New observations on the significance of nipplelike protrusions in the nuclei of endocervical cells

Nuclear nippling was noted in the endocervical columnar cells in smears taken from women of child-bearing age who were using a progesterone-only contraceptive. The phenomenon occurred most consistently in smears from women who were amenorrheic, a condition indicative of a marked decrease of estrogen activity. These observations do not support the previous explanations linking nuclear nippling to estrogenic stimulation. Close observation of the progress of these nuclear protrusions showed that they represented an arrested attempt at nuclear division, with the inhibition possibly due to the rapid rise of the progestogen level, which may be caused either by the use of progesterone-only contraceptives or by the onset of ovulation. The presence of nuclear nippling in normal smears may thus establish the occurrence of ovulation; its observation in metastatic tumors should indicate that the primary tumor has a columnar cell component.