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Case 1

View the images and select the correct diagnosis from the list below.

​Sweat the small stuff?

Pap smear taken from a 35-year old woman, day 25:

Image1 

Image2 

Image3 

Image4 

Select the correct diagnosis:

You answered: Endometrial cells
Sorry, that is INCORRECT


The correct diagnosis is: Small cell carcinoma


CYTOPATHOLOGY:

  • The smear contains numerous groups of loosely cohesive aggregates of small cells with scant cytoplasm.
  • The nuclei are hyperchromatic and angular. Nuclear molding is evident.
  • The cytologic features suggest small cell carcinoma.

DISCUSSION:

  • Small cell carcinoma is a highly aggressive tumour of neuroendocrine differentiation strongly associated with HPV types 18 and 16.
  • The routine cervical smear is a relatively insensitive and nonspecific method of detecting small cell carcinoma. The specific diagnosis on cervical smears is difficult. Small cell carcinoma can mimic follicular cervicitis, endometrial cells, endocervical adenocarcinoma, squamous cell carcinoma of small cell type, and non-Hodgkin's lymphoma. Suspicion should prompt an urgent biopsy to establish the diagnosis and initiate prompt treatment.
  • Biopsies reveal tumours composed of densely packed small to intermediate sized cells with scant cytoplasm, oval to spindle shaped, hyperchromatic nuclei and usually indistinct nucleoli. Mitoses and apoptotic nuclear debris are frequent.

BACK TO IMAGES 


HISTOLOGY


REFERENCES:

Bonfiglio TA, Erozan YS. Gynecologic Cytopathology. Philadelphia: Lipincott-Raven 1997:145.

Zhou, C.Hayes, M. M.; Clement, P. B.; Thomson, T. A. Small cell carcinoma of the uterine cervix: cytologic findings in 13 cases Cancer Cytopathology 1998,85(5), 281-8.

You answered: Marked squamous dyskaryosis
Sorry, that is INCORRECT


The correct diagnosis is: Small cell carcinoma


CYTOPATHOLOGY:

  • The smear contains numerous groups of loosely cohesive aggregates of small cells with scant cytoplasm.
  • The nuclei are hyperchromatic and angular. Nuclear molding is evident.
  • The cytologic features suggest small cell carcinoma.

DISCUSSION:

  • Small cell carcinoma is a highly aggressive tumour of neuroendocrine differentiation strongly associated with HPV types 18 and 16.
  • The routine cervical smear is a relatively insensitive and nonspecific method of detecting small cell carcinoma. The specific diagnosis on cervical smears is difficult. Small cell carcinoma can mimic follicular cervicitis, endometrial cells, endocervical adenocarcinoma, squamous cell carcinoma of small cell type, and non-Hodgkin's lymphoma. Suspicion should prompt an urgent biopsy to establish the diagnosis and initiate prompt treatment
  • Biopsies reveal tumours composed of densely packed small to intermediate sized cells with scant cytoplasm, oval to spindle shaped, hyperchromatic nuclei and usually indistinct nucleoli. Mitoses and apoptotic nuclear debris are frequent.

BACK TO IMAGES


HISTOLOGY


REFERENCES:

Bonfiglio TA, Erozan YS. Gynecologic Cytopathology. Philadelphia: Lipincott-Raven 1997:145

Zhou, C.Hayes, M. M.; Clement, P. B.; Thomson, T. A. Small cell carcinoma of the uterine cervix: cytologic findings in 13 cases Cancer Cytopathology 1998,85(5), 281-8. 

You answered: Small cell carcinoma
That is CORRECT!!


CYTOPATHOLOGY:

  • The smear contains numerous groups of loosely cohesive aggregates of small cells with scant cytoplasm.
  • The nuclei are hyperchromatic and angular. Nuclear molding is evident.
  • The cytologic features suggest small cell carcinoma.

DISCUSSION:

  • Small cell carcinoma is a highly aggressive tumour of neuroendocrine differentiation strongly associated with HPV types 18 and 16.
  • The routine cervical smear is a relatively insensitive and nonspecific method of detecting small cell carcinoma. The specific diagnosis on cervical smears is difficult. Small cell carcinoma can mimic follicular cervicitis, endometrial cells, endocervical adenocarcinoma, squamous cell carcinoma of small cell type, and non-Hodgkin's lymphoma. Suspicion should prompt an urgent biopsy to establish the diagnosis and initiate prompt treatment
  • Biopsies reveal tumours composed of densely packed small to intermediate sized cells with scant cytoplasm, oval to spindle shaped, hyperchromatic nuclei and usually indistinct nucleoli. Mitoses and apoptotic nuclear debris are frequent.

BACK TO IMAGES


HISTOLOGY


REFERENCES:

Bonfiglio TA, Erozan YS. Gynecologic Cytopathology. Philadelphia: Lipincott-Raven 1997:145

Zhou, C.Hayes, M. M.; Clement, P. B.; Thomson, T. A. Small cell carcinoma of the uterine cervix: cytologic findings in 13 cases Cancer Cytopathology 1998,85(5), 281-8. 

You answered: Endocervical Adenocarcinoma
Sorry, that is INCORRECT


The correct diagnosis is: Small cell carcinoma


CYTOPATHOLOGY:

  • The smear contains numerous groups of loosely cohesive aggregates of small cells with scant cytoplasm.
  • The nuclei are hyperchromatic and angular. Nuclear molding is evident.
  • The cytologic features suggest small cell carcinoma.

DISCUSSION:

  • Small cell carcinoma is a highly aggressive tumour of neuroendocrine differentiation strongly associated with HPV types 18 and 16.
  • The routine cervical smear is a relatively insensitive and nonspecific method of detecting small cell carcinoma. The specific diagnosis on cervical smears is difficult. Small cell carcinoma can mimic follicular cervicitis, endometrial cells, endocervical adenocarcinoma, squamous cell carcinoma of small cell type, and non-Hodgkin's lymphoma. Suspicion should prompt an urgent biopsy to establish the diagnosis and initiate prompt treatment
  • Biopsies reveal tumours composed of densely packed small to intermediate sized cells with scant cytoplasm, oval to spindle shaped, hyperchromatic nuclei and usually indistinct nucleoli. Mitoses and apoptotic nuclear debris are frequent.

BACK TO IMAGES


HISTOLOGY


REFERENCES:

Bonfiglio TA, Erozan YS. Gynecologic Cytopathology. Philadelphia: Lipincott-Raven 1997:145

Zhou, C.Hayes, M. M.; Clement, P. B.; Thomson, T. A. Small cell carcinoma of the uterine cervix: cytologic findings in 13 cases Cancer Cytopathology 1998,85(5), 281-8.

 

  

 
 

From the Cytopathology files of the BC Cancer Agency
Submitted by: Brenda Smith, BSc and Tom Thomson, MD

 

SOURCE: Case 1 ( )
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