Multinucleated Cells in PAP Smear- An Institutional Experience
Correspondence Address :
Dr. Vijayashree Raghavan,
D Block, Chettinad Hospital and Research Institute, Chettinad Health City, Rajiv Gandhi Salai, Kelambakkam, Chennai-603103, Tamil Nadu, India.
Cervical cytology, Ciliary metaplasia, Cytopathology, Pleomorphology
The cases which showed multinucleated cells in the papanicolaou smear, were collected after informed consent from the patients from the Department of Gynaecology during the past six months, and stained using papanicolaou staining method (1) were procured. These slides were identified and probable aetiology confirmed by two cytopathologists. The case details are shown in (Table/Fig 1). During the course of the study, it was noted, out of the 13 cases which had multinucleated cells, majority of the cases had reactive cellular changes due to inflammation, followed by atrophy, while one case had history of use of intrauterine contraceptive device, two had herpes infection and one had atypical glandular cell of uncertain significance. In the cases showing inflammation, binucleate and multinucleate cells were seen. The nuclei had regular nuclear contour, without nucleoli or pleomorphism. Some of the cells showed perinuclear halo and cytoplasmic vacuoles. In the case with intrauterine contraceptive device, multinucleate cells without pleomorphism or hyperchromasia were seen. In the cases showing ciliary metaplasia (Table/Fig 2), the multinucleate cells were columnar in shape with basally located multiple nuclei (3-5 nuclei). The nuclei were regular in shape, without atypia (Table/Fig 3). The cell had an end plate from which multiple cilia were seen. The cases with atrophy showed parabasal cells and occasional multinucleate cells with 2-3 nuclei without atypia. In the case with history of tamoxifen intake, changes associated with inflammation were seen along with clusters of small round blue cells with scant cytoplasm, round to oval nuclei with fine chromatin and inconspicuous nucleoli. Few clusters of benign endometrial cells were seen, but there were no malignant cells. In the case with herpes simplex infection, there were multinucleate cells, nuclear overlapping, moulding, intranuclear inclusions and ground glass appearance. The case with atypical glandular cells of uncertain significance showed cells with nucleomegaly, hyperchromasia and irregular nuclear contour. The differential diagnosis for the presence of multinucleated cells in cervical pap smears include atrophy, histiocytes collection, tissue repair, ciliary metaplasia, viral infections, granulomas, radiation, folic acid deficiency, syncytiotrophoblast cells and malignancy (2).
In cases with inflammation and atrophy multinucleation was seen with other reactive changes in intermediate cells as described in Bethesda system of reporting cervical cytology (3). The case with history of tamoxifen intake showed ‘small blue cells’ and multinucleate cells, which were similar to those described by Stewart LO et al., (4). The absence of atypical cells in the background and the round regular nucleus with dispersed chromatin in multinucleate cells ruled out malignancy in this case. The presence of multinucleation and reactive changes in pap smear of a case with intrauterine contraceptive device use were similar to those changes reported by Kishan Prasad HL (5). The changes include intracytoplasmic vacuoles, Intrauterine Device (IUD) cells, metaplastic cells, multinucleation and psammoma body formation. Tubal metaplastic cells were considered as a potential pitfall in cytological diagnosis (6), which mandated proper identification of these cells to avert biopsy. The findings in herpes simplex infection were similar to those reported by Coleman DV showing multinucleation with ground glass nucleus and intranuclear inclusions (7).
These findings suggest that cases with multinucleation in Papanicolaou Smear smear should be carefully screened and correlated with clinical history to prevent erroneous reporting of malignancies and subsequently subjecting the patient to unnecessary interventions.
Date of Submission: Apr 07, 2021
Date of Peer Review: May 13, 2021
Date of Acceptance: Jun 05, 2021
Date of Publishing: Aug 01, 2021
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes
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