PART TWO
Diagnostic Cytology
Fig. 10.32 Endometrial adenocarcinoma, endometrioid type. LBC
SurePath Papanicolaou x HP. In this fragment, malignant endometrial cells
with intravacuolar neutrophils are evident (arrow), while a keratin pearl
indicating squamous differentiation is evident at the bottom. Follow-up
revealed an endometrioid adenocarcinoma with squamous differentiation of
the endometrium.
Fig. 10.34 Serous adenocarcinoma of the endometrium. Conventional
cervicovaginal specimen (Papanicolaou x HP). Note the psammoma body
within the malignant epithelial fragment.
Fig. 10.33 Serous adenocarcinoma of the endometrium. Conventional
cervicovaginal specimen (Papanicolaou x HP). Note the smooth borders of
the malignant papillae and the nuclear atypia.
Detection of Endometrial Disease by Direct
Endometrial Sampling
Benign Endometrial Disease in Direct Endometrial
Cytology
In the peri- and postmenopausal woman, abnormal uterine
bleeding can be associated with a number of benign conditions
including hormonal imbalance (dysfunctional uterine bleeding)
and atrophy. Direct endometrial sampling appears to be advanta-
geous in the diagnosis of atrophy as endometrial curettage often
does not provide an adequate sample.40 Atrophic endometrium
appears as loosely cohesive flat sheets or small cystically dilated
Fig. 10.35 Clear cell carcinoma of the endometrium. LBC SurePath
Papanicolaou x HP, from a postmenopausal woman. Although the malignant
nuclear features are evident, the distinctive clear cell features evident in a
histologic section are not apparent in this preparation.
glands lined by uniform cells without stratification. The nuclei
are monomorphic with smooth nuclear membranes and incon-
spicuous nucleoli.23 The stroma may be present as isolated
aggregates that are fibrous and often crushed.
A common cause of dysfunctional uterine bleeding in peri-
menopausal women is irregular cycles due to anovulation. The
resulting endometrium demonstrates disordered glands due to
prolonged proliferation and stromal breakdown occurs.79 The
recognition of anovulatory patterns is important as the changes
may mimic hyperplasia. With anovulation, fragmented clusters
of endometrial glands are associated with blood and fibrin.
These clusters also contain condensed stromal cells with mark-
edly hyperchromatic nuclei and little or no cytoplasm.79 Irregular
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