Langerhans cell histiocytosis in lymph nodes – cytomorphological diagnosis and pitfalls

Abstract

Background It is a well‐known fact that when an invasive cervical carcinoma is sampled, the smear may exclusively contain blood and no diagnostic cells. We analysed a series of 77 smears of 46 patients who developed squamous cell carcinoma to detect in this series unsatisfactory cervical smears rich in blood and to define their macroscopical features. Materials and Methods All patients who developed squamous cell carcinoma in the Dordrecht region were retrieved and all preceding smears were evaluated light microscopically and with neural network technology to detect abnormal cells. The nine smears containing no diagnosable epithelial cells (neither normal or abnormal) were chosen for this study. The macroscopic features and light microscopic characteristics of the smear background (clean, inflammatory pattern, fresh blood, old blood, fibrin and necrosis) were classified. Results All nine unsatisfactory cervical smears were bloody, often showing a characteristic curdled pattern. Fibrin and lysed blood were seen in the background of the nine smears and can be considered as hall marks of cancer growth. Conclusion Light microscopically, both old and fresh blood were present in thick clumps explaining the curdled macroscopical pattern of the nine smears. The mean period between the unsatisfactory cervical smear rich in blood and the final diagnosis was less than 6 months. We conclude that women with such bloody smears should immediately be sent to the gynaecologist for a histological investigation.