Atypical Glandular Cells from Endometrial Carcinomas: Can Tumor Associated Inflammation Help?
Charles J Bechert, Vicki J Schnadig, Ranjana S Nawgiri. Yale University School of Medicine, New Haven, CT; University of Texas Medical Branch, Galveston
Background: Endometrial cancers are the most common gynecologic cancers in the United States. Often a diagnosis of AGC (atypical glandular cells) on PAP cytology proceeds biopsy confirmation of endometrial adenocarcinoma. Previous reports have noted the association of neutrophils with endometrial carcinoma on cytologic or histologic examination. However, a number of benign conditions also may show numerous neutrophils, such as endometrial hyperplasia, polyps, acute endometritis, and metaplasias. Characterization of tumor associated inflammation on Pap smears has not previously been studied in detail.
Design: 30 Pap smears, with a diagnosis of AGC and biopsy confirmed endometrial adenocarcinoma (EAC) on histology, were selected for examination. All adenocarcinomas were endometrioid type. For comparison, negative control cases consisted of Pap smears with a diagnosis of AGC and that had a concurrent, representative, negative biopsy. Each Pap smear slide was carefully examined by 2 boarded cytopathologists in order to quantitate and characterize the full spectrum of associated inflammation including: neutrophils, lymphocytes, eosinophils, histiocytes as well as the presence of blood/fibrin. Location of cells as intracellular or extracellular was noted. Cells counts were based on 10 HPF at 60x magnification.
Results: Cases of AGC with biopsy proven EAC, showed glandular clusters with multiple (3+), engulfed neutrophils in 22 (76%) of cases; whereas, cases of AGC with representative, negative (NEG) biopsies showed multiple (3+), engulfed neutrophils in no (0%) of cases. Presence of rare (1-3) engulfed neutrophils was similar for both, being present in 14% of AGC/EAC cases and 12% of AGC/NEG cases. The presence of blood/fibrin and other types of inflammatory cells on Pap showed no significant correlation with type of lesion on histology.
Conclusions: Atypical glandular clusters with multiple (3+) intracellular, engulfed neutrophils had the strongest correlation with biopsy proven endometrioid adenocarcinoma. This may prove to be an additional aid in determining when to favor neoplasia on Pap smears with atypical glandular cells.
Tuesday, March 1, 2011 9:30 AM
Poster Session III # 89, Tuesday Morning