A pathologist repos the presence of koilocytotic atypia in a cervical biopsy from a 25 year old woman. On the basis of this histopathologic finding, which of the following conditions does this patient most likely have?
Human papillomavirus (HPV) is the cause of condyloma, which may occur on any mucocutaneous surface of the male or female external genitalia. Squamous epithelial cells infected by HPV show characteristic nuclear and cytoplasmic changes, referred to as koilocytosis or koilocytotic atypia, on tissue sections or Pap smears. These changes allow the diagnosis of HPV infection to be made. The nuclei are condensed and have irregular contours, acquiring a "raisin-like" appearance; cytoplasm vacuolization creates a perinuclear halo. HPV is a crucial etiopathogenetic factor in the development of squamous cell carcinoma of the cervix. Not all types of HPV, however, are associated with cervical carcinoma. High-risk types are 16 and 18, whereas the most frequent low-risk types are 6 and 11. HPV types 16 and 18 express proteins (E6 and E7) that inactivate p53 and Rb tumor suppressor genes, leading to neoplastic transformation. Although HPV infection is a risk factor for the development of squamous dysplasia and carcinoma, koilocytosis is not equivalent to severe squamous dysplasia (choice E) or carcinoma in situ (choice F). In the current Bethesda system for diagnosing and repoing Pap smears, koilocytosis is likened to a low-grade squamous intraepithelial lesion, ie, mild atypia. Remember that koilocytosis (koilocytotic atypia) = HPV infection, not severe dysplasia/carcinoma. Chlamydia infection of the genital tract is due to Chlamydia trachomatis.The infection is often symptomatic in men and clinically silent in women. In addition to urethritis and lymphogranuloma venereum, C. trachomatis causes trachoma, an eye infection endemic in some developing countries. Gonococcal infection, or gonorrhea, is due to Neisseria gonorrhoeae, a gram-negative diplococcus. Herpes simplex type 2 virus manifests with painless blisters, which subsequently break down, forming painful erosions. Ref: Ray C.G., Ryan K.J. (2010). Chapter 19. Papilloma and Polyoma Viruses. In C.G. Ray, K.J. Ryan (Eds), Sherris Medical Microbiology, 5e.
Chlamydia infection
Gonococcal infection
Herpes simplex virus infection
Human papillomavirus infection