The physician takes a sample for Pap smear analysis from a 15 year old girl. Review of the Pap smear demonstrates the presence of koilocytes, which are approximately the same size as an intermediate cells, with enlarged hyperchromatic nuclei and perinuclear halos. The abnormal cells observed in the Pap smear specimen are infected by which of the following viruses?
Various strains of the human papilloma virus (HPV, notably types 16, 18, 31, 33, 35, and 39) have been implicated as causing a variety of genital lesions, including genital was, cervical dysplasia, cervical cancer, vaginal dysplasia, vaginal cancer, and penile cancer. The koilocyte is the term used to describe the characteristic nuclear alterations and perinuclear halo seen with HPV infection in the cervical squamous epithelial cells. Infection with the AIDS virus cannot be recognized by cytologic changes. Cytomegalovirus infection causes nuclei to be large, eosinophilic, and "smudged"; cytomegalovirus is uncommonly seen in Pap smears. Herpes simplex I and II infections cannot be distinguished cytologically, as both produce multinucleated cells whose nuclei develop a characteristic "ground-glass" appearance. Ref: Hoffman B.L., Schorge J.O., Schaffer J.I., Halvorson L.M., Bradshaw K.D., Cunningham F.G., Calver L.E. (2012). Chapter 29. Preinvasive Lesions of the Lower Genital Tract. In B.L. Hoffman, J.O. Schorge, J.I. Schaffer, L.M. Halvorson, K.D. Bradshaw, F.G. Cunningham, L.E. Calver (Eds), Williams Gynecology, 2e.
AIDS virus
Cytomegalovirus
Herpes simplex l
Human papillomavirus