Diagnosis of endometriosis by fine‐needle aspiration cytology

Abstract

Endometriosis is a fairly common disease found in a variety of extrauterine locations. It primarily affects reproductive age women and has symptoms varying from occult to more specific complaints. Occasionally the lesions produce solid nodules and/or cysts that are clinically palpable and easily evaluated by fine needle aspiration (FNA). We describe three cases of endometriosis diagnosed by FNA. The patients ranged in age from 32 to 38 and reported cyclic symptoms of pain, bleeding, or change in mass size. Two patients presented with subcutaneous masses (one along the upper pubic ramus, the other in the lower abdomen) and had ultrasonically guided FNA. The third patient had a vaginal cuff mass sampled by transvaginal FNA. All cytologic smears contained characteristic sheets of epithelial cells and fragments of loosely arranged spindled stroma. One case also showed mild epithelial atypia and plump stromal cells. Hemosiderin-laden macrophages were found in only one case. The cytologic diagnoses were confirmed by tissue in all patients. Endometriotic nodules must be evaluated for possible malignant transformation and differentiated from other benign and malignant masses, especially when clinical symptoms are vague. FNA offers a safe and effective tool for identification of endometriosis and obviates the need for diagnostic surgical procedures in some patients.

Diagnosis of a Vulvar Granular Cell Tumor by Fine Needle Aspiration Biopsy

“…The cytologic features of endometrioma have been previously described. 21 These include background acute inflammation, hemosiderinladen macrophages and interspersed syncytial clusters of epithelial cells. Diagnostic material has been observed in smears and cell blocks.…”

The Adjunctive Value of CD10 Immunostaining on Cell Block Preparations in Pelvic Endometriosis

“…[6][7][8][9]12 Unless associated with cytologic atypia, diagnosis of endometriosis by fine needle aspiration is often uncomplicated. [14][15][16] In PE, the diagnosis can be challenging primarily due to the admixture of blood with pelvic washing samples, which may also contain other cellular elements, such as reactive mesothelial cells. These and other diagnostic pitfalls can be circumvented by supplementing the smears with cell block preparations and applying ICC.…”

Abdominal Wall Endometriosis

“…14 Metastatic carcinosarcoma is also in the differential diagnosis due to the presence of biphasic components (carcinoma and sarcoma); however, the presence of a high nuclear grade in both components excludes endometriosis. 2,15 …”

“…1 Most of the reported cases of abdominal wall endometriosis occur within surgical scars following gynecologic or obstetric operations, and a few spontaneous cases have been described. 1,2 It usually produces firm, palpable nodules that must be evaluated and differentiated from other benign and malignant abdominal wall tumors. Effective utilization of fine needle aspiration cytology can offer an accurate, cost-effective and safe preoperative diagnosis of endometriosis.…”