Pap stain, high power:
Squamous epithelial cell with multinucleation and pale nuclei
Note acute inflammation in background
Pap stain, high power:
Binucleation with molding of nuclei against each other
Note the blue chromatin is pushed to periphery and center is pale
Pap stain, high power (BAL specimen)
Note dark chromatin marginated to periphery and center is pale blue
Pap stain, medium power
Some epithelial cells show multinucleation and molding
Others are uninucleate. All cells show margination of chromatin
Features
• Bronchioloalveolar lavage or washing
• Cerebrospinal fluid
• Esophageal brushings
• Cervicovaginal cytology
• Skin
• Herpes Simplex Viruses-I and II
• Varicella Zoster Virus
• Findings best seen in Pap smear.
• For cutaneous and superficial mucosal lesions Tzanck smear is recommended
• Classic features include:
– Multinucleation
– Molding of nuclei against each other
– Margination of chromatin to periphery (caused by intranuclear virions)
– Eosinophilic, intra-nuclear Cowdry Type-A, inclusion (only occasionally seen)
Background acute inflammation
• Recommend reporting as: Cytopathic changes consistent with Herpes Virus
• Distinction between HSV-I, HSV-II and VZV is based on clinical and microbiologic findings