Endometrial Cells in Liquid-Based Cervical Cytology: A Diagnostic Pitfall Solved by Preparing Cytohistology from the Residual Thin Layer Sample

• Published in: Acta cytologica Vol. 55; no. 4; pp. 327 - 333
• Main Authors: Risse, E.K.J., Ouwerkerk-Noordam, E., Boon, M.E.
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland Karger 01-01-2011
• Subjects: Adenocarcinoma - diagnosis; Biological and medical sciences; Biomarkers, Tumor - metabolism; Carcinoma in Situ - diagnosis; Carcinoma, Squamous Cell - diagnosis; Cytodiagnosis; Cytological Techniques; Diagnosis, Differential; Endometrial Neoplasms - diagnosis; Endometrium - pathology; Female; Gynecologic Cytopathology; Humans; Immunoenzyme Techniques; Investigative techniques, diagnostic techniques (general aspects); Medical sciences; Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques; Prognosis; Stromal Cells - pathology; Uterine Cervical Neoplasms - diagnosis; Vaginal Smears; Cytohistology; Immunohistochemistry; Normal endometrium; Liquid-based cervical cytology; Normal; Layer; Liquid based cytology; Anatomic pathology; Uterus; Female genital system; Diagnosis; Cell; Endometrium
• ISSN: 0001-5547; 1938-2650
• DOI: 10.1159/000327525

Objective: It was our aim to assess the usefulness of cytohistology in cervical thin layer brush samples with problems in the differential diagnosis of endometrial cells. Study Design: This study reveals the cytological, cytohistological and immunohistochemistry findings of 8 cases suspicious of adenocarcinoma in situ (AIS)/adenocarcinoma (AC) in cervical liquid-based cytology (LBC) preparations that turned out to be normal endometrial cells. Results: All 8 cervical LBCs featured endometrial and atypical endocervical-like columnar cells with frequent ragged ‘feathered’ edge appearance and rosette formations. Overlapping atypical glandular cell groups were present on 2 ThinPrep slides as well. In cytohistology of 7 cases, the recognition of endometrial stroma with endometrial glands easily allowed the diagnosis of normal endometrium. In 1 case with very small loose tissue fragments without glands, the diagnosis could be established by positivity for CD10 marker (endometrial stroma) and without proliferative activity in the Ki-67 immunostaining. Conclusion: In cervical LBC preparations, nuclear hyperchromasia, pleomorphism and nucleoli in normal endometrial cells are more obvious than in conventional smears, and their arrangement is sometimes suggestive of AIS or AC. In the 8 cases presented, we could avoid a false-positive diagnosis of AIS or AC through cytohistology/immunohistochemistry, and in consequence, unnecessary colposcopical/histological examination.