7
Microbiology, inflammation, and Viral infections
Fig. 7.18 Vaginal lactobacillosis.
This picture reveals numerous ‘giant"
lactobacilli along with some yeast forms of
C andida
(Papanicolaou x HP).
Fig. 7.19 Allergic vaginitis.
Note the numerous eosinophils in this
preparation. Cervicovaginal smear (Papanicolaou x MP).
Allergic and Acute Vaginitis
Numerous eosinophils may occur in the cervical samples obtained
from women with vaginal discharge. Generally, the causes are
noninfectious and associated with an allergic reaction to vaginal
douche, contraceptives, or various items of clothing30 (Fig. 7.19).
Desquamative Inflammatory Vaginitis (DIV)
This clinical condition is noninfectious in nature and may result
from a number of blister-forming disorders including pemphi-
gus vulgaris, lichen planus, and pemphigoid.31
Pemphigus vulgaris may exfoliate parabasal size cells that
have extremely prominent single or multiple nucleoli, pale chro-
matin, and features of reactive cells. Mitosis may be observed.
Nuclear and cytoplasmic changes can simulate squamous cell
carcinoma or atypical endocervical or metaplastic cells (Figs.
7.20, 7.21).32
Granuloma Inguinale
Gram-negative, encapsulated coccobacillary organisms called
Calymmatobacterium granulomatis
cause this venereally transmit-
ted infection. The infection produces large, ulcerated lesions
that histologically reveal inflammatory granulation tissue and
Fig. 7.20 Pemphigus vulgaris.
In (B) cells show metaplastic changes.
These features can be confused with neoplastic as well as viral changes.
Vaginopancervical smear (Papanicolaou x MP).
numerous macrophages. These macrophages are easily identi-
fiable in ethanol-fixed Papanicolaou stained smears. They are
plump and swollen and have a lobulated cytoplasm. Within the
cytoplasm, a large number of coccobacillary (1-2 pm) struc-
tures (Donovan bodies) are seen. These are safety-pin shaped
with terminal or polar thickening of the cell walls (Fig. 7.22).
The organisms stain faintly with hematoxylin and eosin (H + E)
dyes. They can be stained with Romanowsky or silver stains.
Varying degrees of acute inflammation are commonly observed
in the smears. The infection is more common in the tropics,
and the incidence is high in India and New Guinea. Although
reported, an association of granuloma inguinale and squamous
cell carcinoma is controversial. It is true that the infection may
cause extremely bizarre pseudoepitheliomatous hyperplasia of
the squamous epithelium that can mimic neoplasm.
Tuberculosis (Granulomatous Cervicitis)
This is a disease of the tropics and is usually secondary to
extragenital,
most
often
pulmonary,
tubercular
infection.
Involvement is more common in the fallopian tubes and the
endometrium and is thus difficult to detect cytologically. Angrish
and Verma33a reported a number of cases of cervical tuberculosis
that were detected cytologically. The cervical smears reveal large
99
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