Clear-cell adenocarcinoma of the female genital tract: Presence of Hyaline stroma and tigroid background in various types of cytologic specimens

Abstract

Hyaline basement membrane-like stromal material and tigroid background are distinctive cytologic features observed in Diff-Quik (DQ)- or Giemsa-stained smears of clear-cell adenocarcinoma (CCA) of the female genital tract. However, it is uncertain how often these features are present in different types of cytologic specimens, and which type of preparation is optimal for this diagnosis. We therefore reviewed the cytologic features of CCA in three types of specimens, including 15 scrape cytology specimens, 7 fine-needle aspiration (FNA) specimens, and 15 peritoneal cytology specimens, with emphasis on the features observed in DQ-stained smears. The cell morphology in scrape cytology specimens and FNA specimens was comparable, whereas in peritoneal cytology specimens, the cytoplasm was better preserved. Most tumor cells had fragile cytoplasm containing variable amounts of fine vacuoles, and round nuclei with distinct or prominent nucleoli. Hyaline stroma was present in 93% of scrape cytology specimens, 71% of FNA specimens, and 80% of peritoneal cytology specimens. Tigroid background was observed in 47% of scrape cytology specimens, 43% of FNA specimens, but in none of the peritoneal cytology specimens. Formation of a tigroid background may be prevented by the abundant fluid content in peritoneal cytology specimens. Hyaline stroma and tigroid background were uncommonly seen in scrape smears from other types of primary ovarian tumors, mainly juvenile granulosa cell tumor and yolk sac tumor. However, the additional presence of papillary structures allows CCA to be readily distinguished from these other tumors. We propose that scrape cytology offers the best approach for the intraoperative cytologic diagnosis of CCA.

An Ovarian Tumor With Small Cell Pattern at Intraoperative Assessment

“…Finally, the extracellular hyaline material evident on the smear preparations would be an unusual finding in most ovarian epithelial neoplasms with the possible exception of clear cell carcinoma. 23,24 In our experience, the intraoperative diagnosis of ovarian clear cell carcinoma can present particular difficulty, 25 but the neoplastic cells generally are large, and cytologic material from clear cell carcinomas usually demonstrates 3-dimensional Braspberry[ bodies, a glycogen-rich background, and high-grade nuclei, features that were not identified in the current case. Anecdotally, however, we have also encountered metachromatic hyalinelike material in intraoperative cytologic preparations from other rare epithelial tumors including cases of corded and hyaline endometrioid adenocarcinoma and adenoid cysticlike carcinoma of the ovary.…”

Value of cytology in the intraoperative assessment of ovarian tumors

“…It is recognized that the accurate intraoperative diagnosis of ovarian clear cell carcinomas can be particularly problematic because these tumors exhibit a wide variety of histological patterns that can mimic other primary and secondary ovarian tumors. 28 It has been suggested that cytological preparations may be particularly helpful in the diagnosis of these tumors, notably in highlighting their characteristic hyaline stroma, 29,30 but this feature was not seen in all of the cases in this study. Not surprisingly, rare ovarian tumors also caused greater difficulty in the intraoperative setting and these sometimes elicited a nonspecific or differential diagnosis.…”

Intraoperative Assessment of Clear Cell Carcinoma of the Ovary

“…Interestingly, recent cytological studies have also emphasized the diagnostic value of hyaline stromal change in CCC because this has distinctive metachromatic appearances in air-dried preparations. Therefore, cytology smears or imprints may be a useful adjunct to frozensection diagnosis in the intraoperative assessment of CCC and other ovarian tumors (36,37).…”