet Universitesi Tip Fakultesi Patoloji Anabilim Dali’na gonderilen ve 2001 Bethesda sistemine gore tani alan toplam 8102 servikal smear ornegine ait raporlar retrospektif olarak incelendi. Epitel hucre anormalligi tesbit edilen 97 olgu calismaya dahil edildi. Bunlardan histopatolojik incelemesi olan 25 olguda sito-histopatolojik korelasyon arastirildi. Bulgular. Toplam 8102 servikal smear’in 97’sinde (%1.19) epitel hucre anormalligi saptandi. Epitel hucre anormalligi saptanan olgularin 54’u (%55.6) ASC-US, 14’u (%14.4) ASC-H, 14’u (%14.4) LSIL, 5’i (%5,2) HSIL, 5’i (%5,2) SCC, 3’u (%3.1) AGC ve 2’si (%2.1) adenokarsinom, NOS olarak tani almis idi. Bunlardan biyopsi tanisi olan 25 olgunun 10’unun (%40) nonneoplastik, 2’sinin CIN I (%8), 1’inin (%4) CIN II, 3’unun (%12) CIN III ve 9’unun (%36) invaziv karsinom olarak rapor edildigi saptandi. Bu sonuclara gore ASC-US, ASC-H, LSIL, HSIL, SCC, AGC ve adenokarsinomun pozitif ongorme degeri sirasiyla %0, %50, %100, %80, %100, %0 ve %100 olarak saptandi. Sonuc. Servikal smear’ de verilen karsinom, HSIL ve LSIL tanilari yuksek pozitif ongorme degerine sahip iken, serimizde bu deger ASC-US ve AGC tanilari icin dusuk bulunmus, ancak bu gruplarda takipli olgu sayisinin cok az olmasi nedeniyle bu sonuc guvenilir kabul edilmemistir. Anahtar sozcukler: Servikal smear, sito-histopatolojik korelasyon, epitel hucre anormalligi Abstract Aim. To evaluate the cervicovaginal smears with epithelial cell abnormality examined in our department and to investigate the cyto-histopathological correlation of these cases with their histopathological diagnoses. Method. The reports of cervical smears diagnosed according to 2001 Bethesda System in Cumhuriyet University, Faculty of Medicine, Pathology Department between January 2008 and May 2011 were reviewed retrospectively (n: 8102). Among them, cases with epithelial cell abnormality (n: 97) were included in the study. In 25 of these patients having also histopathological examinations, cyto-histopathological correlation was investigated. . Results. Epithelial cell abnormality was detected in 97 (1.19) out of 8102 cervical smears. In the cytopathological examination, 54 patients (55.6%) had ASC-US, 14 had (14.4%) ASC-H, 14 had (14.4%) LSIL, five had (5.2%) HSIL, five had (5.2%) squamous cell carcinoma (SCC), three had (3.1%) atypical glandular cells (AGC) and two had (2.1%) adenocarcinoma, NOS. Histopathological results of 25 patients revealed that 10 patients had (40%) nonneoplastic, two had CIN I (8%), one had (4%) CIN II, three had (12%) CIN III and nine had (36%) malignant lesion. The positive predictive values for the cases with diagnoses of ASC-US, ASC-H, LSIL, HSIL, SCC, AGC and adenocarcinoma were 0%, 50%, 100%, 80%, 100%, 0% ve 100%, respectively. Conclusion. Eventhough the positive predictive values in diagnosis of carcinoma, HSIL, and LSIL had been high, those values were found to be low in diagnosis of ASC-US and AGC in our series, but since the number of follow-up cases were very few in these groups this result was accepted as not reliable. Keywords: Cervical smear, cyto-histopathological correlation, epithelial cell abnormality

Non-Hodgkin′s lymphoma: A rare diagnosis on cervicovaginal cytology

Cervicovaginal smear screening is well known to reduce morbidity and mortality rates of invasive cervical carcinoma. Herein, we report a case of 56-year-old woman whose cervicovaginal smear was found to consist of malignant cells characterized by high nuclear/cytoplasmic ratio, scant rim of cytoplasm, coarsely granular nuclear chromatin and irregular nuclear membrane that were all reminiscent of a malignant lymphoma. Histopathological examination of the hysterectomy and unilateral adnexectomy specimen confirmed the presence of a diffuse large B-cell non Hodgkin's lymphoma involving the cervix, endometrium, myometrium, serosa and the right ovary.

The presence of eosinophil leucocytes in cervicovaginal smears with Actinomyces-like organisms: Light microscopic examination.

Background:Actinomyces species are part of mucosal surfaces of oral cavity, gastrointestinal and genital tracts. When these mucosal surfaces disrupt, Actinomyces become pathogen and cause infection. Eosinophil leucocytes participate in host defense against helminthic infestation and they generally play a role in asthma and allergy. However, the role of eosinophil leucocytes in host defense against bacteria is conflicting.Aim:To determine whether there is a relationship between Actinomyces-like organisms (ALOs) and eosinophil leucocytes at light microscopic level.Materials and Methods:Cervicovaginal samples obtained from 200 patients were examined by both Pap smear microscopy and anaerobic culturing. Since the results obtained by these methods were not concordant for diagnosis of genital Actinomyces, 6 of 200 patients (3%) diagnosed with ALOs by Pap smear microscopy became the study group. Patients without any infectious agents (n=134) were the control group. Statistical analyses were conducted with χ2 test using SPSS program.Results:The study and control groups were compared statistically in view of the presence of eosinophil leucocytes and it was found that there was a significant correlation between the presence of ALOs and eosinophil leucocytes (P<0.05). Abundant polymorphonuclear leucocytes (PMNLs) and macrophages were also detected in the study group.Conclusion:This study implies that eosinophil leucocytes might have a role in host defense against Actinomyces in addition to PMNLs and macrophages.

Reducing “atypical squamous cells” overdiagnosis on cervicovaginal smears by diligent cytology screening

The frequency of possible reasons for "atypical squamous cells" (ASC) overdiagnosis on Papanicolaou (Pap) smears was analyzed. Pap smears of 199 women with negative biopsy outcome after an ASC diagnosis were reviewed. Special attention was paid to presence of reproductive tract infections (RTIs), perimenopausal cells (PM cells), immature metaplastic cells, hormone-related alterations, and drying artefacts. Comparisons were made using χ(2) test between the two ASC qualifiers and also between premenopausal and peri/postmenopausal women. Possible reasons for ASC overdiagnosis could be assigned on Pap smear review in 88/199 (44.2%) negative biopsies. Overall, PM cells were the most frequent reason for ASC overdiagnosis, being present in 35/199 (17.6%) smears. RTIs were the next most common cause (14.6%). PM cells were the most significant confounding factors for persistent ASC undetermined significance (ASC-US) over interpretation (20.2%) while in none of the cases these were interpreted as ASC-H (P = 0.004). Of these, 32 smears belonged to peri/postmenopausal women while only three to premenopausal women (P < 0.001). Immature metaplastic cells were significantly more frequent cause of ASC-H rather than ASC-US interpretation (P = 0.007). RTIs and drying artefacts were more frequently overcalled as ASC-US (in premenopausal women) while hormonal changes were interpreted as ASC-H. Hormone related changes, immature metaplastic cells and drying artefacts more commonly resulted in ASC interpretation in peri/ postmenopausal smears. The results of this study suggest that diligent screening can substantially reduce ASC overdiagnosis, thereby reducing the referrals/ follow ups.

Investigation of pituitary adenylate cyclase activating polypeptide in human gynecological and other biological fluids by using MALDI TOF mass spectrometry

Pituitary adenylate cyclase activating polypeptide (PACAP) is a multifunctional and pleiotropic neuropeptide. PACAP has diverse effects in the endocrine system, among others, it plays important roles in oogenesis, implantation and development of the nervous system. However, it is not known whether PACAP is present in the fluids of the human reproductive organs. The aim of the present study was to determine, by means of mass spectrometry and radioimmunoassay, whether PACAP is present in human amniotic fluid, ovarian follicular fluid and cervico-vaginal fluid. Samples were obtained from healthy adult volunteers. Our MALDI TOF and MALDI TOF/TOF spectrometry results show that PACAP38 is present in all of the follicular fluid samples, and PACAP-like immunoreactivity was also measured by radioimmunoassay. However, we did not find the characteristic peak representing the unmodified 38 amino acid form of the peptide in normal cervico-vaginal smear and amniotic fluid samples. Furthermore, we analyzed other body fluids for comparison, such as human nasal fluid, saliva and aqueous humor. PACAP was not found in these latter samples. In summary, the present study provides evidence for the presence of PACAP in human follicular fluid, suggesting a role in oocyte function, but determination of the exact physiological significance awaits further investigation.

Presença de células da junção escamo-colunar em esfregaços cérvico-vaginais de mulheres acima de 40 anos Presence of cells of the cervical transicional zone in cervicovaginal smears in women older than 40 years old

to evaluate the frequency of cells of the cervical transitional zone (CTZ) in cervicovaginal smears of women older than 40 years. we conducted a retrospective study with review of 24,316 Pap smear reports during the period from January 2005 to December 2008, to evaluate the cases without material of the CTZ. Exclusion criteria were: total hysterectomy, smears with severe atrophy or unsatisfactory for analysis, cases without visualization of the cervix or the external orifice of the cervix closed during examination and records without the patient's age. A total of 21,866 cervical-vaginal cytology reports were included in this study. We evaluated the relationship between the presence of material of the CTZ and use of hormone replacement therapy (HRT) in patients aged 40 years or more and the relationship between presence of material of the CTZ and a moderate to intense inflammatory process in patients aged 39 years or less. Data were analyzed statistically by the χ2 test and Odds Ratio. only 11.2% of patients younger than 40 years had no material from the CTZ in their smears, while 47% patients older than 40 years had no material from the CTZ (p=0.0001). Most patients aged 40 years or more (92.1%) did not use HRT and this was not a predictor of incidence of CTZ material in these patients (p> 0.05). In contrast, most patients younger than 40 years without CTZ material (74.5%) had abundant inflammation in the smears (p=0.0001). patients aged 40 years or more had a lower incidence of material from the CTZ in cervicovaginal smears, and inflammation was a factor that contributed to the absence of CTZ material in the smears from patients younger than 40 years.

Lsil/asc-h (lsil-h) in cervicovaginal smear: histopathological outcomes and clinical significance

Lsil/asc-h (lsil-h) in cervicovaginal smear: histopathological outcomes and clinical significance

Pediatric vulvar squamous cell carcinoma in a liver transplantation recipient: a case report

Here we report the first Korean case of a girl who developed noninvasive squamous cell carcinoma of the vulva at the age of 16 years. She was taking tacrolimus, an immunosuppressive agent, after living-related liver transplantation. The vulvar masses were microscopically proved as vulvar intraepithelial neoplasm II and III, even squamous cell carcinoma in situ. Human papillomavirus subtypes (69 and 73) and human papillomavirus types (66, 70, 73, and 43) were detected in the vulvar mass and the cervicovaginal smear, respectively. The outcome of liver transplantation for children has been markedly improved during the last several decades. However, the present case highlights the need to perform periodic genital examinations for the adolescents after liver transplantation. In addition to the high risk and probable high subtypes, uncommonly found human papillomavirus subtypes were extracted from her vulvar cancer. The present case is the first to show the possible relationship between previously unknown and uncommon human papillomavirus subtypes and pediatric post-transplant vulvar squamous cell carcinoma. More attention should be paid to the vulvar and cervical surveillance of pediatric transplant recipients by both medical specialists and general physicians.

Lsil/asc-h (lsil-h) in cervicovaginal smear: histopathological outcomes and clinical significance

Lsil/asc-h (lsil-h) in cervicovaginal smear: histopathological outcomes and clinical significance

The analysis of factors which affect resection margin status after conization for cervical intraepithelial neoplasia

목적 자궁경부 원추절제술 후 절제 변연부 침범 소견을 보일 때 병변의 중증도가 이에 미치는 영향에 대하여 살펴보고 절제 변연부 침범과 재발 및 잔류종양의 연관성에 대하여 알아보고자 하였다. 연구방법 2003년 11월부터 2011년 2월까지 자궁경부 원추절제술을 시행 받은 후 cervical intraepithelial neoplasia (CIN)으로 진단된 환자 202명을 대상으로 후향적 연구를 시행하였다. 원추절제술 후 환자는 자궁절제술을 시행 받거나 3-6개월 간격으로 자궁경부세포검사를 통한 추적관찰을 시행하였으며 이상 소견을 보이는 경우 질확대경하에 조직검사를 시행하였다. 재발은 CIN I 이상의 조직 소견을 보이는 경우로 정의하였다. 결과 CIN으로 진단된 환자 202명 중 CIN I은 46명(22.8%), CIN II는 35명(17.3%), CIN III는121명(59.9%)이었다. 절제 변연부 침범 소견을 보인 환자는 67명(33.2%)이었고 CIN I은 7명(10.4%), CIN II는 14명(20.9%), CIN III는 46명(68.7%)으로 CIN의 중증도가 심할수록 절제 변연부의 침범 빈도가 증가하였다(P = 0.009). 자궁절제술을 시행 받은 환자는 28명(13.9%)으로 절제 변연부 침범이 없었던 환자는 13명, 절제 변연부 침범이 있었던 환자는 15명이었고 각각 7명(53.8%)과 5명(33.3%)에서 잔류 병변이 존재하여 절제 변연부의 침범 여부와 잔류종양의 유무는 통계학적으로 유의한 상관관계를 보이지 않았다(P = 0.445). 보존적 치료를 시행한 환자는 174명으로 이 중 절제 변연부 침범을 보인 3명(3/52, 5.7%)과 절제 변연부 침범을 보이지 않은 2명(2/122, 1.6%)의 환자에서만 재발을 보였다(P = 0.335). 결론 CIN 환자에 있어 병변의 중등도가 심할수록 절제 변연부 침범이 있을 가능성이 크지만 절제 변연부의 침범이 있다 하더라도 실제적으로 잔류 병변이 없는 경우가 더 많으며 절제 변연부의 침범 여부가 재발과는 유의한 상관관계가 없는 것으로 나타났다. 따라서 변연부 침범소견을 보이는 경우라도 지속적 추적관찰만 잘 이루어 질 수 있다면 CIN의 치료로 충분하다 할 수 있겠다. 또한 절제 변연부의 침범이 없는 경우에도 잔류종양이 남아 있을 가능성이 있으므로 주의 깊은 추적관찰이 필요할 것으로 생각된다.

Detection and Genotyping of Human Papillomaviruses in Bulgarian Patients for the Period of 2009–2010

ABSTRACTHuman papillomavirus (HPV) is now considered as a causative agent of carcinoma of the uterine cervix. Papillomaviruses are a diverse group of DNA-based viruses that infect the skin and mucous membranes of humans and a variety of animals. Over 100 different human papillomavirus (HPV) types have been identified. Genital human papillomaviruses are classified into low-risk and high-risk. The low-risk HPVs are associated with genital warts and lesions. Persistent infection with a subset of about 13 so-called „high-risk” sexually transmitted HPVs may lead to the development of cervical intraepithelial neoplasia (CIN), vulvar intraepithelial neoplasia (VIN), penile intraepithelial neoplasia (PIN), and/or anal intraepithelial neoplasia (AIN). These are precancerous lesions and can progress to invasive cancer. HPV infection is a necessary factor in the development of nearly all cases of cervical cancer. The main methods in HPV diagnosis are molecular methods. In this research we used Roche's LINEAR ARRAY HPV Genotyping Test (CE-IVD). This method combines multiplex PCR with 40 pairs of primers and DNA hybridization. The products from the PCR are used to hybridize with nylon strips which contain immobilized DNAs of 38 types and subtypes of HPV genotypes. The cervical smears were collected from Bulgarian patients with condylata acuminate lesions, in three hospitals in Sofia—University Hospital of Obstetrics and Gynaecology “Maichin Dom”, „Tokuda” Hospital and the “National Institute of Oncology and Hematology”. One hundred and twenty six cervicovaginal smears and scrapings were tested by this method. Forty two percent of them were found positive for HPV DNA and fifty eight percent, negative. We found more than one type of viral DNA in all positive samples. We found HPV 16 DNA in twenty two samples (38%); HPV 18 DNA, in eight samples (18%); HPV 6 DNA, in five cases (10%); HPV 53 DNA, in seven cases (11%); HPV 31 DNA, in three cases (4%); HPV 35, in four cases (5%), and in two cases we found viral DNA types HPV 61 and HPV 62. Further studies are needed to determine the influence these HPV infections have on the epidemiology of the genital tract of these patients.

Lsil/asc-h (lsil-h) in cervicovaginal smear: histopathological outcomes and clinical significance

Conventional Pap smears exhibiting unequivocal features of 'low grade squamous intraepithelial lesion' (LSIL) are occasionally mixed with some cells suspicious for, but not diagnostic of 'high grade squamous intraepithelial lesion' (HSIL) on daily routine. The 2001 Bethesda System does not address the significance of such cytological entities. We have referred to these changes in our laboratory as'LSIL, atypical squamous cells cannot exclude HSIL' (LSIL/ASC-H). In this study, we aimed to compare the cytology and biopsy results of LSIL/ ASC-H to LSIL, ASC-H and HSIL. Out of 37884 cases which were evaluated between 2005-2009 in our laboratory, cases interpreted as LSIL, LSIL/ ASC-H, HSIL and ASC-H were reevaluated and 153 cases for which biopsy materials were available were selected. The rate of histological CIN2 or worse associated with LSIL/ ASC-H (45%) was between the rates of LSIL (10%) and HSIL (65%), but not significantly different from ASC-H (50%). However, LSIL/ ASC-H was more frequently associated with a definitive histological diagnosis of any CIN2 than ASC-H (30% vs. 8%). Based on our results, we recommend LSIL/ASC-H to be added to Bethesda System, and Pap test cases of LSIL/ASC-H may need to be clinically followed-up in a manner similar to ASC-H, i.e., with colposcopy for all patients.

The PapCone® as a valid cervical sampling device: a comparative ultrastructural and semiquantitative study

The efficiency of cervical cancer screening depends on the proper interpretation of results and on the quality of the sample. For a smear to be considered adequate, cell samples from the endocervix, transformation zone and ectocervix must be present. Our aim was to analyse cervicovaginal smears’ with scanning electron microscopy (SEM), comparing the traditional Ayre’s wooden spatula (Sp) and endocervical cytobrush (Cb) with a new cone-shaped polyurethane (foam) device, the PapCone®(Otto Bock, Duderstadt, Germany). Pap tests were performed with the related informed consent in 22 adult fertile (aged 20-46) women using Sp and/or Cb; sampling with the PapCone® followed 3 months after. The apical extremity of each device was fractured and fixed in toto in 2.5% glutaraldehyde containing vials. Samples were stored at 4°C, postfixed in 1% osmium tetroxide, dehydrated, critical-point dried, mounted on aluminum stubs, coated with platinum, and observed with a Hitachi S-4000 FE-SEM. Statistical analysis was performed evaluating ecto-/endocervical cells, erythrocytes, and/or mucus contained in ten 250x-microscopic fields. There were no significant differences in the number of ectocervical cells and in the quantity of mucus sampled when comparing the 3 devices. The PapCone® sampled significantly more endocervical cells with respect to Sp and Cb, and more erythrocytes with respect to the Sp. These latter data may be due to the characteristic porous and trabecular surface of the PapCone®, which samples a larger volume of material that tends to be also present in less overlapping layers. In conclusion, PapCone® is a better device with respect to Sp and Cb for sampling endocervical cells. Improved cervical sampling will certainly lead to better quality smears and hopefully decrease both false negative and inadequate smear rates.

Vaginal lubricant gel as an artefact on a Pap smear

After reading some articles on the issue of whether the use of lubricant gel may have any effect on cervicovaginal smears, both in conventional cytology and in liquidbased preparations, in our opinion, the authors’ conclusions seem contradictory. Here is an image corresponding to a routine conventional cervicovaginal Pap smear from a young female sex worker. It shows a violet-shaded amorphous material smeared in a wave-like pattern. This material covers both the background and epithelial cells (Fig. C-1), which obscures a large portion of the smear. Some infectious agents such as actinomyces-like organisms (no filamentous structures were observed) and processes like vaginal bacteriosis (absence of the typical ‘‘clue cells’’ and coccobacilli) were discarded as differential diagnosis. As a possible artefact caused by some vaginal cream was suspected, the patient was asked about the use of some product for the genital zone. She answered that she usually put on vaginal gel to provide lubrication during sexual intercourse. Due to painful coituses, vaginal dryness may constitute an important problem, especially when psychological or physiological alterations (menopause, breastfeeding, diabetes, etc.) exist. Therefore, additional lubricants for sexual intercourse are commonly used. Because this type of products may cause artefacts on smears, cytotechnicians and cytologists should be alert when screening is exercised.