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Research Article Volume 11 Issue 1
The prolapse pitfall: differentiating reactive cytologic changes in uterine prolapse from squamous intraepithelial lesions
Hamza Abu-Farsakh, Majeda Al-Jalad, Hussam Abu-Farsakh
Received: March 04, 2026 | Published: April 2, 2026
Citation: Abu-Farsakh H, Al-Jalad M, Ab-Farsakh H. The prolapse pitfall: differentiating reactive cytologic changes in uterine prolapse from squamous intraepithelial lesions. Int Clin Pathol J. 2026;11(1):5-9 DOI: 10.15406/icpjl.2026.11.00221
Abstract
Background: Cervicovaginal cytology is a cornerstone of cervical cancer screening, but its interpretation can be confounded by benign changes, leading to diagnostic pitfalls and potential medicolegal consequences. This study addresses the potential for marked reactive changes associated with uterine prolapse to mimic squamous intraepithelial lesions (SIL), or cervical dysplasia, in cervicovaginal (Pap) smears. Methods: We prospectively collected and studied cervicovaginal smears from 39 patients (age range: 34-75 years; parity range: 4-14, with uterine prolapse. All patients subsequently underwent simple hysterectomy for prolapse symptoms. Cytomorphologic features were evaluated, and Human Papillomavirus status was determined using Polymerase Chain Reaction on cervical swabs. Resected cervical tissue was examined for corresponding histopathologic changes, including HPV/p16 immunohistochemistry. Results: All 39/39 cases demonstrated cytological features concerning for dysplasia, including an increased nuclear-to-cytoplasmic (N/C) ratio, nuclear contour irregularities, and perinuclear halos. However, they also uniformly exhibited changes not typically seen in SIL: frayed cytoplasmic borders (39/39 cases), neutrophilic debris in the background (39/39 cases), and the presence of vesicular nuclei (at least focally, 39/39 cases). All cases were negative for HPV by PCR and negative for HPV/p16 immunostaining on resected tissue. Histopathology of the resected cervix revealed basal cell hyperplasia (34/39), transitional cell metaplasia (32/39), and parakeratosis/koilocyte-like changes (39/39). Conclusion: Cytomorphologic changes in cervical smears from patients with uterine prolapse frequently mimic SIL. Key differentiating cytological features are frayed cytoplasmic borders, abundant neutrophilic debris, vesicular nuclei. Pathologist awareness of this specific reactive entity, supported by clinical history and ancillary HPV testing, is crucial to prevent misdiagnosis and unnecessary patient intervention.
Keywords: uterine prolapse, cervicovaginal cytology, pap smear, reactive cellular changes, squamous intraepithelial lesion (sil) mimic, cervical dysplasia, cytomorphology, human papillomavirus (hpv), polymerase chain reaction (pcr), p16 immunohistochemistry, basal cell hyperplasia, transitional cell metaplasia, parakeratosis, koilocyte-like changes, diagnostic pitfalls.
©2026 Abu-Farsakh, et al. This is an open access article distributed under the terms of the, which permits unrestricted use, distribution, and build upon your work non-commercially.