Is It Possible To Differentiate Endometrial Serous Carcinoma from Endometrioid Type in Liquid-Based Preparation? A Cytomorphologic Study
Reda S Saad, Ahmed F Shehata, Jan F Silverman, Nadia Ismiil, Zeina Ghorab. Sunnybrook Health Sciences Centre, Toronto, Canada; Allegheny General Hospital, Pittsburgh
Background: Although the Pap smear is not a sensitive screening test for endometrial cancer, positive Pap smear may be the first presentation in these patients. The objective of this study is to characterize the cytomorphologic features of endometrial serous carcinoma in Pap smears. In addition, we correlate the Pap smears findings with stage of the disease and other histologic prognostic predictors.
Design: The pathology files were searched for the time period 2001 to present, for cases of adenocarcinoma of endometrial origin in Pap smears, for which there was tissue diagnosis available. All cases were reviewed for nuclear, cytoplasmic, background and architecture features. In addition, thirty randomly selected cases of preoperative negative Pap smears in patients with serous carcinoma were included as control group.
Results: There were a total of 90 cases of Liquid-based preparation Pap smears with the diagnosis of adenocarcinoma, endometrial origin, without further classification. Histologically, 40 cases turn to be serous carcinoma and 50 cases of endometrioid carcinoma. In serous group, the average age was 68 years; while in endometrioid group was 59 years. In serous group, positive Pap smears strongly correlated with lymphovascular invasion (35/40, 88%; P< 0.001), lower uterine segment (33/40, 83%; P< 0.001) and cervical involvement (27/40, 68%; P< 0.01); in comparison to negative cytology group (6/30, 20%; 8/30, 27%; and 5/30, 17%; respectively). Regarding the endometrioid group, cervical involvement was seen in 12/50 (24%), lower uterine segment in 15/50 (30%), lymphovascular invasion in 34/50 (68%). High grade endometrioid carcinoma was seen in 18/50 (36%), and low grade in 32/50 (64%). The presence of foamy macrophages in the background, low grade nuclei with spindle cell features and presence of foamy cytoplasm (mucin) are features correlated with endometrioid diagnosis. On the other hand, the presence of micropapillary architecture (rosette/acinar formation), with hob-nail nuclei, prominent nucleoli, dense cytoplasm and multinucleated cells are features consistent with serous carcinoma.
Conclusions: In our study, both serous and endometrioid carcinomas have different cytologic features in liquid based preparation. Patients with endometrial serous carcinoma who have malignant cytology detected by preoperative cervical cytology are at increased risk of having known poor prognostic factors such cervical involvement, presence of lymphovascular invasion and high stage tumor.
Category: Gynecologic & Obstetrics
Wednesday, March 21, 2012 1:00 PM
Poster Session VI # 200, Wednesday Afternoon