Positive endometrial cytology associated with primary gastric adenocarcinomas: clinical and cytopathologic findings in 16 patients

Abstract

Background. Routine endometrial cytology occasionally includes malignant cells of extra-genital origin. We carried out this study to examine both the clinical and the cytopathologic characteristics of patients with positive endometrial cytology associated with gastric cancer. Methods. Sixteen patients whose endometrial smears contained malignant cells derived from gastric adenocarcinoma were studied. The patients' clinical symptoms, clinical courses, and cytologic and pathological findings were analyzed. Results. Among the 16 patients, 5 showed positive endometrial cytology prior to the initial treatment of gastric cancer, but after its diagnosis; 8 patients were being examined for relapse of gastric cancer; and, in the remaining 3 patients, the endometrial cytology led to the diagnosis of gastric cancer. Eleven patients had some clinical signs or symptoms, including abnormal vaginal discharge. Two patients were positive for serum carcinoembryonic antigen (CEA), while carbohydrate antigen (CA)125 was positive in 5 patients. The histological types of the primary gastric lesions were poorly differentiated adenocarcinoma (including signet ring cell adenocarcinoma) in 14 patients, and moderately differentiated tubular adenocarcinoma in 2 patients. Signet ring cells were observed on endometrial cytology in 12 patients. Four patients showed tumor diathesis on the smears. Metastatic lesions in the uterus were histologically confirmed in 5 patients. All 16 patients died as a result of peritoneal carcinomatosis within 12 months of the positive endometrial smears. Conclusion.Examination of routine reproductive tract smears, especially endometrial cytology, presents gynecologists with the opportunity to identify patients with gastric adenocarcinoma cells in the uterus and/or peritoneal cavity.

Endometrial Scraping Cytology in Women with Extragenital Malignancies

“…3,9 However, few reports have been published on endometrial smears concerning extrauterine malignant cells, especially extragenital ones. [10][11][12][13][14] Endometrial aspiration cytology has been used in previous reports, [10][11][12][13][14] and the positive rate of extrauterine malignant cells is higher for endometrial aspiration smears than for cervical smears. 12,13 One of the routes by which extrauterine carcinoma cells move to the Endometrial scraping smears, because of their simplicity and accuracy, are useful for detecting extragenital malignant cells that enter the uterine cavity.…”

Endometrial Aspiration Cytology for Diagnosis of Peritoneal Lesions in Extrauterine Malignancies

“…Endometrial cytology is useful for assessing peritoneal lesions in patients with stomach cancer, as previously reported from our institute. 8 Of the 30 patients with stomach cancer, 7 had ovarian metastasis, which predominantly presented as Krukenberg's tumor in a narrow sense. However, endometrial aspiration cytology results were positive in only 1 (14.3%) of these patients.…”

“…[5][6][7] Furthermore, due to the sample collection technique, endometrial cytology reportedly facilitates early detection of peritoneal lesions such as stomach and breast cancers. 8,9 In the present study, we investigated the usefulness of endometrial aspiration cytology for assessing not only ovarian and fallopian tube cancers but also peritoneal lesions, including surgically treated breast and gastrointestinal malignancies. We then ascertained the characteristic cytologic findings of these cancers.…”