Viral Infection of FGT

1. Viral Infection of FGT Dr. Tarek Atia

2. General considerations: • Most of the viruses affecting oral mucosa have the ability to infect the vagina. • Routine vaginal smears are usually useful for detecting the typical viral cellular changes.

3. Cellular Changes With Viral Infection • There are non-specific structural changes of infected cells commonly seen with viral infection; such as: 1. Hypertrophy of the cytoplasm, or of the nucleus, or of both (enlarged cells). 2. Changes of the normal granular cytoplasm into hyaline pink cytoplasm.

4. 3. Nucleolus Enlargement followed by nucleolusdistortion and then complete disappearance. 4. Single or multiple intracytoplasmic or intranuclear inclusion bodies surrounded by prominent halo (clear space). 5. Late, ballooning (swelling) cytoplasm and nuclear degenerative vacuolisation.

5. Common viral infection of FGT are:- • Herpes Simplex Virus (HSV) • Human Papilloma Virus (HPV) • Cytomegalovirus Virus (CMV)

6. Herpes Simplex Virus (HSV) • The virus is a Double Stranded DNA with two subtypes: HSV –1 and HSV -2 • HSV -2 has been associated with cancer cervix . • Gross lesion: Vesicle or Ulcers • Site of lesion: Cervix, Vagina, or Valva

7. Clinical findings • It is a sexually transmitted infection. • Early: Fever, enlarged regional lymph nodes, painful lesion, and thin watery discharge. • In pregnant women, the infection could transmit to the baby during delivery. • It could cause abortion • It may play a role in cervical dysplasia or carcinoma

8. Diagnostic scraping of exfoliated infected cells in vaginal smear 1. Early changes: An irregular perinuclear halo. 2. True hypertrophy (enlargement) of the cytoplasm, or of the nucleus, or of both. 3. Homogenous dense pink hyaline cytoplasm, or more basophilic blue cytoplasm.

9. 4. Multinucleated giant cells (crowded nuclei without overlapping) with variation in shape and size .

10. 5. Change of nuclear chromatin distribution 6. Intranuclear acidophilic inclusion red bodies with halo or ground glass appearance of nuclei. 7. Ballooning cytoplasm with multiple vacuolization, or nuclear degeneration indicating irreversible cell injury.

11. Human Papilloma Virus (HPV) • HPV is a sexually transmitted viral infection of FGT. • Human papilloma virus (HPV) is a Double Stranded DNA virus with about 60 types • HPV involves skin and mucous membrane of vulva, vagina, and cervix. • HPV has a role in the pathogenesis of cervical dysplasia and/or carcinoma.

12. HPV- DNA is detected in 85% of cervical cancers, and in 90% of cervical precancerous lesions. • Responsible for squamous proliferations (benign, premalignant, and malignant)

13. Diagnostic cytological scraping smears for HPV • Increased number of inflammatory cells (acute and chronic). • The important cellular changes with HPV are: • Koilocytosis, • Parakeratosis • Dyskeratosis • Hyperkeratosis • Binucletion or multinucletion

14. 1- Koilocytosis • Koilos = cavity = clearing space • Koilocytic cells have characteristic well defined zone of perinuclearhalo, with darkly stained peripheral zone of cytoplasm and irregular cytoplasmic membrane. • It is a characteristic change for HPV infection.

15. Nuclei are enlarged, central and irregular, with perinuclear halo. • Some cells are binucleated or multinucleated without visible inclusion bodies. • Cytoplasmic thickening

16. 2- Dyskeratosis • Dyskeratocytic cells: small, oval or spindle shaped squamous cells, with large nuclei but without perinuclear halo. • Dyskaryosis actually means "abnormal nucleus". • The presence of dyskeratotic cells in cytological smear is strongly suggestive of HPV. • It is precancerous lesion for cervical carcinoma.

18. 3- Parakeratosis • Parakeratosis: means the cells become smaller than normal, i.e. smaller than parabasal cells. • The nucleus show pyknotic changes and cytoplasm may be keratinized

19. 4- Hyperkeratosis • Hyperkeratosis: show anucleatedsquamous cells due to karyolysis. • Karyolysis: disappear of the nucleus; i.e a cell contains cytoplasm without nucleus. • Also show yellow or orange cytoplasm.

20. 5- Binucletion and multinucletion • Binucletion or multinucletion always seen in mature squamous, metaplastic cells and in parakeratotic cells. • The Nuclei are enlarged and show dysplastic changes

21. HPV

22. Cytomegalovirus Virus (CMV) • Cytomegalovirus (CMV) belongs to the family Herpes virus • Disease caused by CMV could be congenital, neonatal, and childhood • During pregnancy lead to congenital disease, mental disorders, deafness with multiple other birth defects • Rarely diagnosed with cervical-vaginal smear.

23. Cytological features • The infected cells are characterized microscopically by eosinophilicintranuclear inclusion bodies with single nuclei. • CMV differ from HPV because multinucletion are not occur. • To confirm CMV case must diagnosed by immunocytochemical method

24. Nuclear inclusions with the appearance of an "owl's eye". • The inclusion is surrounded by a clear halo that extends to the nuclear membrane (typical cytomegalic cell). • CMV infection can occur without the typical cytomegalic cells.