Australian Society of Cytology

Case of the Month

October 2002 - Answer and Discussion

The Pap smear showed malignant cell groups in a clean background.

The possible nature of the these cells:

Squamous ??

No poorly cohesive 2-D sheets & single cells
No ragged group edges
No dense homogenous cytoplasm
No irregular nuclear sizes & shapes

Glandular??

3-D Groupings
Common group borders
Delicate foamy cytoplasm
Enlarged round/oval nuclei
Parachromatin clearing
Round central single macronucleoli

Tubal metaplasia ?

No cilia
Nuclear atypia

Atypical repair ?

Cohesive sheets
Has more open chromatin
Has regular nuclear membranes
Has ordered macronucleoli

Endometrial cells ?

3-d clusters
No small single cells
No regular nuclei
No scant cytoplasm + blebs

Endocervical neoplasia ?

No crowded sheets or single cells
No feathering or strips
No columnar cell forms
No diathesis

Endometrial neoplasia ?

No single cells or small clusters
Tumour cells are smaller
Cytoplasm not scant
No watery diathesis

DIAGNOSIS: Adenocarcinoma with absence of diathesis, favour metastatic origin. Recommend laparotomy to examine ovaries and fallopian tubes.


Subsequent laparotomy showed serous papillary adenocarcinoma of the ovary.

COMMENT

Metastatic tumours in cervical smears are uncommon but show two patterns

Limited numbers of cells & groups, no diathesis, and have usually arrived via a transtubal route
A larger sheet presentation with tumour diathesis which is a usually as a result of direct spread with ulceration.

Absence of debris is key feature
Usually no concurrent squamous dysplasia
Accurate clinical information important
Unusual morphologic features should alert the screener
Review the histology of any previous primary tumour.