Occult human papillomavirus infection of the uterine cervix in postmenopausal women

Atypical Squamous Cells of Undetermined Significance in Women Over 55

“…6,18,19 Others, however, have reported a high incidence of dysplasia and carcinoma on cervicovaginal smears and biopsies in postmenopausal women. 5,16,21 The guidelines for clinical management of postmenopausal women with ASCUS are conflicting. The National Cancer Institute's (NCI's) interim guidelines for management of abnormal cervical cytology recommends a course of topical estrogen therapy for women not receiving hormone replacement therapy.…”

Glandular and Squamous Atypia and Intraepithelial Lesions in Atrophic Cervicovaginal Smears

“…6,25,28 Voytek et al 25 found APK to be associated with both LSIL and HSIL, and no specific feature of the APK cells appeared to identify the severity of the lesion. In a study by Nuovo et al, 15 perinuclear halos and nuclear atypia suggestive of HPV infection were found in similar proportions in HPV-positive and -negative groups. Parakeratosis was the only feature noted at a higher rate in the HPV-positive cases from postmenopausal women.…”

“…8,19,23 Although abnormal Pap smears are reported more frequently in postmenopausal women when compared to younger women, 12,13 the frequency of underlying dysplasia in the elderly population seems to vary significantly. Several groups have reported a high incidence of dysplasia and carcinoma on cervicovaginal smears and biopsies in postmenopausal women, 13,15,24 while others have found that squamous atypia in postmenopausal women is rarely associated with either biopsy-proven dysplasia or human papillomavirus (HPV) DNA detection, 5,20,23 and it is generally thought that the incidence of biopsy proven intraepithelial lesions decreases markedly after menopause. 14 In review of atypical atrophic cervicovaginal smears, Kaminski et al 9 concluded that there was a strong correlation between estrogen deficiency and squamous atypia.…”