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Case 3

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

Birds of a feather

Pap smear taken from a 53-year old woman with abnormal bleeding

Image1 

Image2 

Image3 

Image4 

Select the correct diagnosis:

You answered: Endocervical adenocarcinoma
Sorry, that is INCORRECT 


The correct diagnosis is: Endometrial adenocarcinoma


CYTOPATHOLOGY:

Images 1-3

  • The smear shows loosely cohesive sheets of cells with nuclear overlapping and lack of polarity.
  • There are normal endocervical cells in the background, some ciliated and degenerated inflammatory cells.
  • The abnormal cells have granular cytoplasm, increased N/C ratio, nuclear irregularity in shape and size, hyperchromasia and irregularity in the nuclear outline with finely to coarsely granular chromatin.

Image 4

  • Two groups of loosely cohesive clusters are depicted, one forming an acini and the other showing lack of polarity, and gland cells with cilia in the background.
  • There is an increase in N/C ratio, pleomorphic nuclei with irregular nuclear outline, hyperchromasia and coarse chromatin pattern in the abnormal cells.
  • The biopsy showed endometrial adenocarcinoma of endometrioid type of mixed glandular and solid pattern, with 4mm deep stromal invasion of the endocervix.

DISCUSSION:

  • The majority of low-grade uterine carcinomas are endometrioid endometrial carcinomas but they can also exist as a high grade tumour.
  • Low-grade tumours (well-diffferentiated Grade 1) show a predominantly glandular or villoglandular growth pattern with slight nuclear enlargement and small nucleoli.
  • Moderately-differentiated endometrioid carcinomas (Grade 2) diverge from glandular or papillary to solid sheets of cells (6 – 50% of the tumor) and have enlarged nuclei relative to Grade 1 tumours but nuclear pleomorphism and chromatin clumping is less than a Grade 3 tumour.
  • High-grade tumours (Grade 3) show increased areas of solid growth with cells that are no longer recognizable as columnar, having more pleomorphic nuclei, prominent nucleoli and chromatin clumping.

BACK TO IMAGES


HISTOLOGY


REFERENCES:

Gray W, McKee GT. Diagnostic Cytopathology Second Edition. Churchill Livingstone 2003: 833-836.

Kurman RJ, Zaino RJ, Norris HJ.  Chapter 12: Endometrial Carcinoma. pages 439-446. IN: Kurman RJ. Blausteins Pathology of the Female Genital Tract Fourth Edition. Springer-Verlag. 1994.

Silverberg SG, Kurman RJ, Tumors of the Uterine Corpus and Gestational Trophoblastic Disease, Atlas of Tumor Pathology. 3rd series 1991: 47-64.

You answered: Tubal metaplasia
 Sorry, that is INCORRECT 


The correct diagnosis is: Endometrial adenocarcinoma


CYTOPATHOLOGY:

Images 1-3

  • The smear shows loosely cohesive sheets of cells with nuclear overlapping and lack of polarity.
  • There are normal endocervical cells in the background, some ciliated and degenerated inflammatory cells.
  • The abnormal cells have granular cytoplasm, increased N/C ratio, nuclear irregularity in shape and size, hyperchromasia and irregularity in the nuclear outline with finely to coarsely granular chromatin.

Image 4

  • Two groups of loosely cohesive clusters are depicted, one forming an acini and the other showing lack of polarity, and gland cells with cilia in the background.
  • There is an increase in N/C ratio, pleomorphic nuclei with irregular nuclear outline, hyperchromasia and coarse chromatin pattern in the abnormal cells.
  • The biopsy showed endometrial adenocarcinoma of endometrioid type of mixed glandular and solid pattern, with 4mm deep stromal invasion of the endocervix.

DISCUSSION:

  • The majority of low-grade uterine carcinomas are endometrioid endometrial carcinomas but they can also exist as a high grade tumour.
  • Low-grade tumours (well-diffferentiated Grade 1) show a predominantly glandular or villoglandular growth pattern with slight nuclear enlargement and small nucleoli.
  • Moderately-differentiated endometrioid carcinomas (Grade 2) diverge from glandular or papillary to solid sheets of cells (6 – 50% of the tumor) and have enlarged nuclei relative to Grade 1 tumours but nuclear pleomorphism and chromatin clumping is less than a Grade 3 tumour.
  • High-grade tumours (Grade 3) show increased areas of solid growth with cells that are no longer recognizable as columnar, having more pleomorphic nuclei, prominent nucleoli and chromatin clumping.

BACK TO IMAGES


HISTOLOGY


REFERENCES:

Gray W, McKee GT.  Diagnostic Cytopathology Second Edition. Churchill Livingstone 2003: 833-836.

Kurman RJ, Zaino RJ, Norris HJ.  Chapter 12: Endometrial Carcinoma. pages 439-446. IN: Kurman RJ. Blausteins Pathology of the Female Genital Tract Fourth Edition. Springer-Verlag. 1994.

Silverberg SG, Kurman RJ, . Tumors of the Uterine Corpus and Gestational Trophoblastic Disease, Atlas of Tumor Pathology. 3rd series 1991: 47-64.

You answered: Endometrial adenocarcinoma        

That is CORRECT!! 


CYTOPATHOLOGY:

Images 1-3

  • The smear shows loosely cohesive sheets of cells with nuclear overlapping and lack of polarity.
  • There are normal endocervical cells in the background, some ciliated and degenerated inflammatory cells.
  • The abnormal cells have granular cytoplasm, increased N/C ratio, nuclear irregularity in shape and size, hyperchromasia and irregularity in the nuclear outline with finely  to coarsely granular chromatin.

Image 4

  • Two groups of loosely cohesive clusters are depicted, one forming an acini and the other showing lack of polarity, and gland cells with cilia in the background.
  • There is an increase in N/C ratio, pleomorphic nuclei with irregular nuclear outline, hyperchromasia and coarse chromatin pattern in the abnormal cells.
  • The biopsy showed endometrial adenocarcinoma of endometrioid type of mixed glandular and solid pattern, with 4mm deep stromal invasion of the endocervix.

DISCUSSION:

  • The majority of low-grade uterine carcinomas are endometrioid endometrial carcinomas but they can also exist as a high grade tumour.
  • Low-grade tumours (well-diffferentiated Grade 1) show a predominantly glandular or villoglandular growth pattern with slight nuclear enlargement and small nucleoli.
  • Moderately-differentiated endometrioid carcinomas (Grade 2) diverge from glandular or papillary to solid sheets of cells (6 – 50% of the tumor) and have enlarged nuclei relative to Grade 1 tumours but nuclear pleomorphism and chromatin clumping is less than a Grade 3 tumour.
  • High-grade tumours (Grade 3) show increased areas of solid growth with cells that are no longer recognizable as columnar, having more pleomorphic nuclei, prominent nucleoli and chromatin clumping.

BACK TO IMAGES


HISTOLOGY


REFERENCES:

Gray W, McKee GT. Diagnostic Cytopathology Second Edition. Churchill Livingstone 2003: 833-836.

Kurman RJ, Zaino RJ, Norris HJ.  Chapter 12: Endometrial Carcinoma. pages 439-446. IN: Kurman RJ. Blausteins Pathology of the Female Genital Tract Fourth Edition. Springer-Verlag. 1994.

Silverberg SG, Kurman RJ, . Tumors of the Uterine Corpus and Gestational Trophoblastic Disease, Atlas of Tumor Pathology. 3rd series 1991: 47-64.


You answered: High-Grade Squamous intra-epithelial lesion
Sorry, that is INCORRECT 


The correct diagnosis is: Endometrial adenocarcinoma


CYTOPATHOLOGY:

Images 1-3

  • The smear shows loosely cohesive sheets of cells with nuclear overlapping and lack of polarity.
  • There are normal endocervical cells in the background, some ciliated and degenerated inflammatory cells.
  • The abnormal cells have granular cytoplasm, increased N/C ratio, nuclear irregularity in shape and size, hyperchromasia and irregularity in the nuclear outline with finely  to coarsely granular chromatin.

Image 4

  • Two groups of loosely cohesive clusters are depicted, one forming an acini and the other showing lack of polarity, and gland cells with cilia in the background.
  • There is an increase in N/C ratio, pleomorphic nuclei with irregular nuclear outline, hyperchromasia and coarse chromatin pattern in the abnormal cells.
  • The biopsy showed endometrial adenocarcinoma of endometrioid type of mixed glandular and solid pattern, with 4mm deep stromal invasion of the endocervix.

DISCUSSION:

  • The majority of low-grade uterine carcinomas are endometrioid endometrial carcinomas but they can also exist as a high grade tumour.
  • Low-grade tumours (well-diffferentiated Grade 1) show a predominantly glandular or villoglandular growth pattern with slight nuclear enlargement and small nucleoli.
  • Moderately-differentiated endometrioid carcinomas (Grade 2) diverge from glandular or papillary to solid sheets of cells (6 – 50% of the tumor) and have enlarged nuclei relative to Grade 1 tumours but nuclear pleomorphism and chromatin clumping is less than a Grade 3 tumour.
  • High-grade tumours (Grade 3) show increased areas of solid growth with cells that are no longer recognizable as columnar, having more pleomorphic nuclei, prominent nucleoli and chromatin clumping.

BACK TO IMAGES


HISTOLOGY


REFERENCES:

Gray W, McKee GT. Diagnostic Cytopathology Second Edition. Churchill Livingstone 2003: 833-836.

Kurman RJ, Zaino RJ, Norris HJ.  Chapter 12: Endometrial Carcinoma. pages 439-446. IN: Kurman RJ. Blausteins Pathology of the Female Genital Tract Fourth Edition. Springer-Verlag. 1994.

Silverberg SG, Kurman RJ, . Tumors of the Uterine Corpus and Gestational Trophoblastic Disease, Atlas of Tumor Pathology. 3rd series 1991: 47-64.

 

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From the Cytopathology files of the BC Cancer Agency

Submitted by: Alicia Sabarre, BSc and Roger Amy, MD

SOURCE: Case 3 ( )
Page printed: . Unofficial document if printed. Please refer to SOURCE for latest information.

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