The Pap smear in inflammation and repair

Abstract

Cytology of the uterine cervix is one of the most widely utilized tests and is best known primarily for the cytologic changes seen in precancerous lesions and invasive cancer of the uterine cervix. The more common inflammatory conditions of cervicitis and vaginitis are close clinical differentials, especially when they give rise to excessive blood-stained vaginal discharge. These infective conditions also result in variation in the appearance of otherwise benign squamous and glandular cells in cervical cytology specimens. A variety of physiologic and pathologic conditions are responsible for the conversion of polymicrobial flora of the vagina to a monomicrobial one. The latter may overgrow the others and result in inflammation of the cervix and the vagina. Chronic irritation of the cervix due to intrauterine devices, chemical irritants, inflammation/infection, endocrine changes, and reparative changes can lead to worrisome parakeratosis, hyperkeratosis, and squamous metaplasia of non-keratinized squamous mucosa of the cervix and the vagina and may mimic HPV-related changes. Although some benign changes are specific for certain infections, for example, Trichomonas infestation, most of the reactive and hyperplastic cell morphology are important to recognize only due to the significant morphologic overlap with neoplastic changes in cytology specimens. Identification of different pathogens specifically may not be relevant from a clinical point of view, but is undoubtedly a cytologists’ privilege to inform the clinician! This chapter describes in detail the cytoplasmic and nuclear reactive changes that are found in specific and non-specific inflammatory conditions. In addition, diagnostic pitfalls are emphasized where necessary.

Predictive Value of Various Atypical Cells for the Detection of Human Papillomavirus in Cervical Smears

“…Binucleated cells were most frequently present in the Pap smears of patients with HPV infection. Binucleation is one of several morphological epithelial changes induced by sexually transmitted pathogens, such as Candida and HPV [17][18][19]. These changes, defined as reactive cellular changes under the "negative for intraepithelial lesion or malignancy" category in the Bethesda system, have not yet been distinguished from HPV infection [18].…”

Analysis of HPV prevalence among individuals with reproductive tract infections in a Chinese population

“…Interesting, vaginal microecology can affect the process of HPV infection through various mechanisms. [ 26 , 27 ] Vaginal lactobacilli maintain a low pH, prevent HPV invasion, and produce bacteriocins, effectively inhibiting HPV entry into basal keratinocytes of the cervix. [ 28 ] Anaerobic bacteria in vaginal bacterial vaginosis produce enzymes and metabolites that may disrupt the barrier of cervical epithelial cells and promote HPV entry.…”

Collagen-Based Ovule Therapy Reduces Inflammation and Improve Cervical Epithelialization in Patients with Fungal, Viral, and Bacterial Cervico-Vaginitis

“…The cervical squamous epithelium represents the first and most critical form of protection in the genital environment, providing a mechanical barrier that protects against opportunistic pathogen invasion [ 11 ]. In the absence of this barrier, during a period of active cell replication such as that occurring in the presence of immature metaplasia or cervical ectropion, in a state of cellular inflammation, and in the presence of contributing factors such as altered vaginal pH, various pathogens can replicate more easily and disrupt the normal resident microbiota [ 11 , 12 ]. Our results align with previous research highlighting the importance of a balanced vulvo-vaginal environment in maintaining vaginal health [ 10 , 13 , 14 , 15 , 16 , 17 ].…”