Techniques of Endometrial Cytology

Jiménez-Ayala, Matías; Portillo, Beatriz Jiménez-Ayala

doi:10.1159/000117468

Cited by 2 publications

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“…Endometrial cytology has been used in diagnosis and triage of various endometrial lesions, including carcinomas . Various techniques for collecting endometrial cell samples include endometrial aspiration with the help of canula, cell sampler, Pipelle ® device, “vakutage” device and Vabra aspiration; endometrial washing and endometrial brushing using Medhosa, Mi‐mark, Endobrush, and Endopap methods . While endometrial adenocarcinoma was correctly identified in most studies on endometrial cytology, a substantial challenge was observed in the diagnosis of endometrial hyperplasia.…”

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Complex papillary hyperplasia of the endometrium: An uncommon case report with cytopathological features and diagnostic implications

Rekhi

Menon

Maheshwari

2014

Diagnostic Cytopathology

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Papillary proliferations of the endometrium, without atypia have been uncommonly documented, including on cytology specimens. Herein, we present an uncommon case of a 55-year-old obese lady, on antihypertensive medications, who presented with history of irregular perimenopausal bleeding. A year ago, she was diagnosed with simple cystic hyperplasia on dilation and curettage specimen. Presently, she underwent endometrial aspiration. Cytology smears were prepared from the collected tissue specimen that was further submitted for histopathological analysis. Although the smears were initially diagnosed as negative for malignancy, the tissue sections were reported as a uterine papillary serous carcinoma (UPSC). Review of the smears revealed prominent overlapping clusters and papillary arrangements of relatively banal endometrial cells exhibiting focal metaplasia. Histopathology sections confirmed diagnosis of complex papillary hyperplasia (CPH). Immunohistochemical (IHC) stains reinforced this impression with diffuse estrogen receptor positivity, low Ki-67/MIB1, and lack of diffuse p53 immunostaining. Subsequent hysterectomy, at the time of intraoperative consultation showed a small residual focus of CPH, restricted to endometrium with intramural leiomyomas and adenomyosis. This case is presented to highlight the fact that despite lack of significant atypia, cytological features like overlapping, clustering, and papillary formations are indicators of papillary lesions of the endometrium, including CPH, especially in postmenopausal women. On histopathology, in spite of conspicuous papillary formations, lack of significant nuclear pleomorphism, and tumor invasion are helpful features in avoiding an overdiagnosis of UPSC in such cases. IHC stains are supportive. Correct identification has significant therapeutic implications.

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confidence: 99%