Epithelial cytological atypia associated with intrauterine contraceptive devices

Prolonged usage of an intrauterine contraceptive device [IUD] is often associated with exfoliation of atypical cells. These cells are commonly observed in gynecologic preparations and can cause considerable difficulty in their interpretation; misdiagnosed to represent adenocarcinoma, epidermoid carcinoma, or other dysplastic lesions. The study was conducted at AL-Kadhimiya Teaching Hospital from September 2003 till June 2005. Fifty PAP smears with atypical cells from women wearing IUD were examined cytologically. The age range was 18-42 with average age of 29 years. Ten had at least one previous smear from a period of three months to 5 years, the most common cause of IUCD removal were menstrual disorders. The cases were categorized cytologically into two groups: the first consisted of nine cases consider to represent atypia of reparafive nature resulting from inflammation or infection, the remaining 41 cases of the second group fell into three subgroups: squamous, columnar, and indeterminate type of atypia. Columnar atypia is characterized by abnormal cells which can resemble cells from carcinoma in situ. Unlike the latter the atypical cells from IUD are usually multinucleated contain nucleoli, and are not associated with cells from severe cervical atypia. They are probably endometrial in origin. There is no likelihood of an enhanced incidence of cervical dysplasia or carcinoma, however an awareness of IUCD associated cytomorphological alterations to avoid wrong diagnoses of carcinoma. In every smear with columnar and/or indeterminate atypia in reproductive age group women, the patient should be asked if she wear an IUD to avoid wrong diagnosis of carcinoma