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False‐positive squamous cell carcinoma in cervical smears: Cytologic‐histologic correlation in 19 cases
Author(s) -
Levine Pascale Hummel,
Elgert Paul A.,
Mittal Khush
Publication year - 2003
Publication title -
diagnostic cytopathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.417
H-Index - 65
eISSN - 1097-0339
pISSN - 8755-1039
DOI - 10.1002/dc.10220
Subject(s) - medicine , pathology , dysplasia , cytology , carcinoma in situ , carcinoma , koilocyte , papanicolaou stain , cervical intraepithelial neoplasia , cytopathology , cervical cancer , cancer
Cytologic features of squamous intraepithelial lesions (SIL) can mimic those of invasive squamous‐cell carcinoma. We compare and correlate the cytological findings of 19 false‐positive squamous‐cell carcinomas with follow‐up cone biopsies or hysterectomy specimens to define which type of dysplasia is more prone to diagnostic errors on cervical Papanicolaou (Pap) smears. Out of 128 patients diagnosed with invasive squamous‐cell carcinoma from 1994–2000, 19 (14.8%) with follow‐up cone biopsies or hysterectomy specimens were false‐positive cases, showing only cervical intraepithelial neoplasia (CIN). We reviewed tissue sections from these 19 cases of CIN for cytologic features of squamous‐cell carcinoma, such as markedly pleomorphic and/or dysplastic squamous cells, necrosis, and nucleoli. Twelve of 19 patients (63%) were menopausal. The mean age was 50.5 yr. On review of cervical smears, 18 cases qualified for the cytologic diagnosis of squamous‐cell carcinoma, keratinizing type, and one case qualified for squamous‐cell carcinoma, nonkeratinizing type. Pleomorphic and/or keratinizing dysplasia was found in 15 out of 19 patients (79%), necrosis within superficial endocervical glands in 9 out of 19 patients (47%), and conspicuous nucleoli in 12 out of 19 patients (63%). One or more of these changes were seen in all but 2 patients (89%). Endocervical gland involvement was present and extensive in 18 of the 19 cases (94%). The mean age was older than expected for SIL (50.5 vs. a reported 40), and matched the mean age found in patients with invasive squamous‐cell carcinoma. Pleomorphic and/or keratinizing dysplasia involving endocervical glands may exhibit the cytologic features of squamous‐cell carcinoma on cervical Pap smears. Diagn. Cytopathol. 2003;28:23–27. © 2003 Wiley‐Liss, Inc.