Vulvo-cervico-vaginal manifestations and evaluation of Papanicolaou smears in pemphigus vulgaris and pemphigus foliaceus - 11/08/12
, Lana M. de Aguiar, MD b, Celina W. Maruta, MD a, Valéria Aoki, MD a, Miriam N. Sotto, MD a, Glaucia H.O. Labinas, MD a, Alexandre M. Perigo, BSc a, Claudia Giuli Santi, MD a
Reprint requests: Natasha D. Fairbanks Barbosa, MD, Hospital das Clínicas/Departamento de Dermatologia: Av. Dr. Eneas de Carvalho Aguiar, 155 – 3° floor ICHC/room 3016; CEP: 05403-000 São Paulo, Brazil.Abstract |
Background |
Vulvo-cervico-vaginal involvement has rarely been reported in pemphigus vulgaris (PV) and has not been reported in pemphigus foliaceus (PF).
Objectives |
We sought to evaluate genital lesions and Papanicolaou (Pap) smears in female patients with PV and PF.
Methods |
This prospective study includes all consecutive cases of female patients with PV and PF seen from May 2009 to February 2010. Gynecologic examination was performed and Pap smears were collected for cytologic analysis from each patient.
Results |
A total of 56 patients were given a diagnosis of pemphigus (41 PV and 15 PF). Genital involvement was observed in 9 patients with PV (22%) and the vulva was the most common genital site of involvement. Of these 9 patients, 8 presented with active skin/mucous lesions. Four of 15 patients with PF had genital lesions and vulva was the exclusive site of involvement. Three of 4 patients with PF and genital involvement also showed active cutaneous lesions. Six of 56 patients (5 PV and 1 PF) presented with atypical squamous cells of undetermined significance in Pap smear analysis. Upon further pathologic review, acantholytic cells were seen, confirming the diagnosis of pemphigus.
Limitations |
A small number of PF cases were studied.
Conclusions |
Vulvar lesions were the second most frequent site of mucous membrane PV. Herein we report the first case to our knowledge of symptomatic genital lesions in a patient with PF. Moreover, acantholytic cells in Pap smears were found in a patient with PF who was in complete remission off therapy with no clinical genital lesions and no circulating anti-desmoglein-1 and anti-desmoglein-3 autoantibodies. Gynecologic evaluation in patients with pemphigus, including a careful evaluation of Pap smears, should be recommended.
Le texte complet de cet article est disponible en PDF.Key words : acantholytic cells, atypical squamous cells of undetermined significance, genital involvement, Papanicolaou smears, pemphigus foliaceus, pemphigus vulgaris
Abbreviations used : ASC-US, Dsg, ELISA, HSIL, IIF, LSIL, OD, Pap, PF, PV
Plan
| Supported by Conselho Nacional de Pesquisa. |
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| Conflicts of interest: None declared. |
Vol 67 - N° 3
P. 409-416 - septembre 2012 Retour au numéro
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