PART TWO
Diagnostic Cytology
Fig. 10.38 Simple endometrial hyperplasia. Direct endometrial
sampling (Papanicolaou x LP). Note the irregular dilatation and branching of
the gland. The glandular width may vary in size.
Unusual Uterine Tumors
Sarcomas of the Uterus
Sarcomas of the uterus may show differentiation recapitulating
a single tissue type (leiomyosarcoma, endometrial stromal sar-
coma), or a mixture of both mesenchymal and epithelial ele-
ments (see Table 10.1). Carcinosarcoma, or malignant mixed
mullerian tumor, is composed of both malignant mesenchyme
(sarcoma)
and malignant epithelium
(carcinoma), usually
adenocarcinoma. There is considerable evidence to suggest
that carcinosarcomas are actually carcinomas that have under-
gone spindle cell or sarcomatous differentiation, rather than
originating from both tissue types.87,88 From this perspective
carcinosarcomas are really very poorly differentiated carcino-
mas, rather than true sarcomas.
Both the detection and cytomorphology of uterine sarcomas
are dependent upon the type of sarcoma. Low-grade endometrial
stromal sarcomas frequently do not involve a mucosal surface,
and may not be detectable by exfoliative cytology. Furthermore,
the small neoplastic cells of these sarcomas have no or minimal
cytologic atypia and may not be distinguishable for normal stro-
mal fragments and cells.89 In contrast, most leiomyosarcomas
Fig. 10.39 Endometrial complex hyperplasia with cytologic atypia.
Direct endometrial sampling (Papanicoloau x LP). This cellular fragment
shows one pattern of atypical hyperplasia—a cell clump with a dilated and
branching pattern.
and carcinosarcomas exhibit marked cytologic atypia with easily
identifiable malignant criteria, provided that the sample con-
tains the cells of concern.
About half of uterine carcinosarcomas will exhibit malignant
or atypical findings on conventional cytology specimens.90,91 A
precise cytodiagnosis of carcinosarcoma is rarely made, how-
ever, since a dual malignant cell population is often not present
or appreciated. Usually the cytologic diagnosis rendered is ade-
nocarcinoma or carcinoma only, and the definitive classification
of the tumor is made only upon histologic examination of the
uterus. Abnormal cytologic findings on conventional cytology
are more common in women with cervical involvement by
carcinosarcoma. Accordingly, these abnormal cytologic findings
are an indicator of adverse prognosis.90,91
Lymphomas and Leukemias
Involvement of the female genital tract by hematopoietic neo-
plasms is uncommon. Only 1.5% of extranodal lymphomas
involve the genital tract, most commonly the ovaries. Primary
cervical lymphoma is a rare occurrence likely accounting for
less than 0.5% of extranodal lymphomas.92 Secondary involve-
ment of the genital tract by disseminated nodal lymphomas may
occur in up to 40% of cases although direct cytologic diagnosis is
rarely made.93 Leukemic infiltrates in the cervix may be common
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