images in haematology
False positive cervical smear in a patient with pernicious anaemia
A 50-year-old woman had experienced dyspareunia for a year. She also gave a history of headaches, poor concentration, abdominal ache, occasional diarrhoea, asthenia, anorexia and a burning sensation of the tongue. Physical examination showed pallor of the skin and mucous membranes. In addition to a general physical examination, a cervical smear and a full blood count (FBC) were carried out. The Papanicolaou-stained smear was interpreted as showing a low grade squamous intraepithelial lesion (mild dysplasia), because of the presence of several intermediate squamous epithelial cells of increased size with large nuclei (top image, note cells at the top in comparison with the more normal cells at the bottom. Note also clear perinuclear spaces around the nuclei (intracytoplasmic glycogen), which are similar to koilocytic changes). The FBC showed: leucocytes 42 9 109/l; red cell count 23 9 1012/l; haemoglobin concentration 83 g/l; haematocrit 022; MCV 137 fl; MCH 42 pg; platelet count 190 9 109/l. In view of the macrocytic anaemia, further tests were performed. These showed: vitamin B12 84 pmol/ml (normal range: 180–1100); normal serum folic acid level; lactate
First published online 14 April 2015 doi: 10.1111/bjh.13436
dehydrogenase 938 iu/l (125–243) and bilirubin 291 lmol/l (34–22). A peripheral blood film showed marked anisocytosis, macro-ovalocytes and hypersegmented neutrophils (bottom). Subsequently, the presence of intrinsic factor antibodies was confirmed and gastric endoscopy showed atrophic gastritis. A diagnosis of pernicious anaemia was established, and the possibility of the cervical smear being a false positive result was also considered. After 2 weeks of vitamin B12 therapy the patient0 s anaemia responded very well to the treatment and her symptoms began to improve. Six months later, a repeat cervical smear showed no abnormality. It is important to remember that megaloblastic anaemia, due to deficiency of either vitamin B12 or folate, can lead to a false positive cervical smear as a result of megaloblastic changes in cervical cells. Rafael Martınez-Gir on1 and Santiago Martınez-Torre2 1
CFGS Anatomic Pathology and Cytology, Institute of Piedras Blancas
33450, Asturias, and 2School of Medicine, Oviedo University 33006, Oviedo, Spain. E-mail: [email protected]
ª 2015 John Wiley & Sons Ltd British Journal of Haematology, 2015, 169, 766
False positive cervical smear in a patient with pernicious anaemia
A 50-year-old woman had experienced dyspareunia for a year. She also gave a history of headaches, poor concentration, abdominal ache, occasional diarrhoea, asthenia, anorexia and a burning sensation of the tongue. Physical examination showed pallor of the skin and mucous membranes. In addition to a general physical examination, a cervical smear and a full blood count (FBC) were carried out. The Papanicolaou-stained smear was interpreted as showing a low grade squamous intraepithelial lesion (mild dysplasia), because of the presence of several intermediate squamous epithelial cells of increased size with large nuclei (top image, note cells at the top in comparison with the more normal cells at the bottom. Note also clear perinuclear spaces around the nuclei (intracytoplasmic glycogen), which are similar to koilocytic changes). The FBC showed: leucocytes 42 9 109/l; red cell count 23 9 1012/l; haemoglobin concentration 83 g/l; haematocrit 022; MCV 137 fl; MCH 42 pg; platelet count 190 9 109/l. In view of the macrocytic anaemia, further tests were performed. These showed: vitamin B12 84 pmol/ml (normal range: 180–1100); normal serum folic acid level; lactate
First published online 14 April 2015 doi: 10.1111/bjh.13436
dehydrogenase 938 iu/l (125–243) and bilirubin 291 lmol/l (34–22). A peripheral blood film showed marked anisocytosis, macro-ovalocytes and hypersegmented neutrophils (bottom). Subsequently, the presence of intrinsic factor antibodies was confirmed and gastric endoscopy showed atrophic gastritis. A diagnosis of pernicious anaemia was established, and the possibility of the cervical smear being a false positive result was also considered. After 2 weeks of vitamin B12 therapy the patient0 s anaemia responded very well to the treatment and her symptoms began to improve. Six months later, a repeat cervical smear showed no abnormality. It is important to remember that megaloblastic anaemia, due to deficiency of either vitamin B12 or folate, can lead to a false positive cervical smear as a result of megaloblastic changes in cervical cells. Rafael Martınez-Gir on1 and Santiago Martınez-Torre2 1
CFGS Anatomic Pathology and Cytology, Institute of Piedras Blancas
33450, Asturias, and 2School of Medicine, Oviedo University 33006, Oviedo, Spain. E-mail: [email protected]
ª 2015 John Wiley & Sons Ltd British Journal of Haematology, 2015, 169, 766
