Effects of Chemotherapy and Tamoxifen on Cervical and Vaginal Smears in Bone Marrow Transplant Recipients

Liu, Katharine; Marshall, Jay P.; Shaw, Heather S.; Dodge, Richard K.; Layfield, Lester J.

doi:10.1159/000331349

Cited by 2 publications

(4 citation statements)

References 13 publications

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“…Interestingly, the cytological abnormalities became mild reactive changes or even completely regressed during follow‐up in 3 of the 4 patients. This regression during follow‐up has also been described in previous reports . Previous studies reported that most atypical changes occurred during treatment or in the immediate post–allo‐HSCT phase and diminished after day +100 .…”

Section: Discussionsupporting

confidence: 86%

“…Table shows all the series describing atypical changes in Pap smears related to busulfan treatment in patients who had undergone allo‐HSCT . Most of the patients reported were identified in the pre–HPV testing era, thus most reports on busulfan‐associated atypia mimicking SIL lack information on HPV status . In keeping with the previous reports, the treatment‐related atypia observed in our cases closely resembled SIL.…”

Section: Discussionsupporting

confidence: 81%

“…This regression during follow‐up has also been described in previous reports . Previous studies reported that most atypical changes occurred during treatment or in the immediate post–allo‐HSCT phase and diminished after day +100 . Yu et al observed that treatment‐related atypia was identified in 80% of samples before day +100 after allo‐HSCT and in only 2.6% of specimens after day +100.…”

Section: Discussionsupporting

confidence: 80%

“…Busulfan seems to be the only drug involved in all the cases reported, and it has been considered as being responsible for the cytological atypia. However, it is unclear why only some patients show cytologic atypia whereas others do not .…”

Section: Discussionmentioning

confidence: 99%

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Atypical cytological changes mimicking SIL of the uterine cervix in allogenic hematopoietic stem cell transplantation recipients treated with busulfan

Saco

Alós

Esteve

et al. 2019

Cancer Cytopathology

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BACKGROUND: Allogenic hematopoietic stem cell transplantation (allo-HSCT) is a common procedure in hematological disorders and is preceded by a conditioning regimen that usually includes busulfan. The immunosuppression caused by the conditioning regimen and graft-versus-host disease prophylaxis is associated with human papillomavirus (HPV) persistence and, consequently, with an increased risk of cervical cancer (CC) and squamous intraepithelial lesions (SILs)-the precursors of CC. A gynecological check-up that includes CC screening is recommended in these patients. METHODS:All female recipients of allo-HSCT undergo routine gynecological check-up that includes CC screening. Cervical samples were obtained for liquid-based cytology and HPV testing. Cytology smears were stained with the Papanicolaou (Pap) technique. A colposcopy evaluation was performed if any abnormal result in the screening tests was obtained. RESULTS:Among 15 women undergoing gynecological examination at 1 year after allo-HSCT who had received a conditioning regimen that included busulfan, 4 (26.7%) showed atypical squamous cells in the Pap smear, suggesting high-grade SIL. The abnormalities were identified from 136 to 271 days after allo-HSCT. In all cases, HPV testing was negative, and colposcopy examination was normal. The cytological abnormalities regressed in 3 of the women after 1 year but persisted in 1 woman at day 382 after allo-HSCT. CONCLUSIONS: Treatment-related atypia mimicking SIL is a common finding in allo-HSCT recipients who have received busulfan, particularly in the first year after the procedure. However, atypical changes may persist for more than 1 year. Clinical information, HPV testing, and colposcopy examination are critical to prevent misdiagnosis and overtreatment in these patients.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionsupporting

confidence: 81%

Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Atypical cytological changes mimicking SIL of the uterine cervix in allogenic hematopoietic stem cell transplantation recipients treated with busulfan

Saco

Alós

Esteve

et al. 2019

Cancer Cytopathology

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The Small Blue Cell Dilemma Associated With Tamoxifen Therapy

Yang

Trapkin²,

Demoski³

et al. 2001

Archives of Pathology &Amp; Laboratory Medicine

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Context.—Several endometrial diseases, such as endometrial hyperplasia, endometrial carcinoma, and endometrial polyps, have been reported to be associated with tamoxifen administration. We recently observed a high incidence of distinctive small blue cells in Papanicolaou tests of women who had received tamoxifen treatment for breast carcinoma. Objectives.—To define the characteristics of these small blue cells, to identify the patient population in which they are found, and to determine the clinical significance and possible etiology of these findings. Design.—A total of 154 Papanicolaou tests from 60 patients with a clinical history of tamoxifen therapy were reviewed retrospectively. Results.—Small blue cells were found in 40% of Papanicolaou tests from patients who received tamoxifen therapy. Patients with small blue cells in their Papanicolaou tests were an average of 9 years older at the time tamoxifen therapy was initiated than those without. Among the available follow-up surgical biopsies, no malignant diagnoses were made. Conclusions.—We conclude that these distinctive small blue cells are found more frequently in older patients and most probably represent proliferative reserve cells of cervical/vaginal epithelium resulting from the estrogenic agonist effect of tamoxifen. More importantly, they are nonneoplastic in nature.

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Effects of Chemotherapy and Tamoxifen on Cervical and Vaginal Smears in Bone Marrow Transplant Recipients

Cited by 2 publications

References 13 publications

Atypical cytological changes mimicking SIL of the uterine cervix in allogenic hematopoietic stem cell transplantation recipients treated with busulfan

Atypical cytological changes mimicking SIL of the uterine cervix in allogenic hematopoietic stem cell transplantation recipients treated with busulfan

The Small Blue Cell Dilemma Associated With Tamoxifen Therapy

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