POSTMENOPAUSAL SQUAMOUS ATYPIA - A SPECTRUM INCLUDING PSEUDO-KOILOCYTOSIS

In addition to typical atrophy, the postmenopausal cervix may exhibit a spectrum of epithelial and cellular alterations, including prominent perinuclear halos, nuclear hyperchromasia, variation in nuclear size, and multinucleation. It has not been determined whether such changes, termed postmenopausal squamous atypia (PSA), represent age-related ep ithelial disturbances or human papillomavirus (HPV)-related low-grade squamous intraepithelial lesions (condyloma). We surveyed 30 cervical biopsies from 26 women over the age of 50 that contained cytoplasmic h alos and a spectrum of nuclear alterations, either alone or in associa tion with atrophy. Twenty-three exhibited epithelium with 2- to 3-fold nuclear enlargement, and 18 had moderate or marked nuclear staining i ntensity. Eleven had a maximum of one or more multinucleated cells in a high-power field. Despite the nuclear alterations, none of the biops ies were positive for HPV by PCR analysis, This is in contrast to 104 of 141 low- and high-grade squamous intraepithelial lesions from a wid e age range of women analyzed in the same manner (P = .000006). Featur es distinguishing PSA from HPV-associated low-grade squamous intraepit helial lesions (condyloma) included less variation in nuclear size and staining intensity, more finely and evenly distributed nuclear chroma tin, and greater uniformity of perinuclear halos in PSA. In menopausal or postmenopausal women, PSA should be excluded when considering the diagnosis of a low-grade squamous intraepithelial lesion, specifically if the diagnosis rests on the interpretation of koilocytotic atypia.