Cytyc Corporation - Case Presentation Archive - October 2001

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1 ThinPrep Pap Test History: 82 Year Old Female Specimen Type: Peritoneal Washings Case provided by Dr. Berle Stratton, Southwest Washington Medical Center, Vancouver, Washington. *The images, analysis and diagnosis for this case study were provided by an independent physician. All conclusions and opinions are those of the physician and not Cytyc Corporation. Slide 1 Slide 2

2 Slide 3 Slide 4

3 Slide 5 Slide 6

4 Discussion: Slide 1: A two-cell population consisting of sheets of benign mesothelial cells and abnormal cell clusters. Slide 2: In this case, aggregates appear predominantly papillary in form and of different sizes and shapes. Slide 3: Some papillary groupings appear as small compact balls and others as irregular tight clusters of cells with radiating papillary fronds. Slide 4: Cell groups have smooth borders, scalloping edges, and pale, delicate, vacuolated cytoplasm that pushes nuclei to the periphery. Slide 5: Three calcospherites (psammoma bodies) composed of concentric rings of calcium surrounded by cells with pleomorphic nuclei, prominent red, round nucleoli and abnormal chromatin. Slide 6: Tissue section showing malignant cells and papillary configuration with fibro-vascular cores. Cytologic Diagnosis: Satisfactory for evaluation. Positive for malignant cells, consistent with papillary serous carcinoma with psammoma bodies. Tissue Diagnosis: Cell block of peritoneal washings: Positive for high-grade serous papillary carcinoma. Psammoma bodies identified. Uterus: Serous papillary carcinoma of endometrium. Endometrial polypfocally involved by serous papillary carcinoma. Body cavity washing specimens consist of traumatically exfoliated sheets of mesothelial cells, white blood cells, macrophages, blood, fibrin and debris. Reactive mesothelials can be seen in large clusters of flat sheets or singly. Balls of cells and papillary structures, as well as psammoma bodies, can also be seen in benign conditions. However, complex, branching clusters or papillae usually indicate neoplasia. Endometrial adenocarcinoma in general is the most common gynecological cancer in the United States. 93% of cases occur in women 50 years of age or older. The signs and symptoms are abnormal uterine bleeding or spotting. Pain and systemic symptoms are late manifestations. Estrogen and estrogen related exposure are believed to be a major risk. The 1 year survival rate for endometrial cancer is 92%. The 5 year survival rate is 96% if the cancer is discovered at an early stage and 66% if diagnosed at a regional stage.

5 The subtype papillary serous endometrial adenocarcinoma makes up 10% of endometrial cancers and often grows and spreads more rapidly than the more common type. It has been suggested that abnormal peritoneal washing cytology is more frequent in patients with stage III/IV and does not correlate with histologic subtype, FIGO grade, depth of myometrial invasion, vascular invasion or abnormal cervicovaginal cytology. References: Demay, Richard. The Art and Science of Cytopathology. 1996:287,312 McKee, Grace T. Cytopathology.1997:300,302,304 Bibbo,Marluce., MD. Comprehensive Cytopathology.1990:270 Gu,Mai., MD.et al. Peritoneal Washings in Endometrial Carcinoma. Acta Cytologica. 2000;44: American Cancer Society web site:

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