TVCS Gynae Cytology Workshop 12th July 2005

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TVCS Gynae CytologyWorkshop12th July 2005

• Cytology Department
• QEII Hospital
• WGC

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Case 1

• Age 54
• Heavy discharge
• 2 previous inadequate smears
• 1. Inadequate smear. No endocervical cells or
  squamous metaplasia.
• 2.Thick smear, clumps of endometrial like cells
  probably related to HRT. Advise repeat mid-cycle

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Case 1

• Screeners opinions
• ? degenerate endometrial cells
• ? ovarian
• Cytology report issued
• A poor specimen consisting mainly of superficial
  squamous cells. There are a few groups of
  degenerate endometrial like cells present not
  consistent with date in cycle.
• A gynaecological referral is advised to exclude
  any endometrial pathology.

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Case 1 outcome

• Referred to another hospital
• Repeat smear negative
• 3 months later
• TAH BSO
• Malignant neoplasm of the ovary
• moderately differentiated serous papillary
  cystadenocarcinoma

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Case2

• Age 50
• Erosion
• 2 slides 3 months apart

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Case 2 outcome

• Cytology report
• Single and groups of malignant cells consistent
  with adenocarcinoma
• Histology
• Well differentiated early invasive papillary
  endocervical adenocarcinoma

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Case 3

• Age 54

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Case 3 outcome

• Cytology report
• Malignant cells present undifferentiated
  carcinoma.
• Histology report of vaginal biopsy
• Cellular tissue, glands and papillae from a
  metastatic ovarian carcinoma
• Previous cystadenocarcinoma of ovary one year
  previously

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Case 4

• Age 72
• Tumour in vagina
• Discharge

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Case 4 outcome

• Additional information
• Known Ca bladder
• Cytology report
• Malignant cells present, the morphology is
  consistent with a bladder primary.
• Direct tumour spread from bladder to vagina

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Case 5

• Age 43
• POP
• No periods
• History of fibroids
• Contact bleed
• Ectropion

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Case 5 outcome

• Cytology report
• Endocervical dyskaryosis present consistent with
  CGIN.
• Histology
• High grade CGIN, few strips of squamous
  epithelium with CIN1 and HPV changes.
• Invasion cannot be assessed as much of the
  dysplastic epithelium is without stromal tissue.

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Case 6

• Age 40
• No LMP given
• Previous unsuitable smear
• Ectropion

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Case 6 outcome

• Screener comments
• Vacuolated glandular groups ?endometrials
• No LMP given ?significant.
• Checker comments
• Found on computer records that products of
  conception were received in histology, and this
  smear was taken 14 days later!
• ? Are these 3D vacuolated groups due to the
  above.
• See Pg 669 - Diagnostic Pathology - Gray McKee
• Cytology report
• Unsuitable for a reliable assessment.
• Numerous endometrial glandular cell groups
  present together with an inflammatory exudate.
• Advise repeat smear

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Case 7

• Age 51
• Polyp in Os

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Case 7 outcome

• Cytology report
• Vacuolated malignant glandular cells present
  suggestive of metastasis from large intestinal
  carcinoma.
• Histology
• Caecal biopsy moderately differentiated
  adenocarcinoma
• 2/12 later
• Cervical biopsy lakes of mucin with 2 atypical
  glands, highly suspicious of mucinous
  adenocarcinoma

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Case 8

• Age 35
• TAH for CIN3 15 months previously
• Ovaries left in situ
• Vaginal smear

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Case 8 outcome

• Cytology report
• Numerous severely dyskaryotic squamous cells and
  small bizarre forms of keratinized squamous cells
  present.
• Pattern is suspicious of invasion
• Histology
• (R) fornix bx VAIN 3, evidence of invasion
  which has reached the margin
• Vaginal wall bx focal VAIN 3, no invasion.
• Capillary proliferation and inflammation in the
  wall.

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Case 9

• Age 59
• Discharge
• Occasional bleed for 1 day
• Contact bleed
• Nabothian follicle
• Atrophic cervix

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Case 9 outcome

• Cytology report
• Heavily bloodstained smear
• Cell details partly obscured
• Large sheets of parabasal endocervical type cells
  infiltrated by leucocytes and exudate
• Borderline smear,repeat in 6 months

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Case 9 outcome cont.

• Histology (15 months later)
• Lletz- cervix well differentiated
  adenocarcinoma of endometrioid type, mainly
  exophytic, and wart virus changes
• Tumour present at endocervical margin
• CEA negative suggesting endometrial rather than
  primary cervical
• Endometrial curettage advised to exclude
  endometrial carcinoma
• Endometrial contents - mod.diff adenocarcinoma
• TAH Moderately differentiated villo-glandular
  endometroid adenocarcinoma FIGO stage 2B

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Case 10

• Age 36
• History of discharge
• OCP

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Case 10 outcome

• Cytology report
• Many small groups and single malignant cells of
  glandular type suggestive of endometrial if not,
  extra uterine origin
• Differential curettage advisable
• Histology
• Endometrial curettings proliferative, NEM
• Endocervical tissue metaplastic squamous
  epithelium changes CIN1, and clusters of
  endometrial cells within the stroma
• 2 months later
• LLETZ CIN2 -3. Advise further assessment of the
  pelvic cavity