tvcs g ynae cytology workshop 12 th july 2005 l.
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TVCS G ynae Cytology Workshop 12 th July 2005. Cytology Department QEII Hospital WGC. Case 1. Age 54 Heavy discharge 2 previous inadequate smears 1. Inadequate smear. No endocervical cells or squamous metaplasia.

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tvcs g ynae cytology workshop 12 th july 2005

TVCS Gynae CytologyWorkshop12th July 2005

Cytology Department

QEII Hospital

WGC

case 1
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
case 17
Screener’s 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.

Case 1
case 1 outcome
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
case2
Case2
  • Age 50
  • Erosion
  • 2 slides ; 3 months apart
case 2 outcome
Case 2 outcome
  • Cytology report
    • Single and groups of malignant cells consistent with adenocarcinoma
  • Histology
    • Well differentiated early invasive papillary endocervical adenocarcinoma
case 3
Case 3
  • Age 54
case 3 outcome
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
case 4
Case 4
  • Age 72
  • Tumour in vagina
  • Discharge
case 4 outcome
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
case 5
Case 5
  • Age 43
  • POP
  • No periods
  • History of fibroids
  • Contact bleed
  • Ectropion
case 5 outcome
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.
case 6
Case 6
  • Age 40
  • No LMP given
  • Previous unsuitable smear
  • Ectropion
case 6 outcome
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
case 7
Case 7
  • Age 51
  • Polyp in Os
case 7 outcome
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
case 8
Case 8
  • Age 35
  • TAH for CIN3 15 months previously
  • Ovaries left in situ
  • Vaginal smear
case 8 outcome
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.
case 9
Case 9
  • Age 59
  • Discharge
  • Occasional bleed for 1 day
  • Contact bleed
  • Nabothian follicle
  • Atrophic cervix
case 9 outcome
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
case 9 outcome cont
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
case 10
Case 10
  • Age 36
  • History of discharge
  • OCP
case 10 outcome
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