PART TWO
Diagnostic Cytology
Fig. 12.7 Corpus luteum cyst. The nuclear chromatin is finer
and cytoplasm is more ample than in the follicle cyst. Aspiration
(Papanicolaou x HP).
Fig. 12.8 Serous cystadenoma. Small, uniform columnar cells appearing
in a honeycomb configuration. Cilia are seen at top left. A few macrophages
are present at top center. Aspiration (Papanicolaou x HP).
• Stromal cells, if present, may be confused with ovarian
fibroblast-like stromal cells; and
• Endometriotic cyst occurs in a hemorrhagic background.
Neoplastic Cysts
Benign Epithelial Cyst
Benign epithelial cysts
may be of serous or mucinous types. The
epithelial cell lining in
serous cystadenomas
recapitulates the mor-
phology of the fallopian lining. In cyst fluid, these cells appear as
small fragments of columnar epithelial cells with small, round,
bland nuclei and clear cytoplasm (Fig. 12.8). Cell borders may
not be well defined, depending on the cellular preservation. The
presence of cilia is a helpful diagnostic clue. Psammoma bodies
are rarely seen. Most of the cellular material, however, consists
of macrophages and scattered lymphocytes. Serous cells, when
they are present, tend to be few in number. The background
is clean. Cytologically, the findings may be indistinguishable
from
serous cystadenofibroma, epithelial inclusion cysts, parovarian
Fig. 12.9 Mucinous cystadenoma. A fragment of bland columnar cells
with abundant mucinous cytoplasm. Their nuclei are oriented basally.
Aspiration (Papanicolaou x HP).
cysts,60
or rarely hydrosalpinx. Bland spindle cells, presumably
fibroblasts, may be seen occasionally in cystadenofibromas54
and in serous cystadenomas.60 It is important to emphasize that
the epithelial component of serous cystadenomas may harbor
nuclear atypia severe enough to arouse concerns regarding
borderline or frank malignant change.61
Key features of benign serous tumors
• Sparse cellularity, primarily histiocytes,
• Fragments of columnar epithelium, ideally with cilia;
• Degeneration may preclude identification of cilia;
• Psammoma bodies rarely present;
• Clean background; and
• Serous cystadenoma, cystadenofibroma, epithelial
inclusion cyst, and hydrosalpinx cytologically
indistinguishable.
Benign Mucinous Tumor
In the
mucinous cystadenoma
, the epithelial component recapitu-
lates that of the endocervix and produces abundant mucin. The
mucinous cells are columnar, with small, round, bland nuclei,
and lack cilia (Fig. 12.9). Mucin is commonly seen in the back-
ground of appropriately prepared cytologic material.
The
borderline and malignant epithelial tumors
that may have
cystic features are generally of serous, mucinous, or endometri-
oid types. Depending on the degree of differentiation, it may be
difficult to distinguish one epithelial type from another cytologi-
cally.34 Indeed, distinguishing borderline (atypically proliferat-
ing) from frank serous carcinoma, particularly well-differentiated
tumors, is generally not possible by cytology alone.54,60,62 Nuclear
features of malignancy, including hyperchromasia, anisonu-
cleosis, prominent nucleoli, and irregular nuclear borders, are
present in most adenocarcinomas, although mucinous adeno-
carcinoma can sometimes be deceptively bland. In
serous tumors,
papillary groups, psammoma bodies, and clear to basophilic
granular cytoplasm with rare vacuoles are the cytologic hall-
marks. In
mucinous tumors,
extracellular mucin, intracytoplasmic
vacuoles, and a foamy cytoplasm can be helpful cytologic clues
to the diagnosis.
Endometrioid carcinomas
generally lack these dif-
ferentiating characteristics; however, there are areas of overlap.
Some endometrioid carcinomas show cytoplasmic vacuoles or
even psammoma bodies. It is important to emphasize that cyst
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