Radiation-Induced Cellular Changes May Mimic Cancer Recurrence in Pap Smears
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December 10, 2025“The present case highlights the need for heightened awareness of post-radiation cytology in clinical practice.”
BUFFALO, NY — December 10, 2025 — A new case report was published in Volume 12 of Oncoscience on November 19, 2025, titled “Deciphering radiation effects in pap smears: A case report and review of challenges.”
In this report, Gunvanti Rathod, Monica Mishra, Alisha Khan, and Mishu Mangla from AIIMS Bibinagar describe a case of a 44-year-old woman previously treated for advanced cervical cancer. A follow-up Papanicolaou (Pap) smear revealed abnormal cells that appeared suspicious for cancer recurrence but were ultimately identified as benign changes. The case highlights the importance of recognizing post-treatment changes to prevent misdiagnosis and unnecessary medical procedures.
Cervical cancer is one of the most common cancers affecting women, particularly in low-resource settings. The Pap smear remains a vital tool for both early detection and monitoring after treatment. In advanced cases, therapy often includes surgery, chemotherapy, and radiation. While effective, radiation can cause long-term cellular changes that closely resemble malignancy under microscopic examination.
In this case, the patient had undergone a hysterectomy followed by radiation and chemotherapy. One year later, she returned for routine follow-up. Although she had no symptoms and no visible signs of disease, her Pap smear showed enlarged nuclei, cytoplasmic changes, and multinucleation, characteristics often associated with cancer. However, these were determined to be radiation-induced effects. The patient remained stable and symptom-free at her 12-month evaluation.
“Numerous squamous epithelial cells exhibited: Nuclear enlargement with preserved N:C ratio, Cytoplasmic vacuolation and granularity, Mild hyperchromasia with smudged chromatin, Binucleation and multinucleation, Degenerative nuclear changes such as nuclear pallor, irregular membranes, and chromatin wrinkling, Occasional bizarre-shaped cells and Inflammatory background with atrophy.”
Radiation-related cellular changes are well-documented but can be mistaken for high-grade lesions or recurrence. These effects may persist for years and often overlap with features seen in actual disease. A key difference is that radiation-altered cells typically maintain a normal ratio between the nucleus and cytoplasm and do not show active division. Awareness of these features is essential for accurate interpretation.
The report underscores the need to interpret Pap smear results alongside a patient’s medical history, especially details of prior treatment. Vault smears, used to monitor patients after hysterectomy, remain useful but require cautious evaluation when a radiation history is present.
This case contributes to clinical knowledge by showing how radiation therapy can mimic disease in cytology. It emphasizes the importance of training and awareness among pathologists to ensure accurate diagnoses and avoid overtreatment.
DOI: https://doi.org/10.18632/oncoscience.636
Correspondence to: Gunvanti Rathod – gunvanti.path@aiimsbibinagar.edu.in
Keywords: cancer, papanicolaou smear, radiation cytology, cervical cancer, cytological changes, diagnostic pitfalls
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