7
Microbiology, Inflammation, and Viral Infections
Fig. 7.34 “IUD cells."
These high nucleocytoplasmic (N/C) ratio cells appear to be of endometrial origin. They frequently show multinucleation, nuclear
degeneration, and nucleoli. If not carefully examined, these can be easily mistaken for cervical intraepithelial neoplasm. (A) Vaginopancervical smear
(Papanicolaou x HP). (B) IUD cells in LBGS (Papanicolaou x OI).
Table 7.6
Comparison of IUD cells and cervical intraepithelial neoplasia
(CIN/HSIL) cells
Feature
IUD cell
CIN/HSIL cell
Distribution
Endocervical
Endocervical
Tissue fragments
Rare
Common (LBGS)
Inflammation
Present
Absent
Cellular
degeneration
Present
Absent
Preservation
Poor
Good
Cellular hiatus
Present
Absent
Nucleoli
Present
Absent
Multinucleation
Present
Absent
IUD columnar cells
Present
Absent
associated with
Chlamydia
infection.52,53 Follicular cervicitis is
not uncommonly seen in postmenopausal atrophic smears. The
precise pathogenesis of this condition in this age group is not
well understood. These cells should be distinguished for malig-
nant lymphomas, histocytes, endometrial cells, and metastatic
tumor cells.
Key features of follicular cervicitis
• Must identify tingible-body macrophage;
• Difficult to diagnose in LBGS due to lymphocytic
dispersion; and
• Cells should be distinguished from:
- Lymphoma;
- Metastatic tumor cells;
- Endometrial cells; and
- Histiocytes.
Viral infections
Diseases caused by these intracellular organisms are among the
most common in the human body and include a most hetero-
geneous group of clinical conditions. Although some of the viral
infections have been affecting humanity for thousands of years,
changes in society, social habits, medical practice, and advances
in diagnostic capabilities have resulted in a great many new
Fig. 7.35
L e p to tric h ia b u c c a lis.
Vaginopancervical smear
(Papanicolaou x HP).
viral diseases. Even though smallpox has been eradicated from
the world, with antibiotics and immunosuppressive therapies,
numerous dormant viral infections have become manifest.
Being intracellular by nature, viruses co-opt cellular meta-
bolic processes in their replication cycles. In addition to
the nature of the affected tissues, the virus, general and local
immune responses, and particular enzymatic derangements are
important in determining the cytomorphologic changes and the
nature of the tissue injury or injuries. In some common viral
infections, these cellular changes may be quite typical and con-
sidered of diagnostic significance.
General Features of Viral Infection
Inclusion Formation
Inclusions are discrete, dense, homogeneous, round, or oval
intracellular structures consisting of viral particles in a matrix,
and generally represent a stage in the replication of the virus.
They do not occur in all viral infections, their formation
depending upon a particular agent and on the affected tissue.
Certain inclusions are typical and diagnostic. Inclusions may be
observed within the nuclei, the cytoplasm, or both.
105
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