View the images and select the correct diagnosis from the list below.
Select the correct diagnosis:
You answered: Endocervical adenocarcinoma.
Sorry, that is incorrect.
The correct diagnosis is: Endometrial adenocarcinoma.
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.
- 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-differentiated 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 tumour) 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
- Gray, W. & McKee, G.T. (2003).
Diagnostic Cytopathology second edition. Churchill Livingstone 833-836.
- Kurman, R.J., Zaino, R.J. & Norris, H.J. (1994). Endometrial carcinoma.
Pathology of the Female Genital Tract fourth edition, pages 439-446. Springer-Verlag.
- Silverberg, S.G. & Kurman, R.J. (1991). Tumors of the Uterine Corpus and Gestational Trophoblastic Disease, Atlas of Tumor Pathology. 3rd series. 47-64.
You answered: Tubal metaplasia.
Sorry, that is incorrect.
The correct diagnosis is: Endometrial adenocarcinoma.
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.
- 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-differentiated 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 tumour) 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
- Gray, W. & McKee, G.T. (2003).
Diagnostic Cytopathology second edition. Churchill Livingstone 833-836.
- Kurman, R.J., Zaino, R.J. & Norris, H.J. (1994). Endometrial carcinoma.
Pathology of the Female Genital Tract fourth edition, pages 439-446. Springer-Verlag.
- Silverberg, S.G. & Kurman, R.J. (1991). Tumors of the Uterine Corpus and Gestational Trophoblastic Disease, Atlas of Tumor Pathology. 3rd series. 47-64.
You answered: Endometrial adenocarcinoma.
That is correct.
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.
- 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-differentiated 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 tumour) 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
- Gray, W. & McKee, G.T. (2003).
Diagnostic Cytopathology second edition. Churchill Livingstone 833-836.
- Kurman, R.J., Zaino, R.J. & Norris, H.J. (1994). Endometrial carcinoma.
Pathology of the Female Genital Tract fourth edition, pages 439-446. Springer-Verlag.
- Silverberg, S.G. & Kurman, R.J. (1991). Tumors of the Uterine Corpus and Gestational Trophoblastic Disease, Atlas of Tumor Pathology. 3rd series. 47-64.
You answered: High-grade squamous intra-epithelial lesion.
Sorry, that is incorrect.
The correct diagnosis is: Endometrial adenocarcinoma.
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.
- 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-differentiated 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 tumour) 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
- Gray, W. & McKee, G.T. (2003).
Diagnostic Cytopathology second edition. Churchill Livingstone 833-836.
- Kurman, R.J., Zaino, R.J. & Norris, H.J. (1994). Endometrial carcinoma.
Pathology of the Female Genital Tract fourth edition, pages 439-446. Springer-Verlag.
- Silverberg, S.G. & Kurman, R.J. (1991). Tumors of the Uterine Corpus and Gestational Trophoblastic Disease, Atlas of Tumor Pathology. 3rd series. 47-64.
From the cytopathology files of BC Cancer.
Submitted by: Alicia Sabarre, BSc and Roger Amy, MD.
