Glandular Cells in Vaginal Smears from Posthysterectomy Patients

Origin, Frequency and Clinical Significance of Glandular Cells in Liquid-Based Pap Tests from Patients Posthysterectomy

“…The most plausible hypothesis is a metaplasia related to therapy. A majority of studies 4,7,8,12,13 found an association with prior malignancy (Table VII). This association may purely be incidental because posthysterectomy patients with a history of malignancy undergo more rigorous examination and follow-up.…”

“…One factor contributing to this discrepancy is the lack of established morphologic criteria for the definition of glandular cells. Some reports have utilized strict criteria, 4,10,12 defining true glandular cells as gobletshaped columnar cells with foamy/granular cytoplasm, often containing apical mucin with eccentrically placed nuclei. Other reports have employed broader definitions, identifying glandular cells based on their resemblance to columnar squamous metaplastic cells, or a hybrid of both parabasal/endocervical cells.…”

“…In that study, alcian blue-PAS and mucicarmine stains demonstrate the presence of mucin by the goblet-like cells, with a frequency of 19% for the detection of glandular cells in posthysterectomy patients, a rate much higher than other studies. 4,8,9,12,13 Because that study failed to exclude patients with intact uteri, it is impossible to rule out the origin of some cells from the cervix or upper gynecologic tract. Sodhani et al 9 identified 14 smears with columnar cells and squamous metaplastic cells in women who underwent hysterectomy for benign disease.…”

“…Our findings are similar to results reported in the litera-ture, with benign glandular cells being present in ~2% of posthysterectomy conventional vaginal smears. 4,8,12,13 CK7 in conjunction with alcian blue-PAS and mucicarmine enabled us to evaluate the hybrid-type cells and identify the true glandular cells among them. When in doubt, it is not necessary to use these 3 stains to establish a diagnosis of glandular cells.…”

Vaginal adenosis in a patient on Tamoxifen therapy: a case report

“…Glandular cells seen in post‐hysterectomy vaginal vault smears are rare, although hysterectomy is a relatively common surgical procedure. A recent review of glandular cells in smears from patients who had undergone total hysterectomy showed only 16 such cases in a period of 4.5 years 8 , a total of 91 000 cervical or vaginal smears having been examined by that laboratory during the same period. Glandular cells may show one of three patterns: (i) long bipolar cells in sheets, (ii) goblet type cells with eccentric nuclei, and (iii) tight clusters of small round cells.…”