10
Endometrial Lesions, Unusual Tumors, and Extrauterine Cancer
Fig. 10.20 Secretory endometrium. Direct endometrial sampling
(Papanicolaou x LP). The cellular fragments may show either tubal or sheet
patterns.
of irregular uterine bleeding. In the postmenopausal woman,
polyps present as postmenopausal bleeding. Tamoxifen therapy
is now known to be strongly associated with the development
of polyps. Benign endometrial polyps often erode and break-
down, producing exfoliated and degenerated cells even in the
absence of symptoms. Such exfoliation is evident in cervicovagi-
nal specimens, usually as normal-appearing endometrial cells
(Table 10.7), but also as atypical endometrial cells (Table 10.8).
A number of inflammatory and regenerative conditions of the
endometrium, other than benign endometrial polyps, may be
the origin for "atypical endometrial cells" in both exfoliative and
direct sampling cytology.65,73 Endometrial nuclear atypia has been
identified in the early stages of proliferation, intrauterine device
(IUD) use, and endometritis.74 In some cases the only satisfactory
explanation for apparent atypical endometrial cells may reside in
cervical microglandular hyperplasia and tubal metaplasia.65
Women on tamoxifen therapy for breast carcinoma are at
increased risk of developing endometrial carcinoma, especially
if its use is extended beyond five years. This compound has a
partial estrogenic effect on the genital tract. Consequently, the
maturation index of tamoxifen-treated women is increased.75
There are no special cytologic features of these tamoxifen-
associated endometrial carcinomas. However, endometrial cells
Fig. 10.21 Secretory endometrium. Direct endometrial sampling
(Papanicolaou x HP). Note the honeycomb pattern and increased amount
of cytoplasm relative to that of proliferative endometrium.
Table 10.8 Conditions associated with the presence of atypical
endometrial cells in exfoliative cervicovaginal cytology
specimens
Endometrial adenocarcinoma
Atypical endometrial hyperplasia
Gestational endometrium (Arias-Stella phenomenon)—postpartum and
-abortal
Benign endometrial polyps
Post-radiation
Endometritis
are more often found in cervicovaginal cytology specimens from
women on tamoxifen who have developed endometrial cancer
than in women without endometrial carcinoma, regardless of
a history of tamoxifen therapy.75 The detection of endometrial
cells in this clinical situation requires further evaluation.
Endometrial Hyperplasia and CV Cytology
Endometrial hyperplasia occurs when the endometrium has
excessive proliferative activity resulting in a histology that
contrasts with the normal proliferative phase appearance of
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