Herpesvirus mimics. A potential pitfall in endocervical brush specimens.
The recent media focus on inadequacies in cervical smear collection and interpretation has resulted in improved collection methods, such as endocervical brushes, as well as closer scrutiny of morphologic criteria. However, endocervical cell artifacts may be associated with these endocervical brushes. Recently in our laboratory a case of reactive-atypical endocervical cells that resembled the cytologic changes associated with Herpes simplex virus (HSV) infection resulted in a false-positive diagnosis of HSV infection. Of 14,622 gynecologic specimens accessioned over 14 months, 459 cases with reactive endocervical cells and 117 with atypical endocervical cells were reported. These cases were reviewed by two independent observers with no knowledge of the prior diagnoses and were evaluated for four cytologic criteria considered diagnostic of HSV infection: multinucleation, margination of nuclear chromatin, ground glass chromatin and intranuclear inclusions. Nineteen cases were diagnostic/suggestive of HSV; 19 additional cases were identified as herpesvirus mimics. The original diagnoses, demographics, clinical data and method of collection were reviewed. In all but three cases an endocervical brush was the method of collection. Of the four criteria studied, only ground glass chromatin had both high sensitivity (95%) and specificity (95%). Intranuclear inclusions, while pathognomonic, had low sensitivity (42%). Altered endocervical cells that mimic herpesvirus are a potential pitfall in the diagnosis of HSV infection. Use of strict criteria, knowledge of the collection method and clinical history will avoid misdiagnosis.
Stowell
S B
SB
Department of Pathology, State University of New York Health Science Center at Syracuse, New York 13210.
Wiley
C M
CM
Powers
C N
CN
D002584:Cervix Uteri / Q000166:cytology* / Q000648:ultrastructure; D003937:Diagnosis, Differential; D005189:False Positive Reactions; D005260:Female; D006561:Herpes Simplex / Q000473:pathology*; D006801:Humans; D012680:Sensitivity and Specificity; D002577:Uterine Cervical Diseases / Q000473:pathology*; D014626:Vaginal Smears / Q000295:instrumentation / Q000379:methods*