Adenocarcinoma cells in Pap smears

Early-Stage, BRCA-Associated Ovarian Cancer Detected by Papanicolaou Smear: A Case Report

Historically known as a "silent killer", ovarian cancer is often diagnosed at an advanced stage. We describe an unusual case of stage I, ovarian, high-grade serous carcinoma detected by a routine Papanicolaou (PAP) smear, with no abnormal physical, imaging, or laboratory findings. A 53-year-old woman with newly diagnosed triple-negative breast cancer received a screening Pap smear, which showed malignant cells not coming from the breast or uterine cervix. Pelvic examination, cervical biopsy, and gynecologic ultrasonography found no abnormality. Endometrial curettage yielded free-floating adenocarcinoma cells. The immunohistochemical stain result indicated ovary or fallopian tube cancer. Complete cytoreductive surgery was performed, and high-grade serous carcinoma of bilateral ovaries, FIGO stage IB, was diagnosed. Although extremely rare, when malignant cells not originating from the uterine cervix are detected on a Pap smear, it may lead to an early diagnosis of ovarian cancers, and this warrants further comprehensive workup.

Cytological features of ovarian or tubal high-grade serous carcinoma: A retrospective study of 12 cases with abnormal cervical liquid-based smear

BACKGROUND

High-grade serous carcinoma (HGSC) is the most common epithelial carcinoma of the tubo-ovarian region, with a poor prognosis, which presents with an advanced stage at the time of diagnosis. This study summarizes the cytological features of cervical liquid-based cytological examination in order to diagnose ovarian or tubal HGSC at an early stage by cervical cytology smear.

METHODS

A total of 12 patients who were diagnosed with atypical glandular cell (AGC) and above lesions by cervical cytological examination and ovarian or tubal HGSC by histopathology were enrolled in this study. The cytological characteristics, including the arrangement and shape of the neoplastic cells, nuclear and cytoplasmic features, and the presence of tumor diathesis were reviewed.

RESULTS

Nine cases were determined to be AGC, and three cases were determined to be AGC favor neoplastic (AGC-FN) in the 12 cervical cytological diagnoses. The glandular cells showed significant atypia and proliferated actively with a three-dimensional structure. Increased nuclear-to-cytoplasmic ratios, prominent nucleoli, and hyperchromasia were common. Vacuole-like changes were observed in the cytoplasm. Tumor diathesis was observed in only one case (1/12, 8.30%).

CONCLUSION

Ovarian or tubal HGSC can occasionally be detected using cervical liquid-based cytology. It has distinct cytological characteristics. Primary ovarian or tubal HGSC with positive cervical cytology was accompanied by tumor cells in ascites, which suggested that the patient had progressed to an advanced stage.

Poor Cervical Cancer Screening Attendance and False Negatives. A Call for Organized Screening

Objective

The objective of this study was to describe prior negative screening history and symptoms around the time of diagnosis of incident cervical cancer (CC) cases diagnosed between 2000 and 2010 within the Asturias public health system.

Methods

Records from 374 women diagnosed with CC between 2000 and 2010 from all public hospitals in Asturias were retrieved. Clinical information, FIGO stage and all previous cytological data were extracted from clinical and histopathological records. Proportional differences were assessed using chi-square tests. Logistic regression analysis was used to estimate odds ratios (OR) and 95% confidence intervals (CI). Inter-observer agreement in cytology was checked by comparing concordance values using k-statistics.

Results

No prior screening history was recorded in 60.7% of CC cases and its absence increased with age and advanced stage. Advanced stage (e.g., ≥ II) at diagnosis was associated with age (>50 years) and adenocarcinoma (ADC) compared to younger women and those with a squamous cell carcinoma (SCC). False negative smears were identified in 27.1% of women with CC (ADC 52.6% vs. SCC 16.2%, p<0.05).

Conclusions

Absence of prior screening history was common among CC cases. Organized actions to reduce “under screening” and the use of highly sensitive HPV-based tests could be useful strategies in reducing the burden of CC in Asturias.

High grade serous ovarian carcinoma with serous tubal intraepithelial carcinoma in a case presented with atypical glandular cell favor neoplasm cervical cytology and dermatomyositis

OBJECTIVE

This report describes a case of serous ovarian carcinoma with occult serous tubal intraepithelial carcinoma (STIC), which presented as atypical glandular cells favor neoplasia (AGC-FN) with Pap cytology and dermatomyositis.

CASE REPORT

A 48-year-old woman presented with symptoms of dermatomyositis. An AGC-FN result from a Pap smear, with an absence of a cervical or endometrial lesion was noted. After cancer surveillance, ovarian high grade serous carcinoma associated with serous tubal intraepithelial carcinoma was diagnosed. Two weeks following surgical excision of the carcinoma, dramatic remission of the dermatomyositis symptoms was evident.

CONCLUSION

The patient had serous carcinoma of the ovary with tubal STIC, which presented as dermatomyositis. The AGC-FN identified from a Pap smear hinted at a diagnosis of ovarian carcinoma. These presentations point to an occult malignancy in the genital tract and demand careful diagnostic workup.

Primary fallopian tube carcinoma diagnosed preoperatively by cervical smear

Primary fallopian tube carcinoma is a rare clinical entity that constitutes a diagnostic challenge in gynecological practice. Patients generally suffer from the three symptoms: vaginal bleeding, pelvic pain, and vaginal discharge; however, this is usually not sufficient for confirming the diagnosis preoperatively in most circumstances. In this case report, we present a 49-year-old woman whose cervical smear raised a suspicion for fallopian tube carcinoma. All preoperative examination measures such as ultrasonography, hysteroscopy, and endometrial aspiration were normal. Repeated cervical smears were consistent with adenocarcinoma presumably ensourcing from the fallopian tube. The patient underwent laparatomy,total abdominal hysterectomy, bilateral salpingo-oophorectomy, and pelvic para-aortic lymph node dissection. The primary serous papillary adenocarcinoma of the right fallopian tube was detected at the histopathological analysis, and the patient was referred for adjuvant chemotherapy. Cervical smear findings can be the only clue for the diagnosis of fallopian tube carcinoma.