Endometrial Adenocarcinoma in SurePath™ Cervical Samples: Cytological Features Revisited

Abstract

Objective: The cytomorphological criteria of malignant endometrial lesions in cervical samples are less well described than those of cervical lesions. We wished to investigate if there were features in SurePath™ liquid-based cytology samples that would facilitate more accurate differentiation between benign and malignant endometrial cells. Study Design: This was a two-phase study, with a review of all SurePath™ samples reported as endometrial adenocarcinoma (n = 42) evaluating 12 cytological features in the first phase. In phase 2 (test set), all initial cases plus an additional 83 cases were reviewed using these 12 cytological features to predict the outcome. Results: Out of 12 cytological features evaluated in phase 1 (training set), nuclear chromatin pattern, apoptotic bodies and tingible body macrophages were found to be the most significant features determining malignant histological outcome. These 12 cytological features were re-evaluated in phase 2 (n = 125). Of 125 cases, 54 had a benign and 71 had a malignant or premalignant histological outcome, with a positive predictive value of 56.8%. Conclusion: Granular nuclear chromatin, tingible body macrophages and apoptosis in the background are the most significant factors in determining whether endometrial cells present in cervical samples represent malignancy or are benign. Using these features, relatively accurate predictions of endometrial pathology can be made.

How useful are cervical Pap smears in detecting endometrial carcinomas? A tertiary cancer center experience

“…Type 2 EmCa show a higher positivity on cervical cytology in accordance with Serdy et al 13 These carcinomas are usually associated with high cellularity, 3‐D clusters or papillae show nuclear pleomorphism, irregularly distributed chromatin and macronucleoli 10‐13 . Hence, these carcinomas are easier to detect on cervical cytology.…”

“…A high sensitivity (72.7%) and specificity (100%) in detecting EmCa was obtained by Zhou et al 9 on using ThinPrep Test. A few studies have been conducted, noting importance of endometrial cells on SurePath samples 10‐12 showing variable sensitivity and specificity and positive predictive value (PPV) far lower than those for cervical lesions.…”

Keratinization in atypical glandular cell clusters as a cytological clue to endometrioid carcinoma on cervical cytology

“…22,23 In a case series described by Gupta et al, the authors have attributed the presence of background keratinized squamoid cells, in two cases of endometrioid carcinoma, to squamoid differentiation. 24 From the current cohort of cervical cytology in patients with histologically proven endometrioid endometrial carcinomas, seven cytology specimens with keratinization in AGC clusters were found. The keratinous material appears as orangeophilic, rigid and acellular fragments within clusters of AGCs or is associated with the AGCs among extracellular material (Figure 1D).…”

“…Over 70% of endometrial carcinomas are of endometrioid histology, 20,21 of which many show evidence of squamous differentiation with the formation of squamous morules and even frank squamous differentiation or keratinization 22,23 . In a case series described by Gupta et al., the authors have attributed the presence of background keratinized squamoid cells, in two cases of endometrioid carcinoma, to squamoid differentiation 24 . From the current cohort of cervical cytology in patients with histologically proven endometrioid endometrial carcinomas, seven cytology specimens with keratinization in AGC clusters were found.…”