10
Endometrial Lesions, Unusual Tumors, and Extrauterine Cancer
Fig. 10.29 Serous adenocarcinoma of the endometrium. LBC ThinPrep
Papanicolaou x HP. The abnormal features of these large nuclei and a mitosis
can be discerned in this thin fragment.
Fig. 10.31 Serous adenocarcinoma of the endometrium. LBC ThinPrep
Papanicolaou x HP. At the periphery of this dense fragment large atypical
nuclei with a prominent nucleolus can be seen. Note the absence of any
diathesis.
Fig. 10.30 Atypical endometrial cells. LBC SurePath Papanicolaou x HP.
Note large cellular fragment with three-dimensional appearance; the central
area shows many overlapping nuclei.
endometrioid adenocarcinoma may not be distinguishable
from metaplastic or squamous cells derived from the cervix.
The cellular aggregates in some cases of serous adenocarcinoma
are papillary in form, which may be solidly epithelial, or have
a central fibrovascular core (Fig. 10.33). These papillae may be
difficult to detect since they are often present as compact balls
with peripheral moulding (Fig. 10.25, 10.27). Psammoma bod-
ies may be present, but are not specific for this histologic type of
carcinoma (Fig. 10.34).
Although clear cell adenocarcinomas are quite distinctive in
histologic sections, in cytologic specimens they present as a high-
grade adenocarcinoma with enlarged nuclei containing macro-
and multiple nucleoli. Their distinctive clear cytoplasm found
in histologic preparations is not evident in cytologic material
because alcohol fixation does not wash out the glycogen in the
cytoplasm as does formalin fixation (Figs. 10.35, 10.36).
Table 10.9 Differences between endometrial and endocervical
adenocarcinoma
Cellular
Endometrial
Endocervical
characteristics
adenocarcinoma
adenocarcinoma
Cellularity
+
++++
Cell size
++
+++
Nuclear size
++
+++
Columnar shapes
+
++++
Eosinophilia
++
++++
Cyanophilia
++++
++
Granular cytoplasm
+
++++
Vacuolated cytoplasm
++++
+
Multiple nucleoli
+
+++
Macronucleoli
+
+++
Chromatin
Irregular and finely
Finely to coarsely
granular
granular
Architecture
Loose clusters
Strips, sheets
Tight cell balls
Rosettes and masses
Modified acini
Adapted from Ng,
Diagnostic Cytology,
2nd edn.76
Key features of endometrial carcinoma in CV cytology
• NECs late in the menstrual cycle of a premenopausal
woman, or in a postmenopausal woman;
• Scanty number of abnormal endometrial cells:
- Single and aggregates;
- Nuclei varying from slightly larger to frankly malig-
nant;
- Cytoplasmic vacuolar changes; and
- Subtle, watery diathesis.
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