No abstract

Fine-needle aspiration (FNA) of uterine adnexal cysts and masses is not an uncommon procedure, since it helps in planning surgery for adnexal lesions. This case is a rare insight into a dilemma encountered in the interpretation of fine-needle aspirates from a uterine adnexal cyst, when the needle entered an unintended target, despite it being an intraoperative aspiration, and the pathologist is unaware of the error. Therefore, this article portrays an example of a diagnostic trap in fine-needle aspirates from para-ovarian cysts or masses.A 32-year-old Iranian lady presented to the emergency with lower abdominal pain with referred pain to the shoulder, and vaginal spotting. Her LMP was 6 weeks prior to the date of presentation at the clinic. Ultrasonography confirmed a diagnosis of left tubal ectopic pregnancy. The b-hCG level was 18 934 IU/ml. She was posted for an emergency salpingectomy. Intraoperatively, a uterine adnexal cyst was discovered that was not reported radiologically. The cyst was aspirated and the fluid was sent to cytology.The history that accompanied the sample read "Aspirate from paraovarian cyst." Smears were prepared and stained with Wright Giemsa and Papanicolaou stains. Cytological examination revealed a highly cellular aspirate consisting of numerous complex, branching papillary structures compatible with chorionic villi (Figure 1A,B). The villi showed central mesenchymal, cellular myxoid, and spindle stroma surrounded by trophoblastic cells (Figure 2). Adherent as well as detached from the mesenchymal stroma were numerous clusters and sheets of trophoblastic cells.