Inflammatory or reactive change is seen in these squamous cells which harbor pale bland chromatin surrounded by small perinuclear halos.
A cluster of squamous cells with vesicular chromatin and small but discrete nucleoli is seen admixed with a few inflammatory cells.
Biopsy shows modestly enlarged cells with vesicular nuclei and admixed inflammatory cells. There is no hyperchromasia suggestive of LGSIL.
Also referred to as inflammatory atypia, inflammation can elicit cytologic changes that mimic dysplasia. However, a careful look at nuclear, cytoplasmic and background features can usually help distiguish between the two diagnoses.
Inflamed nuclei are usually enlarged and pale with bland chromatin. In some instances, the nuclei may be dark -- in these instances, they are usually not enlarged. In DeMay's words "inflamed nuclei may be big but not dark, or dark but not big whereas dyplastic nuclei are usually both dark and big." Other helpful diagnostic features include a small clear halo around the nuclei and/or a red hue to the nuclei. In dysplasia, the nuclei stain dark blue, and the halo sometimes seen around koilocytes are much larger and contain obviously dysplastic "raisinoid" nuclei.1
If there is concern that inflammation may have obscured a dysplastic process, a repeat Pap smear may be warranted after the cause of inflammation has been addressed.
• Inflamed or reactive squamous cells have vesicular nuclei with a perinuclear halo.
1 DeMay RM. The Art and Science of Cytopathology. Chicago, IL: ASCP Press; 1996; 109-110.