Significance of Mitotic Activity in Post-Menopausal Atrophic Smears
U Kapur, T Kologinczak, G Staerkel. Loyola University Medical Center, Maywood, IL; MD Anderson Cancer Center, Houston, TX
Background: Dysplasia can be difficult to discern in some atrophic gynecologic smears. Crowded sheets of cells with enlarged, hyperchromatic nuclei can be seen in both dysplastic lesions and atrophy. The presence of mitotic figures in dysplastic smears has been suggested as a discriminating feature. The aim of this study was to determine the value of mitotic activity in identifying dysplasia in post-menopausal atrophic smears.
Design: Liquid based Pap tests obtained from post-menopausal women from 2002 were examined for the presence of atrophy, syncytial cell groups and mitotic activity. Clinical history and pathology records, from 2002 2007, were reviewed for dysplasia or malignancy for those patients whose Pap test showed mitotic activity. Similar information was collected for a subset of 14 post-menopausal patients with a Pap test without mitotic activity (control group). The patient's HPV status, previous history of malignancy and use of hormonal therapy were also recorded.
Results: The average age for this group of patients was 64.6 years (range, 46-85 years). 206 Pap tests showed syncytial cell groups. Twelve of these Pap tests showed the presence of mitotic figures. HPV was negative in the 9 patients who were tested. There were seven patients with a history of breast cancer, one each with endometrial carcinoma and CIN 3, and three with no history of malignancy. Four of the 12 patients had received Tamoxifen and 1 patient was on hormone replacement therapy. None of the 12 patients have developed dysplasia or malignancy at the time of last follow-up. In the control group, HPV was positive in 1 out of the 4 patients who were tested. None of the control group patients received hormonal therapy and other follow-up was negative.
Conclusions: 1. Mitotic figures can be seen in post-menopausal atrophic smears in the absence of dysplasia. 2. Mitoses alone cannot be taken as evidence of dysplasia in atrophic smears. 3. Mitotic activity may be related to hormone therapy in at least a subset of patients.
Monday, March 9, 2009 9:30 AM
Poster Session I Stowell-Orbison/Autopsy Award # 61, Monday Morning