PART TWO
Diagnostic Cytology
Fig. 10.25 Endometrial adenocarcinoma, endometrioid type.
LBC SurePath Papanicolaou x HP. In this sample the adenocarcinoma
presents in a single cell pattern. Follow-up biopsy yielded an endometrioid
adenocarcinoma of the endometrium.
Fig. 10.27 Endometrial adenocarcinoma, endometrioid type. LBC
SurePath Papanicolaou x HP, from a postmenopausal woman. Note the cell
moulding, nuclear pyknosis, and neutrophilic infiltration.
Fig. 10.26 Atypical glandular cells, favor endometrial origin. LBC,
ThinPrep Papanicolaou x HP. A small cluster of cells with striking nuclear
abnormality. Follow-up biopsy showed a FIGO 2/3 endometrioid carcinoma.
Fig. 10.28 Endometrial adenocarcinoma, endometrioid type.
LBC SurePath Papanicolaou x HP. In this large LBC fragment the three-
dimensional appearance is evident and nuclear features can only be
discerned at the periphery. Follow-up biopsy did show an endometrial
adenocarcinoma of endometrioid type.
to be distinguished from the cells of endometrial adenocarci-
noma. Reactive endocervical cells are larger, and tend to present
in aggregates and sheets. These large cells usually have abundant
cytoplasm, and the nuclear/cytoplasmic ratio is low. Degenerative
vacuolar changes in parabasal and metaplastic cells also need to
be recognized. These vacuoles may push the nucleus aside, and
simulate endometrial cells. Such cells may occur in the presence
of an IUD. These cells usually retain some characteristic dense-
staining cytoplasm, and their nuclei lack malignant features.
On occasion, cytologic features may indicate the histo-
logic type of endometrial adenocarcinoma. Most mucinous
adenocarcinomas, being well differentiated, have acytologic
presentation indistinguishable from the common endome-
trioid adenocarcinoma, but occasionally, cytoplasmic vacuoles
containing homogeneous, pale material may still be evident, in
contrast to the degenerative vacuoles usually seen in abnormal
endometrial cells. These cells may assume a signet ring appear-
ance. Although some mucinous adenocarcinoma produce abun-
dant extracellular mucin this production cannot reliably be
distinguished from that of the normal endocervix. The finding
of both malignant squamous and glandular components in a
specimen would suggest a poorly differentiated endometrioid
adenocarcinoma with squamous differentiation, but a cervical
origin should also be considered. The cytologic identification of
endometrioid adenocarcinomas with squamous differentiation
can rarely be made when features of both glandular and squa-
mous differentiation are evident in a single aggregate (Fig. 10.32).
However, the squamous component of a well-differentiated
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