Journal of Cytology & Histology

Cervical cancer has highest incidence in developing countries with almost 90% of cervical cancer deaths and Malawi is not spared. Almost all cases of cervical cancer are caused by the persistent infection with “high-risk” types of HPV, with HPV types 16 and 18 being the most common. Cervical cancer screening has emerged as a very effective method for the prevention of cervical carcinoma. This is because the uterine cervix is anatomically accessible, and the prolonged pre-malignant phase can be detected by studying morphology of exfoliated cells through Papanicolaou Smear (Pap smear) evaluation. From a diagnostic perspective, atrophic smears, typical of smears from postmenopausal women, pose a challenge.

Aim: The aim of this study was to assess pattern of cytomorphology of Pap smears in postmenopausal women.

Methods: 98 processed and stained pap smears from postmenopausal women who came for cervical cancer screening at Malamulo Adventist Hospital were examined retrospectively. Cytomorphology was assessed considering nuclear details including staining, chromatin pattern, and cytoplasmic preservation. Specimen adequacy was also considered. Descriptive statistics were used to analyze data.

Results: Age group of 55-60 years had a highest frequency of 38 (38.8%) women and the lowest frequency was for the age group of more than 70 years with a frequency of 8 (8.2.0%). Majority, 82(83.7%) were seropositive for HIV. On specimen adequacy, majority, 86 (87.8%) were considered satisfactory and 12 (12.0%) were unsatisfactory. In terms of the unsatisfactory samples, 8(8.1%) were due to inadequate squamous cellular component and 4 (4.1%) were due to masking of inflammatory cells. Normal chromatin pattern was found in 79 (92%) and abnormal pattern was in 7(8%) and abnormal nuclear staining was found in 7(8%). Abnormal nuclear membrane was found in 6 (7.0%) and increased nuclear to cytoplasmic ratio was found in 8(9.3%). In terms of neoplasia the study found that 81 (94%) women samples were Negative for Intraepithelial Lesion or Malignancy (NILM), Atypical Squamous Cell of Undetermined Significance (ASC-US) were 3 (3.5%), High Grade Squamous for Intraepithelial Lesion (HSIL) 1 (1.2%), and Squamous Cell Carcinoma (SCC), 1 (1.2%).

Conclusion: In this study cytomorphological pattern of pap smears from women aged 50 and above has been characterized and found that small proportion of smears had abnormal pattern.

Study limitation: The researchers had less control over the procedures for collection and processing of the Pap smear as the study involved already processed archived samples. Again no histological confirmation was done hence the results remain those of a screening test.