A Rare Presentation of Signet Ring Squamous Cells in Ectocervical Squamous Epithelium Causing Diagnostic Difficulty in Reporting Cervical Intra-Epithelial Neoplasia
K. M. Rajyaguru *
Department of Pathology, Faculty of Medicine and Defence Health, National Defence University, Hospital Angkatan Tentera Tuanku Mizan, Kuala Lumpur, Malaysia.
Ahmad Zakuan
Department of Pathology, Hospital Angkatan Tentera Tuanku Mizan, Kuala Lumpur, Malaysia.
S. I. Shahruddin
Department of Obstetrics and Gynecology, Hospital Angkatan Tentera Tuanku Mizan, Kuala Lumpur, Malaysia.
*Author to whom correspondence should be addressed.
Abstract
We present a case of cervical intraepithelial neoplasia Grade II having many areas full of signet ring squamous (SRS) cells in 6-7 parabasal layers, covered by the layers of koilocytotic changes in outermost layers, with a brief review of the literature. Such presentation is extremely rare. A cone biopsy of the cervix was sent to the laboratory after pap smear preparation and small biopsy from the aceto-white area during colposcopy examination, which revealed few malignant cells. We grossed the specimen and selected the tissue from 1-12 o’clock positions and processed for paraffin blocks. H&E stained sections showed SRS cells at the majority of 1-12 positions. These SRS cells were negative for Alcian blue, Mucicarmine, Periodic acid–Schiff (PAS) and PAS-D stain and positive for cytokeratin. This presence of SRS cells has created difficulty in diagnosing the cervical intraepithelial neoplasia (CIN) case.
Keywords: Signet ring squamous cell, cervix, squamous epithelium, intraepithelial neoplasia