False diagnosis in women: How radiation affects pap smears

A new case report was published in Volume 12 of Oncoscience, titled "Deciphering radiation effects in pap smears: A case report and review of challenges."

In this report, Gunvanti Rathod, Monica Mishra, Alisha Khan, and Mishu Mangla from AIIMS Bibinagar took the case of a 44-year-old woman previously treated for advanced cervical cancer.

A follow-up Papanicolaou (Pap) smear revealed abnormal cells that appeared suspicious for cancer recurrence but were ultimately identified as benign changes.

The case highlights the importance of recognising post-treatment changes to prevent misdiagnosis and unnecessary medical procedures.

Cervical cancer is one of the most common cancers affecting women, particularly in low-resource settings and the Pap smear remains a vital tool for both early detection and monitoring after treatment.

In advanced cases, therapy often includes surgery, chemotherapy, as well as radiation and while effective, radiation can cause long-term cellular changes that closely resemble malignancy under microscopic examination.

In this case, the patient had undergone a hysterectomy followed by radiation and chemotherapy.

One year later, she returned for routine follow-up.

Although she had no symptoms and no visible signs of disease, her Pap smear showed enlarged nuclei, cytoplasmic changes, and multinucleation, characteristics often associated with cancer.

However, these were determined to be radiation-induced effects and the patient remained stable and symptom-free at her 12-month evaluation.

“Numerous squamous epithelial cells exhibited: Nuclear enlargement with preserved N:C ratio, Cytoplasmic vacuolation and granularity, Mild hyperchromasia with smudged chromatin, Binucleation and multinucleation, Degenerative nuclear changes such as nuclear pallor, irregular membranes, and chromatin wrinkling, Occasional bizarre-shaped cells and Inflammatory background with atrophy,” the research read.

This case contributes to clinical knowledge by showing how radiation therapy can mimic disease in cytology and emphasises the importance of training as well as awareness among pathologists to ensure accurate diagnoses and avoid misdiagnosis.