{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T19:09:13Z","timestamp":1783969753247,"version":"3.55.0"},"reference-count":20,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2020,3,3]],"date-time":"2020-03-03T00:00:00Z","timestamp":1583193600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["acsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Cytopathology"],"published-print":{"date-parts":[[2020,7]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>The cervical cancer screening recommendation for transgender female\u2010to\u2010male (FTM) patients is the same as that for cisgender females. A lack of literature on testosterone\u2010induced changes in cervical cytology in these patients may result in interpretation errors, especially without a proper clinical history. The aim of this study was to delineate the Papanicolaou (Pap) test findings in this patient population.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A pathology laboratory information system was used to obtain a cohort of FTM transgender patients on testosterone therapy (2009\u20102019). A cohort of age\u2010matched, atrophic, control cisgender female patients (postpartum or menopausal) was selected. A retrospective review of the cytomorphologic findings on cervical Pap smears, pertinent follow\u2010up, and human papillomavirus (HPV) test results was performed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Fourteen transgender patients (age range, 21\u201064\u00a0years; mean age, 42.5\u00a0years) receiving testosterone therapy with 17 Pap smears were identified. One of the 5 available HPV tests was positive for HPV, and 4 were negative. A Pap smear review revealed the following: negative for intraepithelial lesion (NILM; 82.4%), unsatisfactory (5.9%), atypical squamous cells of undetermined significance (ASCUS; 5.9%), and low\u2010grade squamous intraepithelial lesion (5.9%). The Pap smears of the atrophic cisgender cohort (102 patients) revealed the following: NILM (92.5%), unsatisfactory (0.9%), ASCUS (5.6%), and high\u2010grade squamous intraepithelial lesion (0.9%). The difference between the rates of epithelial cell abnormality in the 2 cohorts was not statistically significant. Although atrophy was noted in both groups, cytomorphologic findings of transitional cell metaplasia (TCM; 88.2%) and \u201csmall cells\u201d (82.4%) were characteristic of the testosterone\u2010treated transgender cohort. Histologic correlates of TCM and small cells were noted in hysterectomy specimens from 6 patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Small cells and TCM are common cytomorphologic findings in Pap smears of testosterone\u2010treated transgender (FTM) patients. On the basis of histologic follow\u2010up, small cells most likely represent atrophic parabasal cells of cervical\u2010vaginal epithelium.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cncy.22259","type":"journal-article","created":{"date-parts":[[2020,3,3]],"date-time":"2020-03-03T09:21:15Z","timestamp":1583227275000},"page":"491-498","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":34,"title":["Cytomorphologic findings of cervical Pap smears from female\u2010to\u2010male transgender patients on testosterone therapy"],"prefix":"10.1002","volume":"128","author":[{"given":"Michael P.A.","family":"Williams","sequence":"first","affiliation":[{"name":"Department of Pathology Upstate Medical University, State University of New York Syracuse New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vinita","family":"Kukkar","sequence":"additional","affiliation":[{"name":"Department of Pathology Upstate Medical University, State University of New York Syracuse New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa N.","family":"Stemmer","sequence":"additional","affiliation":[{"name":"Department of Pathology Upstate Medical University, State University of New York Syracuse New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1219-3658","authenticated-orcid":false,"given":"Kamal K.","family":"Khurana","sequence":"additional","affiliation":[{"name":"Department of Pathology Upstate Medical University, State University of New York Syracuse New York"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,3,3]]},"reference":[{"key":"e_1_2_8_2_1","volume-title":"How Many Adults Identify as Transgender in the United States?","author":"Flores AR","year":"2016"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1159\/000087751"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-12-292"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.14712\/18059694.2018.31"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2004.03.022"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e31823ed1c1"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1080\/15532730903439484"},{"key":"e_1_2_8_9_1","first-page":"365","volume-title":"Fenway Guide to Lesbian, Gay, Bisexual, and Transgender Health","author":"Feldman J","year":"2008"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-013-2753-1"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/cyt.12525"},{"issue":"1","key":"e_1_2_8_12_1","first-page":"183A","article-title":"The effects of androgen therapy on female genital tract","volume":"18","author":"Folkes LV","year":"2005","journal-title":"Mod Pathol"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2559.1986.tb02520.x"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0339(199803)18:3<222::AID-DC12>3.0.CO;2-M"},{"key":"e_1_2_8_15_1","doi-asserted-by":"crossref","first-page":"1047","DOI":"10.5858\/2001-125-1047-TSBCDA","article-title":"The small blue cell dilemma associated with tamoxifen therapy","volume":"25","author":"Yang YJ","year":"2001","journal-title":"Arch Pathol Lab Med"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(20010225)93:1<23::AID-CNCR9003>3.0.CO;2-F"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1210\/endo-24-3-339"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/00004347-199704000-00001"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000478-199705000-00002"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.10722"},{"key":"e_1_2_8_21_1","first-page":"122","volume-title":"The Art and Science of Cytopathology: Exfoliative Cytology","author":"DeMay RM","year":"1996"}],"container-title":["Cancer Cytopathology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fcncy.22259","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cncy.22259","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/cncy.22259","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/acsjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cncy.22259","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T20:39:02Z","timestamp":1760301542000},"score":1,"resource":{"primary":{"URL":"https:\/\/acsjournals.onlinelibrary.wiley.com\/doi\/10.1002\/cncy.22259"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,3,3]]},"references-count":20,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2020,7]]}},"alternative-id":["10.1002\/cncy.22259"],"URL":"https:\/\/doi.org\/10.1002\/cncy.22259","archive":["Portico"],"relation":{},"ISSN":["1934-662X","1934-6638"],"issn-type":[{"value":"1934-662X","type":"print"},{"value":"1934-6638","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,3,3]]},"assertion":[{"value":"2019-12-06","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-02-10","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-03-03","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}