Atrophic Pap Smears, Differential Diagnosis and Pitfalls

As a unique preventable cancer, invasive cervical carcinoma is the second most common cancer among the women in developing countries. Change in women’s lifestyle, worldwide spread of HPV infection and women’s lack of effective education and screening programs in less developed countries constitute the most important factors for its high incidence and mortality rate. From a diagnostic perspective, atrophic smears may be interpreted as positive malignant smears in postmenopausal and occasionally in premenopausal women. However, rarely a high grade or malignant smear might be rendered as the atrophic smear. For this reason acquaintance with atrophic smears and their diagnostic challenges should be included in pathology and cytotechnology training courses. In this review, usual pattern of atrophic smears and differential diagnosis of atrophic smears along with mimics will be presented for decision making and particularly avoiding overdiagnosis.