Tuberculosis in Pap samples with emphasis on LBC: Caught only when thought

Area of Science:

• Gynecologic Pathology
• Infectious Diseases
• Cytopathology

Background:

• Cervical tuberculosis is an uncommon but significant infection.
• Clinical diagnosis of uterine cervix tuberculosis is often elusive.
• Identifying tuberculosis on cervical Pap samples presents diagnostic challenges.

Purpose of the Study:

• To highlight the diagnostic difficulties of cervical tuberculosis on Pap smears.
• To describe the subtle cytological features of tuberculosis in cervical samples.
• To emphasize the importance of recognizing these subtle clues for accurate diagnosis.

Main Methods:

• Retrospective review of cervical Pap and liquid-based cytology (LBC) samples.
• Analysis of cytological findings in confirmed cases of cervical tuberculosis.
• Correlation of cytological findings with clinical presentation and tissue diagnoses.

Main Results:

• Typical features of tuberculosis are challenging to identify on Pap smears, especially LBC samples.
• Pale staining epithelioid cell collections are infrequent and easily missed.
• Initial diagnoses included atypical squamous cells of undetermined significance and inflammatory changes.
• Scattered Langhans' giant cells can be a subtle clue to search for epithelioid granulomas.

Conclusions:

• Cervical tuberculosis diagnosis on Pap smears requires careful examination for subtle clues like epithelioid cells and giant cells.
• Misinterpretation as benign conditions can delay diagnosis and treatment.
• Clinical presentation of a mass lesion may contrast with unremarkable cervical cytology findings.