Cytopathology:
- Presence of multinucleated cells.
- Nuclei have a ground glass appearance (due to accumulation of viral particles).
- Molding of nuclei and peripheral margination of chromatin is seen.
- “Cowdry B-type” inclusion seen as a basophilic multinucleation, while eosinophilic intranuclear “Cowdry A-type” inclusions with surrounding halo or clear zone is not appreciated in this case.
- Ballooning degeneration of the cytoplasm in few cells
Practical Points of Pathoclinics:
- HSV cytopathic effect can be mistaken for ASC-US, LSIL or y HSIL, especially if one sees only mononuclear cells, which are infected with herpes virus. Careful search for “3M – multinucleation, margination of chromatin and molding of nuclei” prevents the over diagnosis. Also distinguishing the nuclear hyperchromasia of HSIL from ground glass nuclei and peripheral chromatin margination due to HSV is important key feature.
- Reactive endocervical cells, multinucleated histiocytes, and syncytiotrophoblast cells should not be mistaken as a multinucleated cell of HSV effect.
- Initial herpes infection may not present with all diagnostic nuclear features.