ThinPrep Pap test of endocervical adenocarcinoma with lymph node metastasis: Report of a case in a 17‐year‐old woman

Abstract

Endocervical adenocarcinoma is an uncommon malignancy that is composed of multiple subtypes and accounts for approximately 15% of all cervical cancers. In this article, we describe the cytomorphology and differential diagnosis of an AJCC clinical stage IIIb, FIGO IB2 endocervical adenocarcinoma in a 17-year-old woman in a ThinPrep Pap test.The patient was a 17-year-old G0P0 white woman with no significant past medical history and no prior history of cervical dysplasia. She presented to her physician with a putrid vaginal discharge. A sample was sent to cytology that was interpreted as atypical endocervical cells, favor neoplasia. A subsequent cervical biopsy was diagnosed as endocervical adenocarcinoma with villoglandular features and ultimately, a hysterectomy with lymph node dissection was performed. The final diagnosis was endocervical adenocarcinoma with metastasis to three pelvic lymph nodes.The cytomorphology of endocervical adenocarcinoma on ThinPrep Pap test is similar to that described for conventionally-processed Pap smears. This difficult diagnosis should be considered on a ThinPrep Pap test, regardless of age when the characteristic cytomorphology is observed. On a cytology sample, it is advisable to state atypical endocervical cells, adenocarcinoma in situ, or endocervical adenocarcinoma without providing a specific subtype even if there is a predominance of features for a particular subtype.

Liquid-Based Cytology of Villoglandular Adenocarcinoma of the Cervix: A Report of 3 Cases

“…However, as the nuclear details are better preserved on LBC specimens compared to conventional smears, important nuclear changes including nuclear membrane irregularities and prominent nucleoli can be appreciated better, facilitating the diagnosis of this well-differentiated type of adenocarcinoma by cytology. Prominent nucleoli and thick nuclear membranes have also been described by Wagner et al12 in their LBC (ThinPrep)-based case report.…”

“…There are only a few reports to date describing the cytologic features of VGA; most reports are descriptions of conventional smears,8-11 and one other recent case report has described the ThinPrep LBC findings of an "endocervical adenocarcinoma with villoglandular features. "12 We report for the first time the SurePath™ LBC findings of VGA.…”

“…The differential diagnoses of VGA encompass reactive endocervical cells, tubal metaplasia, adenocarcinoma in situ , squamous dysplasia involving the endocervical glands, and other types of cervical adenocarcinomas, such as serous papillary carcinomas 8-12. Although the lack of obvious cytologic atypia may lead to the underdiagnosis of VGA, the presence of architectural abnormalities such as papillary fragments and nuclear crowding and overlapping are helpful clues to suspect the possibility of this tumor, and the presence of nuclear membrane irregularities and prominent nucleoli on LBC preparations also suggest the possibility of adenocarcinoma.…”

“…Histologically, VGA is characterized by an exophytic growth with long and slender papillary structures and mild nuclear atypia, and the cytologic features of this tumor have been described to be relatively bland-looking compared to conventional adenocarcinomas, potentially leading to an underdiagnosis of reactive cellular changes 8-11. Moreover, the cytologic findings of VGA have been reported in only a few reports,8-11 and to our knowledge, there is only one case report to date describing the liquid-based cytology (LBC) features of an endocervical adenocarcinoma with villoglandular features 12. We report herein the LBC (SurePath™, TriPath Care Technologies, Burlington, NC, USA) findings of three histologically confirmed VGAs which we have recently encountered.…”

High grade endometrial stromal sarcoma on thinprep

“…“Comet cells” with eccentrically placed nuclei and tapered cytoplasm and “bare” nuclei have also been described. In comparison to CS, TP usually displays sharper nuclear detail and more prominent nucleoli due to immediate liquid fixation . In our case, although, the background, architectural and cytoplasmic characteristics of the CS and TP were comparable; the cells were smaller, clusters were more fragmented and nuclear detail was attenuated on the TP due to darker smudged chromatin.…”