Squamous atypia in the atrophic cervical vaginal smear: a new look at an old problem.
BACKGROUND
Squamous atypia in postmenopausal (PM) cervical vaginal smears (CVS) only rarely is associated with a biopsy-proven squamous intraepithelial lesion (SIL), and thus most commonly represents an atrophy-associated benign reactive change.


METHODS
To distinguish atypical squamous cells of undetermined significance (ASCUS) and SIL from atrophy-associated benign reactive changes, a review of atypical atrophic PM CVS was performed. Ninety CVS exhibiting an atrophic smear pattern were considered appropriate for study. Repeat smears and/or biopsy after local estrogen therapy were requested to distinguish atrophic/reactive from dysplastic changes.


RESULTS
Generally, atrophic CVS exhibit uniform nuclear enlargement in the squamous cell population, which, using the criterion of nuclear enlargement alone, would qualify the majority of these cases to be classified as ASCUS. The nuclear enlargement associated with atrophy resolves with the local application of estrogen. 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 features most commonly noted in the cases considered to be ASCUS (nonreactive) and SIL were nuclear hyperchromasia and nuclear contour irregularities.


CONCLUSIONS
Nuclear enlargement alone is not sufficient for diagnosing 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 irregular nuclear contours remain the most reliable cellular characteristics for diagnosing SIL in atrophic CVS.
Laboratory of Pathology, Cytopathology Section, National Cancer Institute/National Institutes of Health, Bethesda, Maryland 20892, USA.
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A
Abati
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Jaffurs
A M
AM
Wilder
D000368:Aged; D001284:Atrophy; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000473:pathology*; D002467:Cell Nucleus / Q000145:classification / Q000648:ultrastructure; D002584:Cervix Uteri / Q000166:cytology / Q000473:pathology; D005260:Female; D006801:Humans; D008875:Middle Aged; D017698:Postmenopause; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000473:pathology*; D014626:Vaginal Smears