Behçet's disease in a vaginal smear. Report of a case with cytologic features and their distinction from squamous cell carcinoma.

A 52-year-old woman who had undergone a hysterectomy 15 years previously for benign disease presented with ulcerative lesions on the perigenital skin and external genitalia. A Papanicolaou smear of the vagina, unaccompanied by any history, showed a heavy, purulent exudate and many isolated pleomorphic and keratinizing squamous cells. The findings were suggestive of squamous cell carcinoma. Subsequently obtained clinical data revealed a long-standing history of ulcerating oral and genital lesions of Behçet's disease. Biopsy confirmed the nonneoplastic ulcerative nature of the process. Given this cytologic pattern, the presence of a substantial purulent exudate and the identification of cytologic features suggesting reparative epithelial changes should caution the observer against an interpretation of squamous cell carcinoma and suggest the presence of a nonneoplastic ulcerative process.