1Associate Professor, Department of Pathology, Mahatma Gandhi Medical College, Jaipur
2Professor & Head of the Department, Department of Pathology, Mahatma Gandhi Medical College, Jaipur
3Professor, Department of Pathology, Mahatma Gandhi Medical College, Jaipur
Online published on 16 January, 2016.
"Carcinoma" the name itself is dreaded, so why scare the patient when differential diagnosis can be done by careful scrutinization. And why not "alert" the patient for her increased predisposition to carcinoma cervix due to an associated virus. To top it all, when this can be done by a simple, non-invasive outpatient procedure-the best screening test available till date-the Pap test, if the degree of suspicion is kept high.
Tuberculosis & Herpes simplex are the infections which clinically mimic & increase the predisposition to cancer cervix respectively.
Case 1-due to its rarity & clinical confusion with carcinoma cervix(1, 8), we present a case of 32 yrs. female, P3L1, with chief complaints of pain abdomen & post coital bleeding.
Case 2-due to its acting as an "accomplice" to another virus-HPV & increasing the risk of carcinoma cervix(13, 19), we present a case of 35 yrs. female with pain lower abdomen, dysfunctional uterine bleeding, low backache & lumbar radiculopathy with restricted SLR (straight leg raising test)
Case 1-patient presented with pain abdomen & post coital bleeding. Per speculum examination revealed bad erosion in the cervix, bleeds on touch & is friable. Clinical suspicion was of carcinoma cervix but Pap smear revealed epitheloid cell granulomas & Langhan's giant cells. Biopsy of the cervix and endometrium confirmed the diagnosis.
Case 2-patient presented with low backache & lumbar radiculopathy in neurosurgery department with associated complaints of itching vulva, pain lower abdomen & DUB. Per speculum revealed vaginitis & a nabothian cyst.
Per vaginal examination revealed cervix downward with thickened & tender left fornix.
Pap smear revealed peripheral margination of chromatin, ground glass nuclei, eosinophilic inclusion body, moulding & multinucleation suggestive of cellular changes consistent with HSV.
Cervical tuberculosis should be considered in the differential diagnosis of carcinoma cervix in young women(1, 8).
HSV patients can present with radiculopathy & as they predispose to CA cervix acting as a synergistic cofactor with HPV, should be advised for close regular follow up.
This simple screening test is beneficial for the patient, hence reemphasizes its importance.
Pap smear, tubercular cervicitis, tubercular endometritis, HPV, HSV-2
