Deciphering radiation effects in pap smears: A case report and review of challenges

Cervical carcinoma remains a major public health issue, especially in developing countries with limited access to screening. The Papanicolaou (Pap) smear is a cost effective, essential diagnostic tool for early detection and post-treatment surveillance of cervical lesions. Conization is used for early-stage disease, while advanced cases are managed with chemoradiation. In the report, a 44-year-old woman treated with hysterectomy and chemoradiation presented with a vault smear showing classic radiation-induced changes e.g. nuclear enlargement with preserved Nuclear: Cytoplasm ratio, cytoplasmic vacuolation and granularity, hyperchromasia with smudged chromatin, multinucleation, degenerative nuclear features including chromatin wrinkling, and occasional bizarre cells. Recognizing these features is vital to prevent misdiagnosis and unnecessary intervention. The present case highlights the need for heightened awareness of post-radiation cytology in clinical practice.