Pelvic washing cytology in serous borderline tumors of the ovary using ThinPrep®: Are there cytologic clues to detecting tumor cells?

Abstract

The detection of tumor cells in pelvic washings of patients with serous borderline tumors of the ovary (SBT) remains a diagnostic challenge. Accurate diagnosis of pelvic washings is important in determining therapeutic regimens and assessing patient prognosis. No study has exclusively examined pelvic washing cytology of patients with SBT using only ThinPrep methodology. The purpose of this study is to examine whether cytologic clues exist in detecting tumor cells of SBT in pelvic washings processed with ThinPrep. Using previously established criteria, we reviewed the pelvic washes of 37 patients with SBT and correlated them with the histologic findings in the omentum. We also compared their cytoarchitectural features with pelvic washes in patients with benign ovarian disease and serous carcinoma. Cytoarchitectural features that achieved statistical significance in distinguishing cells of a SBT from reactive mesothelial cells include the following findings: presence of a two-cell population (P = 0.001), psammoma bodies (P = 0.001), cytoplasmic vacuolization (P = 0.001), smooth group contours (P = 0.004), nuclear size >2x neutrophils (P = 0.004), high nuclear-to-cytoplasmic (N/C) ratio (P = 0.004), absent intercellular windows (P = 0.007), and course nuclear chromatin (P = 0.032). Psammoma bodies were the only statistically significant feature distinguishing SBT from serous carcinoma, being more common in SBT than serous carcinoma (P = 0.035). The prominent number of associated psammoma bodies seen in the SBT group was a notable finding that may aid as a valuable cytologic clue in detecting tumor cells. Overall cellularity remains a source of false-negative diagnosis. Correlation with histologic findings remains crucial given our inability to reliably distinguish tumor cells of SBT from endosalpingiosis or serous adenocarcinoma.

Non‐gynecologic cytology on liquid‐based preparations: A morphologic review of facts and artifacts

“…C-1C). 21,25 In PW, SBT can be distinguished from reactive mesothelial cells by presence of two-cell population, absent intracellular windows, and the neoplas-tic features described above and distinguished from serous ca due to more prominent psammoma bodies. 25 A diagnosis of metastatic malignancy or mesothelioma in effusion requires confirmatory IC.…”

“…21,25 In PW, SBT can be distinguished from reactive mesothelial cells by presence of two-cell population, absent intracellular windows, and the neoplas-tic features described above and distinguished from serous ca due to more prominent psammoma bodies. 25 A diagnosis of metastatic malignancy or mesothelioma in effusion requires confirmatory IC. Use of LBP in effusion cytology have shown to be less time-consuming with a low falsenegative rate (FNR) and high diagnostic sensitivity (99%) for malignant and suspicious fluids compared with other preparatory techniques.…”

“…Use of LBP in effusion cytology have shown to be less time-consuming with a low falsenegative rate (FNR) and high diagnostic sensitivity (99%) for malignant and suspicious fluids compared with other preparatory techniques. 21,24,25 Urinary specimens. Urine cytology comprises the majority of routine non-gyn specimens evaluated in cytology laboratories.…”

Atypical papillary proliferation in gynecologic patients: A study of 32 pelvic washes

“…Most authors recommend caution in overinterpreting psammoma bodies because they can be seen in pelvic washes from endometriosis, endosalpingiosis, and other nonmalignant pelvic diseases. 5,18,19 Covell maintains that psammoma bodies are of no diagnostic significance. 4 However, in a recent study of pelvic-washing cytology in BSTO using liquid-based preparation, psammoma bodies were the only statistically significant feature distinguishing BSTO from serous carcinoma, being more common in the former.…”

Cytologic Findings of Psammocarcinoma in Peritoneal Washings

“…11 In another study, psammoma bodies in peritoneal washings were found to be the only statistically significant feature distinguishing serous borderline tumor from serous carcinoma, being more common in the former. 20 However, in order to qualify for a diagnosis of psammocarcinoma one needs to document innumerable psammoma bodies and a relative dearth of epithelial cells. According to Chen, the diagnosis of psammocarcinoma can only be suggested by cytologic features alone, as the presence or absence of an invasive pattern cannot be assessed in the cytologic specimens.…”