Cervix-Cytology
Inflammation / parasites
Chronic cervicitis

Author: John KSS Philip, M.D. (see Authors page)
Editor: Ziyan T. Salih, M.D.

Revised: 31 March 2017, last major update December 2014

Copyright: (c) 2003-2017, PathologyOutlines.com, Inc.

PubMed Search: Chronic cervicitis [title]
Cite this page: Chronic cervicitis. PathologyOutlines.com website. http://pathologyoutlines.com/topic/cervixcytologychroniccervicitis.html. Accessed August 18th, 2017.
Definition / general
  • Inflammation of cervical mucosa with increased lymphocytes forming lymphoid follicles with germinal center
  • Other frequent findings include plasma cells, neutrophils and tingible body macrophages
Terminology
  • Also called lymphofollicular cervicitis, follicular cervicitis, chronic lymphocytic cervicitis
Epidemiology
  • Can occur at any age
  • More common and more likely to be detected in postmenopausal women, who have thin and atrophic overlying epithelium, than in young women with a thick epithelial covering (Acta Cytol 1975;19:235)
Etiology
Clinical features
  • Frequently asymptomatic with a normal cervix (IARC)
  • Superficial ulceration may be seen
  • Deep ulcers may indicate a herpetic cervicitis
  • No cervical mass is seen
  • Presence of a mass is suspicious for a lymphoma
Case reports
Cytology description
  • Mixed population of lymphocytes in various stages of maturation with a predominance of small lymphocytes
  • Small mature lymphocytes have thin eccentric rim of cytoplasm, round nucleus with dense uniform chromatin and no nucleoli
  • Larger immature lymphocytes have more cytoplasm, open chromatin and may have irregular nuclear membrane or prominent nucleoli
  • Presence of tingible body macrophages, with cytoplasmic cellular debris, is somewhat specific, but may also be seen in high grade lymphoma and invasive carcinoma
  • Plasma cells and neutrophils may be seen
  • In liquid based cytology, clusters resembling hyperchromatic crowded groups may be seen (Cytopathology 2002;13:364), but individual cells show clumped, coarse chromatin typical for lymphocytes
Cytology images

Images hosted on other servers:

Various images

Papanicolaou test

Characteristic cytologic features

Immunohistochemistry
  • Polyclonal, with an admixture of B and T lymphocyte markers
  • No kappa and lambda light chain restriction
Differential diagnosis
  • Adenocarcinoma: usually in syncytia or 3 dimensional group; when dispersed, may have vacuolated cytoplasm and enlarged pleomorphic nuclei with macronucleoli (Arch Pathol Lab Med 2013;137:907)
  • Endometrial cells: cohesive cluster of relatively uniform small cells
  • High grade squamous intraepithelial lesion (HSIL): hyperchromatic nucleus with variation in size and shape, irregular nuclear membrane and cellular cohesion
  • Lymphoma: monomorphous population of lymphoid cells; most cervical lymphomas are diffuse large B cell lymphoma, characterized by large lymphoid cells
  • Small cell carcinoma: scant delicate cytoplasm, nuclear molding with salt and pepper chromatin