Clinical History:
A 35 year- old female not known to be immunocompromised present with abnormal Pap test. She underwent colposcopic biopsy of suspicious cervical lesion.
A: What is the most likely diagnosis?
- Angiocentric lymphoma
- Hodgkin lymphoma
- Lymphoproliferative disorders
- Viral cervicitis
Immunostains were performed to rule out lymphoma/lymphoproliferative disorders:
B: The staining pattern supports the diagnosis of:
- Hodgkin lymphoma
- Reactive lymphocytic infiltrate
- Angiocentric T-cell lymphoma
- T-cell rich B- cell lymphoma
Immunostaining for viral infection show positive staining for CMV
C: CMV cervicitis:
- CMV infection commonly infect squamous epithelial cells
- CMV Inclusion are often seen in Pap smear in infected women
- Intense inflammation and vasculitis with thrombi is often seen in CMV cervicitis
- Approximately 60% of newborns with congenital CMV infection are symptomatic
Answers and Discussion:
A: 4
B: 2
C: 3
CMV cervicitis is uncommon and few cases are reported in the literature. It occurs in both immunocompetent and immunocompromised patients. Intense inflammation, particularly in immunocompetent subjects is often seen. Vasculitis is probably related to endothelial cells infection with the virus or its due to immune complex deposition. CMV cervicitis carries a great risk of fetal infection, thus screening for fetal and neonatal CMV infection is highly recommended in cases of CMV cervicitis.
References
J Clin Pathol. 2004 Jul; 57(7): 691–694. C E McGalie, H A McBride, and W G McCluggage. Cytomegalovirus infection of the cervix: morphological observations in five cases of a possibly under-recognized condition
Nassetta L1, Kimberlin D, Whitley R. Treatment of congenital cytomegalovirus infection: implications for future therapeutic strategies. J Antimicrob Chemother. 2009 May;63(5):862-7. doi: 10.1093/jac/dkp083. Epub 2009 Mar 14.
Case contributed by Isam-Eldin Eltoum, M.D., Vice Chair, Quality and Patient Safety, Professor, Anatomic Pathology