An Unusual Presentation of Aspergillus Species in a Routine Cervicovaginal Pap Smear

Chandra, Smita; Gaur, Dushyant Singh; Harsh, Meena; Chaturvedi, Jaya; Kishore, Sanjeev

doi:10.1159/000325131

Cited by 14 publications

(29 citation statements)

References 6 publications

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“…Additional case reports exhibited a smear test result with a description of a fruiting body in a patient (6,7). Deb and Srivastava (3) and Gupta et al (5) reported concomitant Aspergillus in patients with high-grade intraepithelial lesions, which could be explained by their immunocompromised state (3,5,9). To the best of our knowledge, Hoda et al (10) are the only other authors to report on liquid-based Aspergillus, identifying only one fruiting body; however, they do not report any inflammatory infiltrate or hyphae that could clarify whether the finding was due to contamination (10).…”

Section: Discussionmentioning

confidence: 98%

Aspergillus in liquid-based cervicovaginal cytology in a postmenopausal patient: A case report

et al. 2017

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Abstract.Aspergillus is an opportunistic fungus present in humid environments, whose natural environment is in soil, hay and compost. It is a frequent contaminant in the clinical laboratory. Because of this, the fungus is often inhaled, affecting those with an underlying pulmonary disease or immune deficiency. Fungal genitourinary tract infections are relatively common. A rare Aspergillus spp cervical infection diagnosed via liquid-based cytology is presented in the current study. The 57-year-old woman attended her annual check-up without any relevant medical history. The result of a gynecological examination by Papanicolaou smear was normal and routine liquid-based cytology was performed. The specimen exhibited fungal organisms characterized by septate hyphae branching at acute angles, most consistent with the Aspergillus species. Subsequent cytology demonstrated the same results. Antifungal treatment was initiated and a second post-treatment smear only exhibited atrophy. The cytomorphological features of Aspergillus spp. are discussed in the current study and a brief review of the few reported cases of a primary cervical infection in the literature is provided. In addition, the liquid-based cytology was established as a tool to diagnose the rare Aspergillus infection. IntroductionThe most relevant of the Aspergillus species are fumigatus, flavus and niger. These grow in the natural environment, and in tissues and cultures in the form of hyphae that produce conidia upon exposure to air. Conidia consist of a conidiophore with a terminal vesicle in which one or two layers of phialides are developed. The prevalence of genitourinary tract infections has been reported to be as high as 52% in the female population, with the most common cause being Candida albicans in 28% (1). With the exception of Candida, other fungi are rarely observed in Papanicolaou (Pap) smears or biopsies, with isolated reports of opportunistic infections, such as Blastomyces dermatitidis, Coccidioides immitis, Cryptococcus neoformans and mucor being published (2,3). To the best of our knowledge, this is one of few Aspergillus infection cases reported regarding infection by Aspergillus as diagnosed via liquid-based gynecologic cytology, including a clinical and cytological follow-up. Case reportThe patient was a 57-year-old Mexican woman who had been through the menopause five years previously and she had no relevant medical history. During an annual medical checkup in July 2015, the patient went to the gynecology service at the Hospital Universitario 'Dr José Eleuterio González' (Monterrey, Mexico). She presented without any signs, symptoms or concerns. Furthermore, previous checkups revealed no anomalies. However, the physical examination revealed an atrophic state in the vagina and cervix.Previous patient authorization, a routine liquid-based cervical cytology was performed and demonstrated atrophy with a predominance of parabasal cells and scarce endocervical cells. Of note, multiple fungal structures with uniform and homogeneous forms, and...

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Section: Discussionmentioning

confidence: 98%

Aspergillus in liquid-based cervicovaginal cytology in a postmenopausal patient: A case report

et al. 2017

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“…The fruiting body provides clue about the particular fungus and its species (3,6). Determination of the length and width of conidiophores, shape of vesicles, phialides and chains of conidia are noted for the species characterization.…”

Section: Discussionmentioning

confidence: 99%

Concomitant aspergillus species infection and squamous cell carcinoma diagnosed on pap smear

Gupta¹,

Goyal²,

Kaushal³

2013

TJPATH

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Concomitant infection with Aspergillus species and cervical squamous cell carcinoma in the female genital tract is a rare occurrence and attributed to the opportunistic nature of infection in the immunocompromised state due to the underlying malignancy. The contamination of smears with Aspergillus species should be excluded. The diagnosis of Aspergillus species infection along with squamous cell carcinoma was established on cervicovaginal pap smears in a 62-year-old female presented to gynecological clinic with complaints of stress urinary incontinence. Speculum examination revealed first-degree cervical descent. Smears showed features of squamous cell carcinoma along with fungal spores and fruiting body with hyphae of Aspergillus species. The presence of fruiting bodies and hyphae of Aspergillus species with coexisting squamous cell carcinoma is rare in routine pap smears. True infection needs to be distinguished from contamination by Aspergillus species. Early diagnosis can be established on routine cervicovaginal Pap smear examination.

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“…When encountered it is important to distinguish between a true infection and contamination [25][26][27][28]. A contaminated smear overrules the toxic antifungal therapy and undue follow-up, whereas true infection requires careful study of immune status and prompt therapy [6].…”

Section: Aspergillus As Contaminant In Cervicovaginal Papanicolaou Smmentioning

confidence: 99%

“…Laboratory solutions and water used for staining may also contribute. All these source of contamination should be ruled out diligently in each case of cervicovaginal smear with fungal components [6]. Culturing and characterization of fungus before initiating therapy is important to avoid unnecessary treatment due to contaminant fungus.…”

Section: Aspergillus As Contaminant In Cervicovaginal Papanicolaou Smmentioning

confidence: 99%

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2017

ICPJL

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An Unusual Presentation of Aspergillus Species in a Routine Cervicovaginal Pap Smear

Cited by 14 publications

References 6 publications

Aspergillus in liquid-based cervicovaginal cytology in a postmenopausal patient: A case report

Aspergillus in liquid-based cervicovaginal cytology in a postmenopausal patient: A case report

Concomitant aspergillus species infection and squamous cell carcinoma diagnosed on pap smear

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