Nuclear features in endometrial cytology: Comparison of endometrial glandular and stromal breakdown and endometrioid adenocarcinoma grade 1

Abstract

This study was to clarify the nuclear features of "condensed clusters of stromal cells (EGBD-stromal cells)" and "metaplastic clumps with irregular protrusions (EGBD-metaplastic cells)" which may be recognized in endometrial glandular and stromal breakdown (EGBD) cases in liquid-based cytologic (LBC) preparations of endometrial brushings. The material consists of cytologic smears of 20 cases of proliferative endometrium (PE), 20 cases of EGBD, and 20 cases of endometrioid adenocarcinoma grade 1 (G1) for which histopathological diagnosis was obtained by endometrial curettage. Nuclear findings were examined in PE cells, EGBD-stromal cells, EGBD-metaplastic cells, and G1 cells, respectively. It was examined about the following items: (1) Nuclear shape; (2) A long/minor axis ratio in cell nuclei; (3) An area of cell nuclei; (4) Overlapping nuclei; (5) The distribution pattern of nuclei within cell clusters. The following observations were made: (1) In PE cells, round-oval nuclei appeared to predominate, overlapping nuclei were not observed, and a slightly abnormal distribution pattern of nuclei was recorded; (2) In EGBD-stromal cells, reniform nuclei were characteristically observed, nuclei had small size and a generally elongated appearance, overlapping nuclei were recognized, and a remarkable abnormal distribution pattern of nuclei was found; (3) In EGBD-metaplastic cells, spindle nuclei were a characteristic feature, nuclei were larger in size and had a bipolar appearance, overlapping nuclei with moderately abnormal distribution pattern of nuclei were identified; (4) In G1 cells round-oval nuclei predominated, overlapping nuclei with moderately abnormal distribution pattern of nuclei were found. The study demonstrates that the analysis of selected nuclear findings appears to be very useful in the cytopathological assessment of endometrial lesions in LBC samples, especially for the discrimination of EGBD and G1.

Nuclear characteristics of the endometrial cytology: Liquid‐based versus conventional preparation

“…The degenerated stromal cells and the metaplastic change of an EGBD cause that may simulate the cancer cells were leading to difficulty in cytological interpretation. We reported nuclear findings of cell clumps in EGBD (“condensed cluster of stromal cells” and “metaplastic clumps with irregular protrusion”) and endometrioid adenocarcinoma grade1 (G1) in our current study,13 because it seemed that a grasp of detailed nuclear findings was indispensable for the establishment of an accurate LBC diagnosis in addition to criteria of cytoarchitecture.…”

“…The following features were observed and recorded Nuclear shapeWith relation to the nuclear shape, 50 cells in one clump were classified in type 3 as round‐oval, spindle, and reniform,13 using objective lens 40×. Five clumps from each case were examined, and the frequency of nuclear shape of the 250 cells was calculated. A long/minor axis ratio in cell nucleiWith relation to the long axis and minor axis, 50 cells in one clump were measured by using image analysis software HANAKO (Just Systems Inc., Tokyo, Japan).…”

The Role of Liquid-Based Preparation in the Evaluation of Endometrial Cytology

“…The following discriminating nuclear features were further defined: (1) in CCSC of EGBD, the nuclei were characteristically small, of reniform or spindled shape, nuclear chromatin tended to be hyperchromatic, overlapping nuclei with nuclear crowding and the derangement of nuclear distribution were frequently found; (2) in MCIP of EGBD, larger, spindle-shaped nuclei are characteristic, with overlapping nuclei with nuclear crowding and the derangement of nuclear distribution; (3) concerning the clumps of cancer cells (CCC) in G1, round-oval nuclei appear to predominate, overlapping nuclei with nuclear crowding and the derangement of nuclear distribution are recognized [56,57]. …”

A Diagnostic Approach to Endometrial Cytology by Means of Liquid-Based Preparations

“…Light Green Bodies [46] In the CSC or background, "light green bodies": that is, light green amorphous substance blocks with patchy granular or fibrillary staining pattern may also be observed (seemingly fibrin clots). [6,47] MCIP to and CSC in LBCs may cause differential diagnostic problems with adenocarcinoma. The following discriminating nuclear findings should be highlighted: while nuclei are either reniform or spindle shaped and hyperchromatic in CSC and MCIP, atypical round nuclei appear to predominate in "clusters of cancer cells (CCC)" of G1 EAC.…”