HERPESVIRUS MIMICS - A POTENTIAL PITFALL IN ENDOCERVICAL BRUSH SPECIMENS

The recent media focus on inadequacies in cervical smear collection an d interpretation has resulted in improved collection methods, such as endocervical brushes, as well as closer scrutiny of morphologic criter ia. However, endocervical cell artifacts may be associated with these endocervical brushes. Recently in our laboratory a case of reactive-at ypical endocervical cells that resembled the cytologic changes associa ted with Herpes simplex virus (HSV) infection resulted in a false-posi tive diagnosis of HSV infection. Of 14,622 gynecologic specimens acces sioned over 14 months, 459 cases with reactive endocervical cells and 117 with atypical endocervical cells were reported. These cases were-r eviewed by two independent observers with no knowledge of the prior di agnoses and were evaluated for four cytologic criteria considered diag nostic of HSV infection: multinucleation, margination of nuclear chrom atin, ground glass chromatin and intranuclear inclusions. Nineteen cas es were diagnostic/ suggestive of Hsv; 19 additional cases were identi fied as herpesvirus mimics. The original diagnoses, demographics, clin ical data and method of collection were reviewed. In all but three cas es an endocervical brush was the method of collection. of the four cri teria studied, only ground glass chromatin had both high sensitivity ( 95%) and specificity (95%). Intranuclear inclusions, while pathognomon ic, had low sensitivity (42%). Altered endocervical cells that mimic h erpesvirus are a potential pitfall in the diagnosis of Hsv infection. Use of strict criteria, knowledge of the collection method and clinica l history will avoid misdiagnosis.