Characterizing "blue blobs". Immunohistochemical staining and ultrastructural study.
OBJECTIVE
To investigate the nature and origin of "blue blobs" (Bbs) in atrophic Pap smears in postmenopausal women and to study their clinical significance.


METHODS
A retrospective study of 412 atrophic Pap smears from postmenopausal women was done to detect the presence of Bbs. The smears from 24 cases showing Bbs were further studied to evaluate the nature of the Bbs with special stains, immunohistochemistry and electron microscopy.


RESULTS
Bbs showed a heterogeneous morphology, with variable numbers and staining intensity. The diameter of Bbs was approximately equivalent to that of a parabasal/intermediate squamous cell. Special stains showed Bbs to be positive for periodic acid-Schiff and methyl green pyronin and negative for mucicarmine and calcium. Immunohistochemistry revealed Bbs to be positive for cytokeratin, epithelial membrane antigen and carcinoembryonic antigen and negative for vimentin and muscle-specific actin. Some Bbs had residual ghost nuclear shadows. Electron microscopy revealed cellular skeletons with residual tonofilaments enmeshed within a loose cytoskeleton matrix and nuclei with variable degrees of degeneration.


CONCLUSIONS
Special stains, immunohistochemistry and electron microscopy indicated that Bbs represent parabasal/intermediate squamous cells exhibiting various degree of degeneration. In general, Bbs appear to be of no clinical significance except as a source of potential diagnostic error.
Department of Pathology, Faculty of Medicine, Kuwait University, Safat, Kuwait.
M
M
Abdulla
S
S
Hombal
A
A
Kanbour
M
M
Becich
D
D
Stankovich
A
A
Ries
A
A
Kanbour-Shakir
D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000473:pathology; D000951:Antigens, Neoplasm / Q000032:analysis; D002584:Cervix Uteri / Q000473:pathology* / Q000648:ultrastructure; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D002479:Inclusion Bodies / Q000648:ultrastructure*; D008875:Middle Aged; D065006:Papanicolaou Test; D017698:Postmenopause; D012189:Retrospective Studies; D013194:Staining and Labeling; D014626:Vaginal Smears
D000951:Antigens, Neoplasm