CYTOLOGIC CORRELATES OF BENIGN VERSUS DYSPLASTIC ABNORMAL KERATINIZATION

The purpose of this study was to determine the cytologic and histologi c features that differentiate benign from squamous intraepithelial les ion (SIL)-associated cervical abnormal keratinization, defined as hype rkeratosis, parakeratosis, or individual cell dyskeratosis. Fifty-four cervical Papanicoloau (Pap) smears that contained abnormally keratini zed cells were reviewed without knowledge of the concurrent biopsy. Tw enty-three Pap smears were diagnosed as SIL and the corresponding biop sy showed SIL in 21 (91%) of these cases. Of the 23 Pap smears diagnos ed as negative for SIL, the corresponding biopsy in 20 cases (87%) sho wed benign (SIL negative) abnormal keratinization. Eight Pap smears sh owed squamous atypia, of these 5 showed SIL on biopsy, and the other 3 revealed benign keratinization. The Pap smear correlates of the 25 bi opsies that were negative for SIL included marked hyperkeratosis (18/2 5-72 vs. 5/29-17% for biopsies with SIL) and regular nuclear membranes (16/18-89% cases with nucleated dyskeratotic cells vs. 5/29-17% for b iopsies with SIL). The cytologic correlates of the 29 biopsies that sh owed SIL included irregular chromatin clumping (27/29-93% vs. 3/18-17% for biopsies without SIL), and a disorganized growth pattern (24/29-8 3 vs. 5/25-20% for biopsies without SIL). It is concluded that the cyt ologic distinction between benign and SIL-related Pap smears with abno rmal keratinization can be reliably made by the degree of hyperkeratos is, nuclear chromaticity pattern and contour, and the growth pattern o f the dyskeratotic cells. (C) 1997 Wiley-Liss, Inc.