A Rare Presentation of Signet Ring Squamous Cells in Ectocervical Squamous Epithelium Causing Diagnostic Difficulty in Reporting Cervical Intra-Epithelial Neoplasia

Abstract

We present a case of cervical intraepithelial neoplasia Grade II having many areas full of signet ring squamous (SRS) cells in 6-7 parabasal layers, covered by the layers of koilocytotic changes in outermost layers, with a brief review of the literature. Such presentation is extremely rare. A cone biopsy of the cervix was sent to the laboratory after pap smear preparation and small biopsy from the aceto-white area during colposcopy examination, which revealed few malignant cells. We grossed the specimen and selected the tissue from 1-12 o’clock positions and processed for paraffin blocks. H&E stained sections showed SRS cells at the majority of 1-12 positions. These SRS cells were negative for Alcian blue, Mucicarmine, Periodic acid–Schiff (PAS) and PAS-D stain and positive for cytokeratin. This presence of SRS cells has created difficulty in diagnosing the cervical intraepithelial neoplasia (CIN) case.