Cytologic indicators of condylomatous lesions of the uterine cervix with histologic correlation: an outpatient laboratory's experience

Human papillomavirus (HPV) is widely implicated as a primary etiologic factor in cervical carcinoma. Cytology plays an important role as the initial screening tool in the early detection of cervical lesions with koilocytotic features. The purpose of this study was to describe the various cytologic indicators of condylomatous lesions of the uterine cervix with histologic correlation. Cervical smears and biopsy specimens from 278 women seen in an outpatient clinical setting between January 1, 1985; and January 1, 1987, were reviewed. The histologic categories consisted of (1) flat condylomas with minimal cellular atypia; and (2) cervical intraepithelial neoplasia (CIN), I, II, or III with atypical koilocytosis. Cytologically in 57 cases, flat condylomas were composed predominantly of koilocytes containing large perinuclear halos and dyskeratotic cells. In the 221 cases of CIN with atypical koilocytosis, the cervical smears were composed predominantly of atypical koilocytes with large hyperchromatic nuclei and small perinuclear halos; a variable number of koilocytes with large perinuclear halos; pleomorphic dyskeratotic cells; and abnormal multinucleated cells. Mild, moderate, or severely dysplastic/carcinoma-in-situ cells (CIS) were also present. An understanding of the cytologic features associated with condylomatous lesions of the cervix will enable the cytopathologist to alert the clinician of the need to perform colposcopy with the appropriate follow-up treatment.