Pemphigus vulgaris of the cervix: diagnostic difficulties associated with the Pap test.
Pemphigus vulgaris (PV) is a rare mucocutaneous disease caused by the abnormal production of antibodies against epithelial cell surface glycoproteins, resulting in loss of cell adhesion and intraepithelial blister formation. Cervical involvement in PV has been poorly reported, and there is little information regarding the criteria about consequential cytological changes identified in a Papanicolaou-stained cervicovaginal smear (Pap smear). Here, we report a case of PV manifesting in the cervix as well as the difficulty associated with the cytomorphological identification and interpretation of acantholytic cells. This case involved a 40-year-old patient with no history of Pap test abnormalities and no prior diagnosis of PV. In the cytological assessment, cells were identified both in isolation and in clusters that exhibited round nuclei of increased volume, inconspicuous nucleoli, and perinuclear halos. The patient underwent a cervical biopsy that revealed vesiculobullous lesions and morphological pattern consistent with PV. A skin biopsy confirmed this diagnosis. We concluded that knowledge of PV cytomorphology is important because difficulties associated with the identification and interpretation of acantholytic cells might be responsible for false positive diagnoses of cervical neoplasia. However, a suspected diagnosis of PV is possible if the cytological findings are carefully correlated with the clinical data.
Pathology Residency Program, Hospital Municipal São José, Joinville, SC, Brazil.|Division of Cytopathology, Centro De Diagnósticos Anátomo-Patológicos-CEDAP, Joinville, SC, Brazil.
Karina
K
Munhoz de Paula Alves Coelho
Division of Cytopathology, Centro De Diagnósticos Anátomo-Patológicos-CEDAP, Joinville, SC, Brazil.
Jaqueline
J
Stall
Department of Medicine, Universidade Da Região De Joinville-UNIVILLE, Joinville, SC, Brazil.
Paulo
P
Henrique Condeixa de França
Pathology Residency Program, Hospital Municipal São José, Joinville, SC, Brazil.|Division of Cytopathology, Centro De Diagnósticos Anátomo-Patológicos-CEDAP, Joinville, SC, Brazil.
Lara
L
Cristina de Carvalho Tavares
Division of Cytopathology, Centro De Diagnósticos Anátomo-Patológicos-CEDAP, Joinville, SC, Brazil.|Department of Medicine, Universidade Da Região De Joinville-UNIVILLE, Joinville, SC, Brazil.
Giuliano
G
Stefanello Bublitz
Pathology Residency Program, Hospital Municipal São José, Joinville, SC, Brazil.|Division of Cytopathology, Centro De Diagnósticos Anátomo-Patológicos-CEDAP, Joinville, SC, Brazil.
Beliza
B
Loos
Pathology Residency Program, Hospital Municipal São José, Joinville, SC, Brazil.|Division of Cytopathology, Centro De Diagnósticos Anátomo-Patológicos-CEDAP, Joinville, SC, Brazil.
Luciana
L
Carvalho Costa
Pathology Residency Program, Hospital Municipal São José, Joinville, SC, Brazil.|Division of Cytopathology, Centro De Diagnósticos Anátomo-Patológicos-CEDAP, Joinville, SC, Brazil.
Hercílio
H
Fronza Júnior
D000328:Adult; D001706:Biopsy; D002467:Cell Nucleus / Q000473:pathology; D002584:Cervix Uteri / Q000473:pathology* / Q000601:surgery; D003937:Diagnosis, Differential; D004817:Epidermis / Q000473:pathology* / Q000601:surgery; D004847:Epithelial Cells / Q000473:pathology; D005260:Female; D006651:Histocytochemistry; D006801:Humans; D065006:Papanicolaou Test; D010392:Pemphigus / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery
Pap smear; cervix; pemphigus