Curschmann's spirals in cervicovaginal smears. Prevalence, morphology, significance and origin

A retrospective examination of 172,119 cervical and vaginal smears was undertaken to study the prevalence, morphology, significance and origin of Curschmann's spirals in such specimens. Spirals morphologically identical to those seen in sputum were found in 101 specimens from 100 patients, for a prevalence of 1 in 1,704 smears. Spirals were found only in patients who had not had their cervices removed. The presence of the spirals could not be correlated with any particular gynecologic or nongynecologic abnormality. Most of the patients had no gynecologic abnormality. The literature contains suggestions that Curschmann's spirals in cervicovaginal smears are a manifestation of orogenital sexual contact or are formed in endocervical mucus, particularly in cigarette smokers. To investigate whether such spirals have an extraneous origin, we examined the smears for dust-containing histiocytes, vegetable cells, skeletal muscle fibers and other extraneous material, none of which was found. We found no correlation between the presence of spirals and cigarette smoking. Moreover, histologic sections of the uterine cervices from some of the patients who had spirals in their smears showed evidence of spiral formation in endocervical mucus. We conclude that Curschmann's spirals in cervicovaginal smears are an uncommon finding with no clinical significance, that they are formed from endocervical mucus and that their presence has nothing to do with orogenital sexual contact or cigarette smoking.