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TVCS meeting
on 30 March 2000 at Whittington Hospital, Highgate
Dr Alistair
Deery
told us how a cervical smear consisting of high levels of keratin
is characterised by a distinctive orange and eosinophilic appearance.
The presence of keratin can be due to benign conditions associated
with inflammation, such as the presence of a candida infection,
IUCD in situ, cervical rings, and procidentia in the over 45 years
olds in rare cases.
Keratinised areas can also be the result of previous treatment for
disease, such as punch or cone biopsy. Leukoplakia may be associated
with underlying disease.
Abnormal keratotic features can also be caused by the presence of
squamous carcinoma, the human papilloma virus (HPV) and dyskaryosis.
The occurrence of keratinised cells in cervical smears seen in women
under the age of 45 years mirrors the incidence of CIN and HPV in
the population.
The physical presentation of groups of keratinised cells should
be paid close attention to when screening as this may be characteristic
of underlying dyskaryosis. Examples include ‘rafts, spikes
and whorls’ which typically display as tightly packed groups/sheets
of keratinised cells with flattened, long nuclei at the edges and
with a central ‘core’.
Also associated are deformed and marginated keratinised cells in
the absence of koilocytes showing degenerate nuclear enlargement.
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