UNUSUAL PATTERNS OF SQUAMOUS EPITHELIUM OF THE UTERINE CERVIX: CYTOLOGIC AND PATHOLOGIC STUDY OF KOILOCYTOTIC ATYPIA

Much of the fascination of the study of exfoliative cytology of the uterine cervix results from the fact that one can observe cellular abnormalities that are not obvious on histologic examination of tissues. The insistence of cytologists on correlating morphologic cellular changes with tissue patterns has undoubtedly been a factor in directing the attention of pathologists toward low-grade alterations of cervix epithelium that were hitherto little known and either passed unnoticed or were labeled, without due consideration, chronic cervicitis, and thus thrown into the diagnostic waste basket of gynecologic pathology. The difficulty of correct classification of such tissue changes has been well known for years. It was frequently circumvented by the creation of special diagnostic classifications such as the famous “rubrics” of Hinselrnanne7 On many occasions, new names have been created for groups of lesions of unknown standing. Thus the terms anapla~ia,’~ atypical hyperplasia,’* dysplasia,+ precancerous metaplasia? restless epithelium,6 to name a few, were attached to poorly defined cervix lesions. Inevitably, over a period of years, we have encountered a number of cases difficult, if not impossible, to classify on histologic grounds. .4s a result of long-term study, it appears that one and, possibly, a second tissue pattern of disorderly epithelium can be isolated among these lesions. The first one is characterized essentially by the presence in histologic sections of large cells with relatively small but irregular and hyperchromatic nuclei surrounded by clear and transparent cytoplasm. Thus, the nucleus seems to be suspended in an empty space. For descriptive purposes, we have coined the term koilocytotic atypia, from the Greek word “koilos,” meaning hollow or cavity, to designate this lesion. Many of these lesions were recognized primarily in smears before their recognition in tissues. The term “warty dyskeratosis” was commonly used in the pathology laboratory when referring to this type of epithelial change. The second atypical pattern, which will be mentioned only briefly in the present paper, is not well defined and is characterized by the presence of abnormally elongated, spindly cells. Therefore, the term spiizdly atypia will be used to describe it. Review of the literature reveals that the koilocytotic atypia has been noticed and illustrated by others, without any attempt, however, to isolate it as a pathologic entity. Thus, Ayrel uses photographs of several of these lesions to illustrate his precancer cell complex. Wespi14 calls it irregular epithelium. Lapid and Goldbergerg call it atypical cervix lesion. Reagan et al.’? call it atypical hyperplasia or dysplasia of slight degree. Yon Haam4 calls it dys-