PART TWO
Diagnostic Cytology
Fig. 10.19 Proliferative endometrium. Direct endometrial sampling
(Papanicolaou x MP). Note the orderly arrangement of the epithelial cells.
Fig. 10.18 Proliferative endometrium. Direct endometrial sampling
(Papanicolaou x LP). Note the straight and tubal endometrial gland with
cohesive stromal cells.
Cytomorphology of Direct Endometrial Sampling
The theoretical advantages of direct endometrial sampling over
exfoliative cytology include the retrieval of a greater number of
endometrial cells, a more representative sample, and the elimi-
nation of degeneration. For these reasons several techniques
for direct endometrial sampling have been developed.40,71 The
adequacy of any sample must be carefully assessed as it is not
always possible to pass the sampling device through a stenotic
cervix.40 Inadequate samples are usually hypocellular and
contain only exo- or endocervical cells.
With direct endometrial sampling, the appearance of benign
endometrium combines tubular glands and flat epithelial
sheets with uniform stroma.40,72 In proliferative phase, cohesive
sheets of cells and short segments of tubular glands are present
(Figs 10.18 and 10.19). The glands are lined by pseudostrati-
fied cells with ovoid nuclei and dense cytoplasm. There may
be nuclear overlap and mild to moderate nuclear variation
in size. The stroma appears homogeneous but can vary from
cellular to fibrous. The stromal cells are spindle-shaped with
indistinct cytoplasm and bland nuclei. Thin-walled blood
vessels are present in the background, which is otherwise clean.
The appearance of normal endometrium in the secretory
phase varies from early to late in a pattern that mimics the
well-defined histologic counterparts.72 In general, the glandular
cells take on a more spread-out honeycomb arrangement with
abundant cytoplasm and well-defined cell borders (Figs 10.20
and 10.21). Secretory vacuoles and clearing of the cytoplasm
may be noted in the early and mid-secretory phase. The nuclei
are rounded and nucleoli may become more apparent. The stro-
mal cells remain spindled but have more abundant cytoplasm.
Mucoid material is often present in the background. Predecidual
changes are noted in the late secretory phase with well-defined
dense cytoplasm and vesicular nuclei.
During the menstrual phase the background is bloody and
condensed, degenerated epithelial-stromal fragments mixed
with neutrophils and nuclear debris are present.72 Predecid-
ual cells may still be present in the background similar to the
exodus pattern noted in exfoliative cytology taken during the
menstrual phase.25
The Detection of Endometrial Abnormalities
Detection of endometrial Disease by cV cytology
Benign Endometrial Disease in CV Cytology
Benign endometrial polyps are a common finding in both pre-
and postmenopausal women. These endometrial polyps are not
true neoplasms, and are usually considered to be "functional" in
origin. Their constituent glands are usually inactive or atrophic in
type, but occasionally proliferative or secretory. In the premeno-
pausal woman these functional polyps may persist throughout
several or many menstrual cycles, and are a common source
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