Significance of extensive hyperkeratosis on cervical/vaginal smears

To assess the significance of reporting hyperkeratosis on cervical/vaginal (CV) smears.

Cases diagnosed with extensive hyperkeratosis (E-HK) and without prior or concurrent history of neoplasia, squamous intraepithelial lesion or atypical squamous cells of undetermined significance (ASCUS) were retrieved from our files for the period January 1994-August 2001. E-HK is defined in our practice as patches of anucleated squames with irregular, angulated edges present in at least 5 low-power (10 x eyepiece and 10 x objective) fields on a conventional CV smear. On liquid-based preparations, we use 3 low-power fields. Only cases with a follow-up CV smear and/or cervical biopsy (CB) were selected.

Among 328 cases of E-HK, 138 patients met the study selection criteria. Eighty-one cases had negative CV smears and/or CB, 17 (12.3%) patients had persistent E-HK, and a subsequent diagnosis of ASCUS or higher was made in 40 patients (28.9%). Among the 40 cases with subsequent abnormalities, 13 (9.4%) were diagnosed with ASCUS, 24 (17.4%) with HPV or dysplasia, and 3 (2.1%) with malignancy.

While isolated, anucleate squames may have no clinical importance in patient management, E-HK can be a significant marker of underlying neoplastic disease. This should be kept in mind as one decides how to report CV cytology based on 2001 Bethesda System recommendations.