PART TWO
Diagnostic Cytology
Fig. 10.11 Normal-appearing endometrial cell ball. LBC ThinPrep
Papanicolaou x HP from a 51-year-old woman. Note dense stromal core and
epithelium (arrows). Numerous apoptotic bodies and neutrophils are present.
Fig. 10.12 Normal-appearing endometrial cells. LBC ThinPrep
Papanicolaou x HP, from a 21-year-old woman. Note the tightly packed
arrangement, bean-shaped nuclei, and small amount of cytoplasm.
Key features of normal endometrial cells in CV cytology
• Condensed stromal cells are surrounded by paler
epithelial cells ("exodus balls");
• Closely packed epithelial cells have small hyperchro-
matic nuclei;
• Nuclear molding with variation in shape and size and
apoptotic bodies may be noted;
• Cytoplasm is usually scant, small vacuoles and
engulfed neutrophils can be seen; and
• In liquid-based preparations, endometrial cells groups
are more closely packed and the nuclei may appear
bean-shaped with greater pleomorphism and with
nucleoli evident.
Endometrial cell groups may be directly abraded from the
lower uterine segment with vigorous use of devices intended
to sample the endocervical canal (Fig. 10.14). Their presence
Fig. 10.13 Normal-appearing endometrial cells. LBC ThinPrep
Papanicolaou x HP from a reproductive-age woman. Note the overlapping
nuclei, minimal cytoplasm, and some nuclear grooving. Some nuclear
pleomorphism is often evident in LBC (arrow).
Fig. 10.14 Lower uterine segment fragment. Conventional
cervicovaginal specimen (Papanicolaou x MP). The fragment is cellular but
has a bland cytology likely due to endocervical brush retrieval.
can be mistaken for more significant disease. These groups
can be differentiated when intact tubular glands that may
demonstrate branching are present and attached portions
of dense stroma are present43-45 (Fig. 10.15). These cells are
often well preserved and demonstrate more uniformity of
size and shape. The finding of mitoses in endometrial cells
abraded during the proliferative phase should not be taken as
an indicator of abnormality.45 On occasion, endometrial cells
may acquire tubal or serous characteristics with prominent
ciliated borders (Fig. 10.16).
Key features of normal endometrial cells in direct
cytology
• Intact tubular glands with branching and attached
portions of dense stroma; and
• Cells are have uniform size and shape and mitoses
may present.
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