Role of cytology in herpetic stomatitis

Sir,

Herpetic stomatitis is an infectious viral disease caused by herpes simplex virus (HSV). The disease occurring in children are usually primary lesions and are called as primary herpetic stomatitis. The only natural reservoirs for these viruses are humans. On reactivation, these viruses develop recurrent infections and are called as recurrent herpetic labialis/stomatitis. In this article, we are reporting a case with all the characteristic cytological features of herpetic stomatitis.

A 31-year-old female patient attended our dental department with painful ulcers on her left buccal mucosa. Patient had generalized weakness and myalgia. Cytosmear was taken by scraping the lesion gently with a tongue blade. The sample was smeared on a glass slide, spray fixed and stained with Papanicolaou stain. Cytosmear showed epithelial cell with ballooning degeneration, margination of nuclear chromatin along the nuclear membranes, eosinophilic intranuclear inclusion bodies and perinuclear halo around the nucleus [Figure 1a]. Few multinucleated giant cells were seen which showed ground glass nuclei with margination of nuclear chromatin [Figure 1b and c]. Some of the giant nuclei showed nuclear molding along with ground glass appearance and margination of the nuclear chromatin [Figure 1d]. This appearance suggested a viral infection probably due to HSV.

Figure 1.

(a) Epithelial cells with ballooning degeneration, margination of nuclear chromatin along the nuclear membranes, eosinophilic intranuclear inclusion bodies and perinuclear halo around the nucleus (Pap, ×400). (b and c) Multinucleated giant cells showing ground glass nuclei with margination of nuclear chromatin (Pap, ×400). (d) Giant cell nuclei showing nuclear molding along with ground glass appearance and margination of the nuclear chromatin (Pap, ×400)

Diagnostic cytology is primarily used for the detection of epithelial and cellular abnormalities and infectious diseases. Cytodiagnosis is very simple, rapid, cheap and reliable method for diagnosing cutaneous tumors, immunobullous lesions, infectious diseases and genodermatosis.[1] Intranuclear inclusion bodies surrounded by subtle clear halo are characteristic of herpetic infection, but are often difficult to find.[1] The main cytologic feature of HSV is the remarkable nuclear changes seen in the infected cells. Nuclear alterations such as ballooning degeneration, nuclei with homogenous ground glass appearance, molded nuclei with prominent eosinophilic inclusion and multinucleation may be seen.[2] The multinucleated giant cells in the herpetic lesion may be similar to other giant cells seen in various oral lesions, but nuclear changes like molding and ground glass appearance are characteristic features of herpes. As cytologic differentiation between herpes simplex, herpes zoster and varicella is not possible; a clinical correlation and monoclonal antibody assay or viral culture may be required to ascertain the final diagnosis. Since biopsy is an invasive procedure, oral cytology can be a primary step in diagnosing infectious diseases like herpes. Cytology is the most rapid method of diagnosing these lesions, thereby helping in its prompt treatment.