Pagetoid dyskeratosis of the cervix - An incidental histologic finding in uterine prolapse

Pagetoid dyskeratosis, is considered a reactive process in which a small pa rt of the normal population of keratinocytes is induced to proliferate. The lesion is characterized by pale cells resembling those of Pagets disease w ithin the epidermis. These cells have been seen as an incidental finding in a variety of benign papules most commonly located in intertriginous areas. Among the inductors of the lesion, friction is suspected. To the best of o ur knowledge, these pale cells have not been reported in the cervix. We des cribe the location of the lesion in the ectocervix and the incidence of thi s lesion in a group of 100 unselected patients surgically treated for uteri ne prolapse. Another group of 100 unselected patients treated for uterine l eiomyoma was used as a control. Pagetoid dyskeratosis was found in 37 cases (37%) of uterine prolapse and in five cases (5%) of uterine leiomyomas. Th e lesion is more common in uterine prolapse (p < 0.001) and is not signific antly associated with cornification of the epithelium (p = 0.72343). The ce lls of pagetoid dyskeratosis show an immunohistochemical profile different from the surrounding squamous cells characterized by premature keratinizati on. Pagetoid dyskeratosis cells have shown positivity for high molecular we ight cytokeratin and negative reaction for low molecular weight cytokeratin , epithelial membrane antigen, carcinoembryonic antigen, and human papillom a virus. Pagetoid dyskeratosis cells must be distinguished from artefactual clear cells, glycogen-rich cells, koilocytes, extramammary Paget's disease cells, and pagetoid spread of carcinoma cells to the cervix. In cases in w hich pagetoid dyskeratosis shows a florid expression, there is a hazard of overdiagnosis. The pathologist should be aware of the histologic features o f pagetoid dyskeratosis in the ectocervix to avoid misdiagnosis and unneces sary treatment. Routine histologic study is usually sufficient to identify the lesion.