Cervical dyskeratotic cells as predictors of condylomatous changes on biopsy

Human papillomavirus (HPV) infections cause the koilocytotic and dyskeratotic cell changes seen in cervical smears. Although the koilocyte is pathognomonic, the role of the isolated dyskeratocyte in predicting the presence of HPV infection is not yet defined. One hundred patients, ranging in age from 7 to 71 years (mean: 26 years), with a cytologic diagnosis of dyskeratotic cells and a simultaneous, colposcopically directed cervical biopsy, were studied to determine the tissue correlates of such cells. On biopsy, 61 had condylomatous changes; 14 of the 61 had an associated cervical intraepithelial neoplasia (CIN). Of the 39% without condylomatous changes, 12 had an unremarkable biopsy, 19 had squamous metaplasia, 5 had hyperkeratosis and 3 had CIN. Condyloma plus CIN was diagnosed at least two months previously in 14 of these 39 patients; 6 had CIN alone. The results show that dyskeratocytes in cervical smears are predictive of a simultaneous HPV infection in 61% of the cases and of an infection at some time in 75% of the cases. Since only 14% of the patients had a condyloma plus CIN and 3% had CIN alone, patients with a smear diagnosis of dyskeratotic cells may need a more careful follow-up. Other histologic correlates of the dyskeratocyte included squamous metaplasia and hyperkeratosis.