You answered: Endometrial adenocarcinoma with squamous differentiation
Sorry, that is INCORRECT
The correct diagnosis is: Clear cell carcinoma of the endometrium
- The smear contains loosely cohesive sheets and single atypical cells that have abundant finely vacuolated, clear cytoplasm.
- In some groups, cells have a linear arrangement suggesting a glandular pattern.
- The nuclei are enlarged, eccentric in the cell, have smooth nuclear outlines and show some variation in size.
- The cytologic findings suggest clear cell adenocarcinoma.
- Squamous cell carcinoma would be expected to show cells with enlarged, hyperchromatic, pleomorphic nuclei and coarse, irregular chromatin.
- Given the history, reactive/radiation change may be a consideration. The smear does show a squamous component with mixed maturation, including many cells with benign atrophic changes and hyperkeratosis. Although vacuoles are common in radiation change, they usually involve both nucleus and cytoplasm, are degenerate in appearance and are associated with multinucleation and polychromatophilia.
- The endometrial curettings reveal malignant glands with a tubular pattern lined by deceptively bland cells with clear cytoplasms typical of clear cell adenocarcinoma.
- Although clear cell carcinoma often reveals cells with high grade nuclei, hobnail cells and intracytoplasmic hyaline globules, these are not seen in this case.
- Clear cell adenocarcinomas may have tubulocystic, papillary or solid growth patterns.
- Cell clearing is due to glycogen.
- Approximately 3-6% of endometrial carcinomas are clear cell carcinomas. Endometrioid endometrial adenocarcinoma and endometrial clear cell adenocarcinoma have similar clinical presentations, although the typical mean age is older in patients with clear cell carcinomas than with endometrioid carcinoma (67 vs. 59 years).
- Prior pelvic irradiation may be a contributing factor in the pathogenesis of clear cell adenocarcinoma.
BACK TO IMAGES
DeMay RM. The Art & Science of Cytopathology. Chicago: ASCP Press, 1996: 125-7.
Robboy SJ, Anderson MC, Russel P. Pathology of the Female Reproductive Tract. London: Churchill Livingstone, 2002: 348-9.
Clement PB, Young RH. Atlas of Gynecologic Surgical Pathology. Philadelphia: W.B. Saunders Company, 2000: 98-9, 314-17.