Significance of extensive hyperkeratosis on cervical/vaginal smears

Beth Anne Williamson*, Denise DeFrias, Raymond Gunn, Gabor Tarjan, Ritu Nayar

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


OBJECTIVE: To assess the significance of reporting hyperkeratosis on cervical/vaginal (CV) smears. STUDY DESIGN: Cases diagnosed with extensive hyperkeratosis (E-HK) and without prior or concurrent history of neoplasia, squamous intraepithelial lesion or atypical squamous cells of undetermined significance (ASCUS) were retrieved from our files for the period January 1994-August 2001. E-HK is defined in our practice as patches of anucleated squames with irregular, angulated edges present in at least 5 low-power (10 × eyepiece and 10 × objective) fields on a conventional CV smear. On liquid-based preparations, we use 3 low-power fields. Only cases with a follow-up CV smear and/or cervical biopsy (CB) were selected. RESULTS: Among 328 cases of E-HK, 138 patients met the study selection criteria. Eighty-one cases had negative CV smears and/or CB, 17 (12.3%) patients had persistent E-HK, and a subsequent diagnosis of ASCUS or higher was made in 40 patients (28.9%). Among the 40 cases with subsequent abnormalities, 13 (9.4%) were diagnosed with ASCUS, 24 (17.4%) with HPV or dysplasia, and 3 (2.1%) with malignancy. CONCLUSION: While isolated, anucleate squames may have no clinical importance in patient management, E-HK can be a significant marker of underlying neoplastic disease. This should be kept in mind as one decides how to report CV cytology based on 2001 Bethesda System recommendations.

Original languageEnglish (US)
Pages (from-to)749-752
Number of pages4
JournalActa Cytologica
Issue number5
StatePublished - Jan 1 2003


  • Cervix diseases
  • Cervix neoplasms
  • Hyperkeratosis
  • Papanicolaou smear

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Histology

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