???Atypical Condyloma??? With Bizarre Cells Mimicking Invasive Keratinizing Squamous Cell Carcinoma

Background: The general cytologic features of the keratinizing form of squamous cell carcinoma are well characterized and include pleomorphic squamous cells present singly or in loosely cohesive aggregates. Abnormal shapes including tadpole/spindled or heavily keratinized cells and nuclear pleomorphism with chromatin abnormalities can all be seen. However, Meisels et al described an unusual form of human papillomavirus infection of the cervix (“atypical condyloma”) that can closely mimic the cytology of keratinizing squamous cell carcinoma. We herein report 2 cases where bizarre human papillomavirus associated changes were noted. One case was associated with tumor diathesis. Both were interpreted as squamous cell carcinoma on cytology. Materials and Methods: The patients were a 34-year-old woman (case A) and 37-year-old woman (case B), with no significant past gynecologic history for case A and unknown for case B. Each patient had a routine screening conventional cervical cytology smear sent for evaluation at Northwestern Memorial Hospital. Results: Cytology showed squamous epithelial cells with pleomorphism of cell size, shape, and nuclei. Morphologic features noted included large or “monstrous,” bizarre cells with hyperchromatic, somewhat smudgy nuclei. Cytoplasmic orangeophilia and karyorrhexis were also present. However, nucleolar prominence and tumor diathesis were lacking in case A and noted in case B. Follow-up surgical biopsy showed moderate dysplasia with bizarre cells (case A) and squamous cell carcinoma with bizarre cells (case B). Conclusion: Human papillomavirus–associated cytopathic effect can mimic invasive squamous cell carcinoma. Awareness of this phenomenon is important for accurate classification of these lesions.