Unusual Fungal Bodies in Conventional Cervical Smears: Report of Nine Cases Gaurav Jain, M.D., 1 Meeta Singh, M.D., 1 * Anshuja Singhla, M.D., 2 Abhijit Das, M.D., 1 Srishti Gupta, M.D., 1 Sompal Singh, M.D., 1 Sanjay Jain, M.D., 3 and Leela Pant, M.D. 1 Candida spp have often been reported in cervical cytology, other fungal organisms are very rare in modern literature. We report nine cases of conventional cervical smears showing Peni- cillium, Aspergillus, and Cladosporium spp in healthy imuno- competent females. Penicillium spp seen in four out of nine smears, Cladosporium spp alone in three out of nine smears, and Cladosporium spp along with Aspergillus spp in two out of nine smears. A detail of these nine cases is presented with dis- cussion on importance of these structures when observed in con- ventional cervical smears. Awareness of such contaminants is important to differentiate from true infection for relevant thera- peutic implications. A systematic step-wise approach to such structures is also suggested. Diagn. Cytopathol. 2015;43:234– 237. V C 2014 Wiley Periodicals, Inc. Key Words: aspergillus; penicillium; cladosporium; conven- tional; cervical cytology Introduction Fungal organisms like Candida are commonly seen in conventional cervical smears. Unusual and rare fungi-like Aspergillus spp, Penicillium spp, and Cladosporium spp have been individually reported in literature in cervical smears. 1–7 We report nine cases of Penicillium, Aspergil- lus, and Cladosporium contaminating conventional cervi- cal smears from healthy women. Systematic approach to such unusual structures is also proposed. Case Reports Our study comprises of nine patients, cervical smears from whom were received from different units of Depart- ment of Gynaecology in Hindu Rao hospital, collected over a period of 1 week and processed in single batch. The patients were of age from 26 to 62 years. Most (five out of nine) smears were done for routine screening pur- pose having unremarkable examination findings. Two had minimal discharge on per speculum examination, and two complained of postcoital bleeding. Common to all nine smears was presence of fungal structures of variable mor- phology (Fig. 1). Four smears showed features consistent with Penicillium spp (Fig. 2). The other five smears showed features most consistent with Cladosporium spp (Fig. 3). Two out of these five smears also had Aspergil- lus spp present (Fig. 4). On diagnostic interpretation, two smears were interpreted as positive for intraepithelial lesion [one case each of atypical squamous cells—unde- termined significance, i.e., ASC-US (Fig. 5) and low- grade squamous intraepithelial lesion]. The remaining seven cases were negative for intraepithelial lesion show- ing reactive cellular changes due to inflammation. These details have been shown in Table I. In the light of clinical details and morphological smear findings, these fungal structures were interpreted as contaminants. Discussion The presence of exogenous structures and fungal bodies in cervical smear (contamination) often poses a challenge to cytopathologist. These unusual structures and fungal bodies are to be differentiated from true infection. Most of the workers in cytology have only a modicum of train- ing in mycology and may not recognize many fungi other than Candida. Awareness about such exogenous structures helps in their correct categorization and discrimination from true infection. To date, there are only seven cases of 1 Department of Pathology, NDMC Medical College and Hindu Rao Hospital, Delhi, India 2 Department of Obstetrics and Gynaecology, NDMC Medical College and Hindu Rao Hospital, Delhi, India 3 Department of Microbiology, NDMC Medical College and Hindu Rao Hospital, Delhi, India *Correspondence to: Dr. Meeta Singh, M.D., Assistant Professor, Department of Pathology, NDMC Medical College and Hindu Rao Hos- pital, Malka Gunj, Delhi, India-110007. E-mail: meetamamc@gmail.com Received 18 December 2013; revised 31 March 2014; Accepted 9 May 2014 DOI: 10.1002/dc.23179 Published online 24 June 2014 in Wiley Online Library (wileyonlinelibrary.com). 234 Diagnostic Cytopathology, Vol. 43, No 3 V C 2014 WILEY PERIODICALS, INC.