Endometrial Lesions, Unusual Tumors, and Extrauterine Cancer
Fig. 10.42 Ovarian carcinoma, mixed serous and clear cell type. (LBC
ThinPrep Papanicolaou x HP).
localization of the primary extrauterine site of the tumor. There
are some features that may facilitate identification of a likely pri-
mary site. A distinctive papillary differentiation, with any associ-
ated psammoma body formation, should raise the possibility
of an ovarian (or primary peritoneal) origin. The presence of
psammoma bodies alone, however, is not an indicator of malig-
nancy; the formation of psammoma bodies is commonly seen
in association with benign mesothelial reactions, endosalpingi-
osis, and benign ovarian cystadenofibromas.106 The presence of
small bland-appearing epithelial cells107 or detached ciliary tufts
("ciliocytophthoria")108 clinging to psammoma bodies strongly
favors a benign origin. When malignant cells are arrayed in a lin-
ear, discohesive pattern, primary breast and gastric carcinomas
should be considered.
Not unexpectedly, direct endometrial sampling may also
detect ovarian carcinoma cells, possibly with higher sensitivity
than exfoliative cervicovaginal cytology.103
CV cytology has the ability to detect abnormalities beyond the
range of lesions that arise at the transformation zone of the cer-
vix, including uterine and extrauterine neoplasms. Although CV
cytology has had no or minimal impact on the incidence rates of
endometrial carcinoma, the recognition of normal and abnor-
mal endometrial cells can lead to the diagnosis of significant
endometrial disease. Furthermore, both normal and abnormal
endometrial cells need to be distinguished from cervical glan-
dular and squamous lesions. Direct endometrial cytologic sam-
pling may be of some value in some situations, but its limited
capability to detect architectural features restricts its diagnostic
potential and use. In the future molecular markers may expand
the diagnostic utility of CV cytology in detecting lesions from
the uterine cavity and extrauterine sources.
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268; discussion 268-271.