Herpesvirus mimics. A potential pitfall in endocervical brush specimens

Area of Science:

• Cytopathology
• Gynecologic Pathology
• Infectious Disease Diagnostics

Background:

• Media attention has driven improvements in cervical smear collection and interpretation.
• Endocervical brushes, while beneficial, can introduce cellular artifacts.
• These artifacts may mimic cytologic changes of Herpes simplex virus (HSV) infection.

Purpose of the Study:

• To evaluate endocervical cell artifacts that mimic HSV infection.
• To identify reliable cytologic criteria for distinguishing true HSV from mimics.
• To assess the impact of endocervical brush collection on diagnostic accuracy.

Main Methods:

• Reviewed 14,622 gynecologic specimens, focusing on reactive and atypical endocervical cells.
• Two independent observers evaluated cases for HSV-specific cytologic criteria.
• Analyzed sensitivity and specificity of multinucleation, chromatin margination, ground glass chromatin, and intranuclear inclusions.

Main Results:

• 19 cases were suggestive of HSV, while 19 were identified as herpesvirus mimics.
• Endocervical brushes were the collection method in most cases.
• Ground glass chromatin demonstrated high sensitivity (95%) and specificity (95%) for HSV.
• Intranuclear inclusions had low sensitivity (42%) despite being pathognomonic.

Conclusions:

• Altered endocervical cells can be mistaken for HSV, causing misdiagnosis.
• Strict adherence to diagnostic criteria, particularly ground glass chromatin, is essential.
• Knowledge of collection method and clinical history aids in avoiding false-positive HSV diagnoses.