A Cervical Smear Scare due to Monsel's Solution: A Case Report.

Area of Science:

• Gynecologic Oncology
• Surgical Pathology
• Cytopathology

Background:

• Monsel's solution (ferric subsulphate) is a topical hemostatic agent used for minor epithelial disruptions since the late 19th century.
• Its styptic properties are valuable in various minor gynecological, dermatological, and surgical procedures.
• Accurate cytological and histological evaluation is crucial for diagnosing cervical conditions like cervical intraepithelial neoplasia (CIN).

Observation:

• A patient with adenomyosis presented with intermenstrual bleeding due to a Nabothian cyst, treated with Monsel's solution.
• Three days post-treatment, the patient experienced recurrent bleeding, prompting a cervical smear and HPV swab.
• The cervical smear showed atypical cells suspicious for malignancy, with colposcopy revealing a suspicious lesion.

Findings:

• Punch biopsies revealed only CIN I/koilocytosis, contrasting with the initial smear and colposcopy findings.
• A subsequent laser cone biopsy confirmed CIN I with clear margins.
• The discrepancy was attributed to Monsel's solution interfering with the cytological and histological interpretation of the cervical sample.

Implications:

• Monsel's solution can cause artifactual changes in cervical cytology and histology, mimicking or obscuring true pathology.
• It is recommended to delay cervical smears and biopsies for at least 3 weeks after Monsel's solution application.
• This delay ensures accurate diagnostic interpretation and avoids potential misdiagnosis or unnecessary invasive procedures.