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Saco A, Alòs S, Esteve R, Suárez-Lledó M, Martínez C, Perez FM, Vega N, Martí C, Torne A, Ordi J, Del Pino M. Atypical cytological changes mimicking SIL of the uterine cervix in allogenic hematopoietic stem cell transplantation recipients treated with busulfan. Cancer Cytopathol 2019; 127:399-406. [PMID: 31145550 DOI: 10.1002/cncy.22148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 04/29/2019] [Accepted: 04/30/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Allogenic hematopoietic stem cell transplantation (allo-HSCT) is a common procedure in hematological disorders and is preceded by a conditioning regimen that usually includes busulfan. The immunosuppression caused by the conditioning regimen and graft-versus-host disease prophylaxis is associated with human papillomavirus (HPV) persistence and, consequently, with an increased risk of cervical cancer (CC) and squamous intraepithelial lesions (SILs)-the precursors of CC. A gynecological check-up that includes CC screening is recommended in these patients. METHODS All female recipients of allo-HSCT undergo routine gynecological check-up that includes CC screening. Cervical samples were obtained for liquid-based cytology and HPV testing. Cytology smears were stained with the Papanicolaou (Pap) technique. A colposcopy evaluation was performed if any abnormal result in the screening tests was obtained. RESULTS Among 15 women undergoing gynecological examination at 1 year after allo-HSCT who had received a conditioning regimen that included busulfan, 4 (26.7%) showed atypical squamous cells in the Pap smear, suggesting high-grade SIL. The abnormalities were identified from 136 to 271 days after allo-HSCT. In all cases, HPV testing was negative, and colposcopy examination was normal. The cytological abnormalities regressed in 3 of the women after 1 year but persisted in 1 woman at day 382 after allo-HSCT. CONCLUSIONS Treatment-related atypia mimicking SIL is a common finding in allo-HSCT recipients who have received busulfan, particularly in the first year after the procedure. However, atypical changes may persist for more than 1 year. Clinical information, HPV testing, and colposcopy examination are critical to prevent misdiagnosis and overtreatment in these patients.
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Affiliation(s)
- Adela Saco
- Department of Pathology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Silvia Alòs
- Department of Pathology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Roser Esteve
- Department of Pathology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - María Suárez-Lledó
- Long-Term Follow-Up Unit and Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, August Pi i Sunyer Institute for Biomedical Investigations, University of Barcelona, Barcelona, Spain
| | - Carmen Martínez
- Long-Term Follow-Up Unit and Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, August Pi i Sunyer Institute for Biomedical Investigations, University of Barcelona, Barcelona, Spain
| | - Francisco M Perez
- Department of Pathology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Naiara Vega
- Department of Pathology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Cristina Martí
- Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clinic, August Pi i Sunyer Institute for Biomedical Investigations, University of Barcelona, Barcelona, Spain
| | - Aureli Torne
- Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clinic, August Pi i Sunyer Institute for Biomedical Investigations, University of Barcelona, Barcelona, Spain
| | - Jaume Ordi
- Department of Pathology, Hospital Clinic, University of Barcelona, Barcelona, Spain.,ISGlobal, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Marta Del Pino
- Long-Term Follow-Up Unit and Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, August Pi i Sunyer Institute for Biomedical Investigations, University of Barcelona, Barcelona, Spain.,Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clinic, August Pi i Sunyer Institute for Biomedical Investigations, University of Barcelona, Barcelona, Spain
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Yang YJ, Trapkin LK, Demoski RK, Bellerdine J, Powers CN. The small blue cell dilemma associated with tamoxifen therapy. Arch Pathol Lab Med 2001; 125:1047-50. [PMID: 11473455 DOI: 10.5858/2001-125-1047-tsbcda] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Several endometrial diseases, such as endometrial hyperplasia, endometrial carcinoma, and endometrial polyps, have been reported to be associated with tamoxifen administration. We recently observed a high incidence of distinctive small blue cells in Papanicolaou tests of women who had received tamoxifen treatment for breast carcinoma. OBJECTIVES To define the characteristics of these small blue cells, to identify the patient population in which they are found, and to determine the clinical significance and possible etiology of these findings. DESIGN A total of 154 Papanicolaou tests from 60 patients with a clinical history of tamoxifen therapy were reviewed retrospectively. RESULTS Small blue cells were found in 40% of Papanicolaou tests from patients who received tamoxifen therapy. Patients with small blue cells in their Papanicolaou tests were an average of 9 years older at the time tamoxifen therapy was initiated than those without. Among the available follow-up surgical biopsies, no malignant diagnoses were made. CONCLUSIONS We conclude that these distinctive small blue cells are found more frequently in older patients and most probably represent proliferative reserve cells of cervical/vaginal epithelium resulting from the estrogenic agonist effect of tamoxifen. More importantly, they are nonneoplastic in nature.
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Affiliation(s)
- Y J Yang
- Department of Pathology, Upstate Medical University, State University of New York, 750 E Adams St, Syracuse, NY 13210, USA.
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