Clinical Information F69 Vaginal bleeding 3 weeks ago

Clinical Information • F/69 • Vaginal bleeding (3 weeks ago) • Liquid-Based Preparation

Cytologic Findings • Intermediate cellularity (atypical cells cellularity : low) • Clear background • Small loose clusters of atypical cells • Degenerative change of atypical cells • Large pleomorphic nuclei • Nuclear overlapping • Coarsening of the chromatin • Multiple prominent eosinophilic nucleoli • Abundant cytoplasm • Intracytoplasmic inflammatory cells

Cytologic Findings • No SIL • No koilocytosis • No keratinization • No diathesis • No glandular architecture of atypical cells

Differential Diagnosis Malignant non-squamous neoplasm Benign Squamous VS. Non-squamous Malignant

Differential Diagnosis Malignant non-squamous neoplasm • EPITHELIAL CELL ABNORMALITIES – GLANDULAR CELL • Atypical – endocervical cells – endometrial cells – glandular cells • Atypical – endocervical cells, favor neoplastic – glandular cells, favor neoplastic • Endocervical adenocarcinoma in situ • Adenocarcinoma – endocervical – endometrial – extrauterine – not otherwise spedified (NOS) • OTHER MALIGNANT NEOPLASMS The 2001 Bethesda System

Cellular characteristics Endocervical adenocarcinoma Endometrial adenocarcinoma Cellularity ++++ + Cell size +++ ++ Nuclear size +++ ++ Columnar shapes ++++ + Eosinophilia ++++ ++ Cyanophilia ++ ++++ Granular cytoplasm ++++ + Vacuolated cytoplasm + ++++ Multiple nucleoli +++ + Macronucleoli +++ + Chromatin Finely to coarsely granular Irregular and finely granular Architecture Strips, sheets Rosettes and masses Loose clusters Tight cell balls Modified acini M. Bibbo et al. , Comprehensive cytopathology, 3 rd ed. , p. 263

Cellular characteristics Endocervical adenocarcinoma Endometrial adenocarcinoma KCP-725 Cellularity ++++ + ++ Cell size +++ ++ +++ Nuclear size +++ ++ +++ Columnar shapes ++++ + + Eosinophilia ++++ ++ + Cyanophilia ++ ++++ Granular cytoplasm ++++ + +++ Vacuolated cytoplasm + ++++ ++ Multiple nucleoli +++ + +++ Macronucleoli +++ + ++++ Chromatin Finely to coarsely granular Irregular and finely granular Finely granular Architecture Strips, sheets Rosettes and masses Loose clusters Tight cell balls Modified acini Loose clusters M. Bibbo et al. , Comprehensive cytopathology, 3 rd ed. , p. 263

Differential Diagnosis Malignant non-squamous neoplasm Endocervical VS. Endometrial Low cellularity Intracytoplasmic Multiple nucleoli neutrophils Non-columnar shape Degenerative change Macronucleoli Cyanophilia Small loose clusters

Differential Diagnosis Malignant non-squamous neoplasm Endocervical VS. Endometrial Extrauterine etc. Clear background Metastasis ? Unusual cell type

WHO classification Uterine Cervix, Glandular tumors and precursors Endometrial carcinoma – Endometrioid adenocarcinoma – Adenocarcinoma, NOS – Mucinous adenocarcinoma • • • – – – Endocervical Intestinal Signet-ring cell Minimal deviation Villoglandular Endometrioid adenocarcinoma Clear cell adenocarcinoma Serous adenocarcinoma Mesonephric adenocarcinoma Early invasive adenocarcinoma Adenocarcinoma in situ • Variant with squamous differentiation • Villoglandular variant • Secretory variant • Ciliated cell variant – – – – Mucinous adenocarcinoma Serous adenocarcinoma Clear cell adenocarcinoma Mixed adenocarcinoma Squamous cell carcinoma Transitional cell carcinoma Small cell carcinoma Undifferentiated carcinoma WHO classifacation of tumours, Tumours of the Breast and Female Genital Organs, 2003

Endometrioid adenocarcinoma ? • Small cuboidal or columnar cells • Eccentric nuclei • Small nucleoli • Scanty dense cyanophilic coarsely granular cytoplasm

Mucinous adenocarcinoma ?

Serous adenocarcinoma ? • Identical to serous carcinoma of the ovary • Three dimensional balls and papillary fragments • Marked cellular pleomorphism • Psammoma bodies may be seen

Clear cell adenocarcinoma ? • Single cells or small clusters • Round to oval nuclei with delicate border • Large eosinophilic nucleoli ± multiple • Varying amounts of cytoplasm (none to abundant)

Diagnosis Adenocarcinoma - High grade - Endometrial or Extrauterine origin > Endocervical origin