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Case 4

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

A subtle hint

Vaginal vault smear from an 85-year-old woman, total hysterectomy 7 years ago for malignancy

Image 1 

Image 2 

Image 3 

Image 4 

Select the correct diagnosis:

 

You answered: Non-keratinizing squamous cell carcinoma
 Sorry, that is INCORRECT 


The correct diagnosis is: Endometrial adenocarcinoma


CYTOPATHOLOGY:

  • The smear contains atypical cells with increased N/C ratio and hyperchromatic nuclei in loosely cohesive sheet and glandular-like groups. (Images 1,2)
  • The cells are enlarged and of variable size, with predominantly round to oval nuclei, and slightly irregular nuclear membranes.
  • The cytoplasm is wispy and indistinct.
  • A few of the groups of cells suggest acinar formation (Images 3,4)
  • The background contains atrophic squamous cells, inflammation and a watery diathesis
  • These cytologic features are suggestive of a recurrent endometrial adenocarcinoma

DISCUSSION:

  • The biopsy reveals malignant endometrial cells and atrophic squamous mucosa.
  • This tumour is positive for both cytokeratin and vimentin and is negative for CK20 (usually positive in colorectal carcinoma).
  • The sheets of tumour cells in the smear suggest squamous differentiation, but acinar formation within some groups and ill-defined cell borders are more consistent with a glandular lesion.
  • Malignant endometrial cells tend to have a more rounded nuclear shape, instead of the columnar shape of malignant endocervical cells.

BACK TO IMAGES


HISTOLOGY

 

REFERENCES:

Bonfiglio TA, Erozan YS.  Gynecologic Cytopathology. Philadelphia: Lipincott-Raven 1997: 138-139.

Kini SR. Color Atlas of Differential Diagnosis in Exfoliative and Aspiration Cytopathology. Baltimore: Williams & Wilkins 1999: 79-80.

DeMay RM. The Art & Science of Cytopathology. Chicago: ASCP Press, 1996: 126.

You answered: Atypical squamous cells, recommend stilbestrol 
Sorry, that is INCORRECT 


The correct diagnosis is: Endometrial adenocarcinoma


CYTOPATHOLOGY:

  • The smear contains atypical cells with increased N/C ratio and hyperchromatic nuclei in loosely cohesive sheet and glandular-like groups. (Images 1,2)
  • The cells are enlarged and of variable size, with predominantly round to oval nuclei, and slightly irregular nuclear membranes.
  • The cytoplasm is wispy and indistinct.
  • A few of the groups of cells suggest acinar formation. (Images 3,4)
  • The background contains atrophic squamous cells, inflammation and a watery diathesis.
  • These cytologic features are suggestive of a recurrent endometrial adenocarcinoma.

DISCUSSION:

  • The biopsy reveals malignant endometrial cells and atrophic squamous mucosa.
  • This tumour is positive for both cytokeratin and vimentin and is negative for CK20 (usually positive in colorectal carcinoma).
  • The sheets of tumour cells in the smear suggest squamous differentiation, but acinar formation within some groups and ill-defined cell borders are more consistent with a glandular lesion.
  • Malignant endometrial cells tend to have a more rounded nuclear shape, instead of the columnar shape of malignant endocervical cells.

BACK TO IMAGES


HISTOLOGY


REFERENCES:

Bonfiglio TA, Erozan YS. Gynecologic Cytopathology. Philadelphia: Lipincott-Raven 1997: 138-139.

Kini SR. Color Atlas of Differential Diagnosis in Exfoliative and Aspiration Cytopathology. Baltimore: Williams & Wilkins 1999: 79-80.

DeMay RM. The Art & Science of Cytopathology. Chicago: ASCP Press, 1996: 126.

You answered: Endocervical adenocarcinoma
Sorry, that is INCORRECT 


The correct diagnosis is: Endometrial adenocarcinoma


CYTOPATHOLOGY:

  • The smear contains atypical cells with increased N/C ratio and hyperchromatic nuclei in loosely cohesive sheet and glandular-like groups (Images 1,2)
  • The cells are enlarged and of variable size, with predominantly round to oval nuclei, and slightly irregular nuclear membranes
  • The cytoplasm is wispy and indistinct
  • A few of the groups of cells suggest acinar formation (Images 3,4)
  • The background contains atrophic squamous cells, inflammation and a watery diathesis
  • These cytologic features are suggestive of a recurrent endometrial adenocarcinoma

DISCUSSION:

  • The biopsy reveals malignant endometrial cells and atrophic squamous mucosa.
  • This tumour is positive for both cytokeratin and vimentin and is negative for CK20 (usually positive in colorectal carcinoma).
  • The sheets of tumour cells in the smear suggest squamous differentiation, but acinar formation within some groups and ill-defined cell borders are more consistent with a glandular lesion.
  • Malignant endometrial cells tend to have a more rounded nuclear shape, instead of the columnar shape of malignant endocervical cells.

BACK TO IMAGES


HISTOLOGY


REFERENCES:

Bonfiglio TA, Erozan YS.  Gynecologic Cytopathology. Philadelphia: Lipincott-Raven 1997: 138-139. 

Kini SR.  Color Atlas of Differential Diagnosis in Exfoliative and Aspiration Cytopathology. Baltimore: Williams & Wilkins 1999: 79-80.

DeMay RM. The Art & Science of Cytopathology. Chicago: ASCP Press, 1996: 126.

You answered: Endometrial adenocarcinoma       

That is CORRECT!! 


CYTOPATHOLOGY:

  • The smear contains atypical cells with increased N/C ratio and hyperchromatic nuclei in loosely cohesive sheet and glandular-like groups (Images 1,2)
  • The cells are enlarged and of variable size, with predominantly round to oval nuclei, and slightly irregular nuclear membranes
  • The cytoplasm is wispy and indistinct
  • A few of the groups of cells suggest acinar formation (Images 3,4)
  • The background contains atrophic squamous cells, inflammation and a watery diathesis
  • These cytologic features are suggestive of a recurrent endometrial adenocarcinoma

DISCUSSION:

  • The biopsy reveals malignant endometrial cells and atrophic squamous mucosa.
  • This tumour is positive for both cytokeratin and vimentin and is negative for CK20 (usually positive in colorectal carcinoma).
  • The sheets of tumour cells in the smear suggest squamous differentiation, but acinar formation within some groups and ill-defined cell borders are more consistent with a glandular lesion.
  • Malignant endometrial cells tend to have a more rounded nuclear shape, instead of the columnar shape of malignant endocervical cells.

BACK TO IMAGES


HISTOLOGY


REFERENCES:

Bonfiglio TA, Erozan YS.  Gynecologic Cytopathology. Philadelphia: Lipincott-Raven 1997: 138-139.

Kini SR. Color Atlas of Differential Diagnosis in Exfoliative and Aspiration Cytopathology. Baltimore: Williams & Wilkins 1999: 79-80.

DeMay RM. The Art & Science of Cytopathology. Chicago: ASCP Press, 1996: 126.

 

 
 
 

 

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

SOURCE: Case 4 ( )
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