PREDICTORS OF HUMAN PAPILLOMA-VIRUS IN PATIENTS WITH KERATINIZATION

Given the prevalence of human papilloma virus (HPV) infection, an atte mpt was made to determine whether certain factors such as keratinizati on and/or squamous atypia are associated with its development. Review of our gynecologic cytology files from 1989 yielded 1,615 specimens sh owing parakeratosis and/or hyperkeratosis, without cytologic evidence of HPV. Concomitant diagnoses included no atypia [keratinization only (KO)], inflammatory squamous atypia (ISA), and squamous atypia (SA). M orphological follow-up including repeat cytology or biopsy was availab le for 916 cases, 92 (10.0%) of which possessed changes of HPV. For an y case with both cytologic and biopsy evidence of HPV, only the biopsy result was tabulated.HPV on follow-up examination was detected in 52 (6.7%) of the 764 cases with KO; in 20 (20.8%) of the 96 cases with ke ratinization and ISA (KISA); and in 20 (35.7%) of the 56 cases with ke ratinization and SA (KSA). The definitive diagnosis of HPV was based o n previously described features (Gupta, In: Comprehensive Cytopatholog y, Philadelphia: WB Saunders, 1991:133-140) including nuclear enlargem ent with nuclear membrane irregularities in combination with sharply d emarcated paranuclear cytoplasmic clearing. Affected cells have rounde d borders. Binucleated cells are not uncommon. The increasing percenta ge of HPV from KO to KISA to KSA is not necessarily surprising. Howeve r, mathematical analysis revealed statistically significant difference s in the development of HPV in each of the 3 groups: KISA vs. KO (P < 0.001), KSA vs. KO (P < 0.001), and KSA vs. KISA (P < 0.05). Therefore , a cytologic diagnosis of keratinization with ISA or especially SA sh ould warrant closer follow-up than that of KO. (C) 1995 Wiley-Liss, In c.