PART TWO
Diagnostic Cytology
Fig. 7.21 Pemphigus vulgaris, cervix.
Tissue biopsy reveals cellular changes
similar to those seen in the smear in Fig. 7.20. Cervical biopsy (H&E x MP).
Fig. 7.23 Epithelioid cells.
Notice the syncytial formation of cells with ill-
defined margins. Vaginopancervical smear (Papanicolaou x MP).
Fig. 7.22 Donovan bodies.
A single macrophage reveals the cytoplasmic
lobules containing numerous safety-pin-shaped bacillary structures.
Vaginopancervical smear (Papanicolaou x OI).
aggregates of epithelioid cells. These appear as pale, cyanophilic
cells in a syncytial formation with indistinct and arborizing bor-
ders and vesicular, oval nuclei (Fig. 7.23). Intermixed with these
one may occasionally observe Langhans-type multinucleated
giant cells (Fig. 7.24). These cells may contain as many as 20
to 30 peripherally arranged vesicular nuclei. A variable number
of lymphocytes may be present in the background. Secondary
infection is common in these ulcerated lesions, and heavy, acute
inflammatory exudates may be present. A cytologic diagnosis of
granulomatous disease, probably tuberculosis, can be suggested
under appropriate clinical and cytologic settings.
Malacoplakia
Malacoplakia is a rare disorder that may affect the cervix. We
have observed two cases occurring in postmenopausal women
with atrophic smears and persistent vaginal discharge.33 Numer-
ous macrophages with the characteristic intracytoplasmic, lami-
nated inclusions (Michaelis-Gutmann bodies) may be observed
(Fig. 7.25). They can be stained for calcium salts including cal-
cium phosphates and carbonates by histochemical techniques
such as Von Kossa's method.34
Fig. 7.24 Cervical tuberculosis
(H&E x LP).
Langerhans Cell Histiocytosis
This rare disease of unknown etiology may involve the lower
female genital tract and the endometrium. It has been included
here because the lesions can both clinically and cytologically
may be indistinguishable from inflammatory or neoplastic
processes. It can occur as "pure" genital tract or part of the gen-
eralized systemic disease. Cervical cytology may contain atypi-
cal histiocytic cells (Fig. 7.26), numerous macrophages with
intranuclear grooves, eosinophils, and an occasional multinu-
cleated giant cell (Fig. 7.27). This diagnosis may be considered
in the presence of intranuclear grooves in the macrophages, and
eosinophils in the smear. The exact morphologic features vary
from the stage of the disease. Immunohistochemical stains S100
and CD1a as well as ultrastructural demonstration of Birbeck
granules are helpful diagnostically.35,36
Actinomyces
These organisms belong to the order of higher bacteria that also
include Mycobacteriaceae and
Streptomycetaceae.
There are three
common species of
Actinomyces
A. israelii, A. bovis,
and
A. naes-
lundii.
These bacteria are nonmotile, non-spore-forming, and
100
previous page 102 ComprehensiveCytopathology 1104p 2008 read online next page 104 ComprehensiveCytopathology 1104p 2008 read online Home Toggle text on/off