Journal of Pathology and Translational Medicine

Original Article

Comparison of Cytologic Characteristics between Adenoid Cystic Carcinoma and Adenoid Basal Carcinoma in the Uterine Cervix: Juhyeon Jeong, Seung Yeon Ha, Hyun Yee Cho, Dong Hae Chung, Jungsuk An; J Pathol Transl Med. 2015;49(5):396-402. Published online August 17, 2015; DOI: https://doi.org/10.4132/jptm.2015.07.08

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Background
Adenoid cystic carcinoma (ACC) and adenoid basal carcinoma (ABC) are rare in the uterine cervix. ACC is more aggressive than ABC, thus accurate differential diagnosis is important. In this study, we identified cytologic features useful in distinguishing these two tumors for diagnosis. Methods: Three cases of ACC and five cases of ABC were selected for this study. Cervicovaginal smear slides were reviewed retrospectively, and the area, circumference, major axis, and minor axis of nuclei were measured using an image analyzer. Results: ACC displayed three-dimensional clusters with a small acini pattern. ABC displayed peripheral palisading without an acini pattern. The nuclei of ACC were more irregular and angulated than those of ABC, and the former showed a coarsely granular chromatin pattern. The nucleic area, circumference, major axis, and minor axis were 18.556±8.665 µm², 23.320±11.412 µm, 5.664±1.537 µm, and 4.127±1.107 µm in ACC and 11.017±4.440 µm², 15.920±5.664 µm, 4.612±1.025 µm, and 3.088±0.762 µm in the cases of ABC. All measured values showed statistically significant difference (p < .001). Conclusions: Although the nuclei of both of these tumor types were oval shaped, inferred from the ratio of minor axis to major axis (0.728 in ACC and 0.669 in ABC), the area of nuclei was approximately 1.7 times larger in ACC than in ABC. Distinguishing nucleic features, including area, morphology, and chromatin pattern, may be helpful in making a correct diagnosis.

Citations

Citations to this article as recorded by

Adenoid basal carcinoma of the uterine cervix
Anas Mohamed, Tesfalem Korga, Ahlam Ali, Javier Laurini
International Journal of Gynecological Cancer.2025; : 101873. CrossRef
Adenoid Basal Carcinoma of the Uterine Cervix: A Case Report
Tatsuya Kanuma, Keiko Kigure, Tosio Nishimura, Yuji Ibuki, Shigeru Tsuchida, Harumi Kamiyama, Misa Iijima, Kazuto Nakamura
The KITAKANTO Medical Journal.2016; 66(1): 11. CrossRef

Brief Case Report

The Limitations of Endoscopic Ultrasound-Guided Fine Needle Aspiration Cytology in the Diagnosis of Pancreatic Serous Cystadenoma: A Brief Case Report: Heae Surng Park, Sun Och Yoon, Beom Jin Lim, Joo Hee Kim, Soon Won Hong; Korean J Pathol. 2014;48(5):405-408. Published online October 27, 2014; DOI: https://doi.org/10.4132/KoreanJPathol.2014.48.5.405

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Original Articles

Cytological Evaluation and REBA HPV-ID HPV Testing of Newly Developed Liquid-Based Cytology, EASYPREP: Comparison with SurePath: Youn Soo Lee, Gyungyub Gong, Jin Hee Sohn, Ki Sung Ryu, Jung Hun Lee, Shin Kwang Khang, Kyung-Ja Cho, Yong-Man Kim, Chang Suk Kang; Korean J Pathol. 2013;47(3):265-274. Published online June 25, 2013; DOI: https://doi.org/10.4132/KoreanJPathol.2013.47.3.265

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Abstract PDF

Background

The objective of this study was to evaluate a newly-developed EASYPREP liquid-based cytology method in cervicovaginal specimens and compare it with SurePath.

Methods

Cervicovaginal specimens were prospectively collected from 1,000 patients with EASYPREP and SurePath. The specimens were first collected by brushing for SurePath and second for EASYPREP. The specimens of both methods were diagnosed according to the Bethesda System. Additionally, we performed to REBA HPV-ID genotyping and sequencing analysis for human papillomavirus (HPV) on 249 specimens.

Results

EASYPREP and SurePath showed even distribution of cells and were equal in cellularity and staining quality. The diagnostic agreement between the two methods was 96.5%. Based on the standard of SurePath, the sensitivity, specificity, positive predictive value, and negative predictive value of EASYPREP were 90.7%, 99.2%, 94.8%, and 98.5%, respectively. The positivity of REBA HPV-ID was 49.4% and 95.1% in normal and abnormal cytological samples, respectively. The result of REBA HPV-ID had high concordance with sequencing analysis.

Conclusions

EASYPREP provided comparable results to SurePath in the diagnosis and staining quality of cytology examinations and in HPV testing with REBA HPV-ID. EASYPREP could be another LBC method choice for the cervicovaginal specimens. Additionally, REBA HPV-ID may be a useful method for HPV genotyping.

Citations

Citations to this article as recorded by

Virome capture sequencing for comprehensive HPV genotyping in cervical samples
Thanayod Sasivimolrattana, Sasiprapa Liewchalermwong, Wasun Chantratita, Insee Sensorn, Arkom Chaiwongkot, Parvapan Bhattarakosol
Science Progress.2025;[Epub] CrossRef
High-Risk Human Papillomavirus Detection via Cobas® 4800 and REBA HPV-ID® Assays
Sasiprapa Liewchalermwong, Shina Oranratanaphan, Wichai Termrungruanglert, Surang Triratanachat, Patou Tantbirojn, Nakarin Kitkumthorn, Parvapan Bhattarakosol, Arkom Chaiwongkot
Viruses.2022; 14(12): 2713. CrossRef
Evaluation of nuclear chromatin using grayscale intensity and thresholded percentage area in liquid‐based cervical cytology
Hyekyung Lee, Myungein Han, Taejo Yoo, Chanho Jung, Hyun‐Jin Son, Migyung Cho
Diagnostic Cytopathology.2018; 46(5): 384. CrossRef
Comparison of EASYPREP® and SurePath® in thyroid fine‐needle aspiration
Yosep Chong, Ki Hyun Baek, Jee Young Kim, Tae‐Jung Kim, Eun Jung Lee, Chang Suk Kang
Diagnostic Cytopathology.2016; 44(4): 283. CrossRef

Evaluation of Low-Grade Squamous Intraepithelial Lesions, Cannot Exclude High-Grade Squamous Intraepithelial Lesions on Cervical Smear.: Sung Ran Hong, Bock Man Kim, Hye Sun Kim, Yi Kyeong Chun, Hy Sook Kim; Korean J Pathol. 2010;44(5):528-535.; DOI: https://doi.org/10.4132/KoreanJPathol.2010.44.5.528

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Abstract PDF

BACKGROUND
We examined cervicovaginal smears that contained definite low-grade squamous intraepithelial lesion (LSIL) cells and rare atypical cells suggestive of high-grade SIL (HSIL) (ASC-H) or contained borderline dysplastic cells between LSIL and HSIL. Such lesions were classified as LSIL-H. This study aimed to investigate the cytologic and histologic characteristics of LSIL-H category and we evaluated the associated clinical risk.
METHODS
The histologic outcomes of LSIL-H were compared with those of LSIL and ASC-H. Both the cytologic and histologic findings of LSIL-H that were confirmed as cervical intraepithelial neoplasia 2 (CIN2) or greater (CIN2+) were investigated.
RESULTS
LSIL-H accounted for 0.09% of the Pap tests. On the follow-up histology, the most frequent outcome was CIN2, and the risk of CIN2+ was higher than that for ASC-H. In the cases of LSIL-H that was histologically confirmed as CIN2+, most of the atypical cells suggestive of HSIL were cytologically similar to those of CIN2, and the corresponding cervical tissues were characterized by small CIN2+ lesions in a large background of flat condyloma/CIN1. The LSIL-H cases not confirmed on initial colposcopically-directed biopsy required further follow-up.
CONCLUSIONS
LSIL-H may be a valid diagnostic category with distinctive features that are different from LSIL or ASC-H. LSIL-H needs further follow-up for the proper management.

Citations

Citations to this article as recorded by

The Clinical Significance of “Squamous Intraepithelial Lesion of Indeterminate Grade” as a Distinct Cytologic Category
Dorothy Wong, Crystal Teschendorf, Grace Y. Lin, Farnaz Hasteh
American Journal of Clinical Pathology.2012; 137(5): 753. CrossRef

Case Report

Enterobius vermicularis Ova in a Vaginal Smear.: Seung Kyu Choi, Eun Kyung Kim, Young Ok Hong, Ho Jung Lee, Won Mi Lee, Sook Kyung Ko, Jong Eun Joo; Korean J Pathol. 2010;44(3):341-342.; DOI: https://doi.org/10.4132/KoreanJPathol.2010.44.3.341

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Abstract PDF

Enterobius vermicularis is one of the most common parasites found in the intestine of humans. The gravid female worms migrate outside the anus to release eggs on the perianal skin. Rarely, they migrate to the genitourinary tract in female patients. We present a case in which pinworm eggs were found in a cervicovaginal smear of a 37-year-old woman. The eggs were elongated oval shaped and flattened on one side. The thick, double contoured birefringent shell stained bright yellow or orange. Some coarsely granular embryos or curved larvae were enclosed in the refractile shell. Empty eggs or wrinkled shells with clumped granular material were also present. Although pinworm eggs are easily identified because of their characteristic morphologic appearance, careful screening is needed due to the frequent masking by inflammatory cells.

Citations

Citations to this article as recorded by

High case enterobiasis in school children and potential eggs distribution on the bed
Didik Sumanto, Sayono E, Wulandari Meikawati, Tri Dewi Kristini, Wahyu Handoyo, Aris Sugiharto
Journal of Microbiology & Experimentation.2022; 10(1): 33. CrossRef
Enterobius vermicularis larvae in urine sample of female student: The first case report in Indonesia
Didik Sumanto, Sayono Sayono, Puji Lestari Mudawamah
Journal of Microbiology & Experimentation.2021; 9(1): 1. CrossRef
Vaginal Enterobius vermicularis diagnosed on liquid‐based cytology during Papanicolaou test cervical cancer screening: A report of two cases and a review of the literature
Chun‐Yi Tsai, Rachel Junod, Martine Jacot‐Guillarmod, Charles Beniere, Sonia Ziadi, Massimo Bongiovanni
Diagnostic Cytopathology.2018; 46(2): 179. CrossRef
Recurrent paediatric pinworm infection of the vagina as a potential reservoir for Enterobius vermicularis
B. Kashyap, J.C. Samantray, S. Kumar, R. Jhamb, A.K. Singh, I.R. Kaur
Journal of Helminthology.2014; 88(3): 381. CrossRef

Original Articles

Comparison of Qualified Diagnosis of "Atypical Squamous Cells of Undetermined Significance" with Subsequent Biopsy .: Jae Soo Koh, Jin Haeng Chung, Seung Sook Lee, Kyung Ja Cho; J Pathol Transl Med. 1999;10(1):1-5.

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Abstract PDF: To evaluate whether different qualifications of a cytologic diagnosis of "atypical squamous cells of undetermined significance(ASCUS)" predict a greater or lesser likelihood of tissue diagnosis of uterine cervix, we compared different cytologic qualifications of ASCUS with the tissue diagnosis. One hundred twenty-two con secutive Papanicolaou smears showing ASCUS in women who had undergone cervical biopsy within nearest 30 days were collected. The 122 smears were qualified as "favor reactive"(25%), "favor low grade squamous intraepithelial lesion (LSIL)"(24%), "favor squamous intraepithelial lesion(SIL)"(16%), "favor high grade squa mous intraepithelial lesion(HSIL)"(16%), and "not otherwise specified"(19%). Squamous intraepithelial or invasive lesion was pathologically confirmed by cervical biopsy in 13% of the "favor reactive", 27% in "favor LSIL", 70% in "favor SIL", 75% in "favor HSIL", and 35% in "not otherwise specified" smears. There were significant asso ciations between the favor reactive smear and the benign biopsy finding and between the favor SIL smear and the biopsy showing a squamous intraepithelial or more severe lesion. Nevertheless, most of favor LSIL smears exhibit reactive process in tissue biopsy. Conclusively, qualified ASCUS stratifies women into different risk groups for SIL. The cytopathologist should make the cytologic diagnosis of "ASCUS, favor LSIL" circumspectly.

Cytologic Features of Endometral Papillary Serous Carchinoma.: Gu Kong, Eun Kyoung Hong, Jung Dal Lee; J Pathol Transl Med. 1990;1(2):121-128.

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Abstract PDF: Endometrial papillary serous carcinoma (EPSC) is a distinct variant of endometrial adenocarcinoma that histologically resembles ovarian serous papillary adenocarcinoma and has an aggressive clinical course. Usually, the tumor is diagnosed at the advanced stage. The tumor has well confused with metastatic ovarian tumor of identical histology. Diagnosis of EPSC should be considered when the cervico-vaginal smear reveals numerous papillary clusters of tumor cells with macronucleoli and psammoma bodies. Recently, we have experienced two cases of EPSC diagnosed on cervico-vaginal smears, which revealed characteristic cytologic features including numerous papillary clusters of tumor cells with macronucleoli. The cytologic diagnoses were confirmed on histologic sections.

Curschmann's spirals in cervico-vaginal smears.: In Ae Park, Eui Keun Ham; J Pathol Transl Med. 1991;2(1):56-61.

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Abstract: Curschmann' spirals morphologically similar to those seen in sputum were found in cervico-vaginal smears of six patients ranged from 28 to 40 years of age, during 18 months from January. 1985 to June. 1986. The prevalence was 1 in 2147 smears in that period. All of them had gynecologic disorders without systemic effect such as chronic cervictis in three, leiomyoma in one, pelvic inflammatory disorder in one, and primary infertility in one. The Curshmann' spirals in the smear showed varying degrees of maturation from wavy incipient ones to highly coiled mature ones, admixed with thick mucinous background, suggesting of their production in the uterine cervix itself. Also the recent history of undergone cryocautery, electrocautery or parturition suggest its production in the endocervical gland due to mechanical obstruction and/or change in biochemical composition of mucus.

Case Report

Superficial Endometriosis of the Uterine Cervix as a Source of Atypical Glandular Cells of Undetermined Significance in the Cervicovaginal Smear: A Report of Two Cases.: Hye Jeong Choi, Seung Koo Lee, Kyu Rae Kim; Korean J Pathol. 2001;35(3):263-266.

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Abstract PDF: Superficial endometriosis of the uterine cervix refers to a lesion in which endometrial stroma and/or gland is located immediately subjacent to the surface epithelium. The cells on the cervicovaginal smear shed from the lesion can be a significant source of atypical glandular cells of undetermined significance (AGUS), or can be easily mistaken for glandular dysplasia or adenocarcinoma in situ. Not infrequently it occurs at the conization site for cervical neoplasia. We describe the cytologic and histologic features of 2 cases of superficial endometriosis of the uterine cervix, which were discovered during an evaluation for AGUS detected on the cervicovaginal smears, with an emphasis on the utility of trichrome and reticulin staining for the diagnosis of superficial endometriosis. The cervicovaginal smears show sheets and clusters of glandular cells having mild to moderately pleomorphic oval nuclei with inconspicuous nucleoli and indistinct cytoplasmic border. Single cells or tumor diathesis were not present. Diagnostic histologic findings were the absence of thick or abundant collagen bundles, the encasement of individual stromal cells by a fine reticulin network and thick reticulin fibers around the spiral arterioles within the endometriotic foci. Therefore, superficial endometriosis should be considered as a potential source of AGUS, especially during follow-up after conization for cervical intraepithelial neoplasia.

Original Article

The Cytologic Analysis of Microinvasive Squamous Cell Carcinoma of the Uterine Cervix on Cervical Smear .: Hyun Joo Choi, In Ae Park; J Pathol Transl Med. 2001;12(1):31-37.

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Abstract PDF: While cytologic characteristics of squamous dysplasia, carcinoma in situ, and invasive squamous cell carcinoma of the uterine cervix are well documented, relatively few studies have dealt with the cellular features of microinvasive carcinoma. In order to describe the cellular characteristics of microinvasive squamous cell carcinoma, we retrospectively reviewed 45 cervovaginal smears(15 carcinoma in situ, 15 microinvasive cancer, 15 invasive cancer) which were confirmed by histologic examination of specimens obtained by hysterectomy at the Seoul National University Hospital during 5 years from 1995 to 1999. The cytologic features about tumor diathesis, inflammatory background, cell arrangement, anisonucleosis, nuclear membrane irregularity, nuclear chromatin pattern, and nucleoli were observed. The cytologic characteristics of microinvasive squamous cell carcinoma of the uterine cervix are syncytial pattern, mild tumor diathesis, the irregularity of nuclear membrane, irregularly distributed nuclear chromatin, and occurrence of micronucleoli. But, correlation between the depth of invasion and the cytologic feature had limited value.

Case Report

Exfoliation of endometrial cells on cervicovaginal smears.: Miseon Kang, Hye Kyoung Yoon; J Pathol Transl Med. 2001;12(2):97-103.

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Abstract PDF: The significance of endometrial cells on cervicovaginal smears is underestimated. The aim of this study is to evaluate the detection rate of endometrial cells on cervicovaginal smears. The materials consisted of two groups. Group I was 701 cervicovaginal smears from patients with no gynecological problems. Group II was 208 cervicovaginal smears from patients with abnormal uterine bleeding followed by endometrial curettage; 31 cases of endometrial adenocarcinoma(CA), 19 cases of endometrial hyperplasia(HP), 83 cases of dysfunctional uterine bleeding(DUB), and 75 cases of normal endometrium. Cervicovaginal smears was reviewed according to the criteria of The Bethesda System. Endometrial cells were identified in 15 of 701 cases(2.1%) in group I and 64 of 208 cases(30.8%) in group II. Among group II, detection rate of endometrial cells was the highest in CA (51.6%) compared to HP(26.3%), DUB(41.0%), and normal endometrium(12.0%) (p<0.05). Cytologic atypia of endometrial cells was not found in group I, but was more frequently identified in CA(87.5%) than in HP(10.5%) or DUB(14.7%) (p<0.05). Exfoliation of endometrial cells might be related to abnormal endometrial lesion, and reporting of endometrial cells in the cervicovaginal smear may increase a chance to detect endometrial lesions especially in patients with abnormal uterine bleeding.

Original Articles

Exfoliation of Endometrial Cells on Cervicovaginal Smears.: Miseon Kang, Hye Kyoung Yoon; J Pathol Transl Med. 2002;13(1):1-7.

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Abstract PDF: The significance of endometrial cells on cervicovaginal smears is underestimated. The aim of this study is to evaluate the detection rate of endometrial cells on cervicovaginal smears. The materials consisted of two groups. Group I was 701 cervicovaginal smears from patients with no gynecological problems. Group II was 208 cervicovaginal smears from patients with abnormal uterine bleeding followed by endometrial curettage; 31 cases of endometrial adenocarcinoma(CA), 19 cases of endometrial hyperplasia(HP), 83 cases of dysfunctional uterine bleeding(DUB), and 75 cases of normal endometrium. Cervicovaginal smears were reviewed according to the criteria of The Bethesda System. Endometrial cells were identified in 15 of 701 cases(2.1%) in group I and 64 of 208 cases(30.8%) in group II. Among group II, detection rate of endometrial cells was the highest in CA (51.6%) compared to HP(26.3%), DUB(41.0%), and normal endometrium(12.0%) ( p<0.05). Cytologic atypia of endometrial cells was not found in group I, but was more frequently identified in CA(87.5%) than in HP(10.5%) or DUB(14.7%) ( p<0.05). Exfoliation of endometrial cells might be related to abnormal endometrial lesion, and reporting of endometrial cells in the cervicovaginal smear may increase a chance to detect endometrial lesions especially in patients with abnormal uterine bleeding.

A Comparision of AutoCyte PREP with Matched Conventional Smear in Cervicovaginal Cytology.: Jaejung Jang, Jungsun Kim, Kyung Ja Cho, Shin Kwang Khang, Joo Hyun Nam, Gyungyub Gong; J Pathol Transl Med. 2002;13(1):8-13.

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Abstract PDF: This study was designed to compare the performance of liquid-based preparation from the AutoCyte PREP with the conventional cervicovaginal smear in masked split-samples. In randomly selected 840 cases, the conventional smear was always prepared first, and the AutoCyte PREP used the residual cells on the collecting device. Parallel AutoCyte PREP slides and matched conventional smears were screened in a blind fashion. All abnormals and 10% random normal cases were reviewed by two pathologists in a blind fashion. The Bethesda System was used for reporting the diagnosis and specimen adequacy. The diagnoses from the two methods were agreed exactly in 767(91.3%) of 840 cases. The AutoCyte PREP demonstrated a 25% overall improvement in the detection of squamous intraepithelial lesion(SIL). The ratio of ASCUS to SIL was decreased as 0.45 compared with 1.00 of conventional smear. The AutoCyte PREP produced excellent cellular preservation and superior sensitivity for detection of atypical cells as compared to the conventional smear. It makes us to be able to subclassify ASCUS into from WNL to HSIL. We thought that the AutoCyte PREP method might contribute to increase the detection rate of abnormal cells than conventional methods.

Case Report

Cytologic Features of Signet Ring Cell Carcinoma of the Uterine Cervix: A Report of Two Cases.: Hyun Yee Cho, Seung Yeon Ha, Jaegul Chung, Young Ha Oh, Dong Hae Chung, Na Rae Kim, Jong Min Lee, Eui Don Lee; J Pathol Transl Med. 2003;14(2):66-70.

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Abstract PDF: Signet ring cell carcinoma is a rare type of mucinous adenocarcinoma of the uterine cervix. To the best of our knowledge, there is no report on cytologic findings of primary signet ring cell carcinoma of the uterine cervix in the literature. Recently, we experienced two cases of signet ring cell carcinoma of the uterine cervix. The finding of characteristic signet ring cells on cervicovaginal smear led to the diagnosis of signet ring cell carcinoma. However, primary signet ring cell carcinoma could not be cytologically distinguished from more common metastatic tumor. Therefore, diagnosis rests upon the recognition of signet ring cells and the absence of signet ring cell carcinoma elsewhere.

Original Articles

Immunocytochemical Staining for p16 of Atypical Squamous Cells in Cervicovaginal Smear.: Hwal Woong Kim, Jong Sil Lee, Jeong Hee Lee, Gyung Hyuck Ko; J Pathol Transl Med. 2004;15(1):28-32.

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Abstract PDF: It was reported that the main cause of intraepithelial neoplasm and squamous cell carcinoma of the uterine cervix is human papilloma virus infection, and that the expression of p16 is increased in cells infected by human papilloma virus. We performed an immunocytochemical staining for protein p16 in 17 cases of cervocovaginal smears initially diagnosed as atypical squamous cells of undetermined significance, to know whether the staining could help the differentiation of neoplastic cells from reactive atypical cells. Of 17 smears, 6 were diagnosed finally as high grade intraepithelial neoplasm or invasive squamous cell carcinoma by follow-up biopsy and smear, and 5 of the 6 were positive for p16. Three were diagnosed as koilocytosis, and one of them was weakly positive for p16. Eight were diagnosed as reactive atypical cells, and all of them were negative for p16. We thought that immunocytochemical staining of p16 in cervocovaginal smears could help the differentiation of neoplastic cells from reactive atypical cells.

Liquid-Based Cytology Using MonoPrep2(TM) System in Cervicovaginal Cytology: Comparative Study with Conventional Pap Smear and Histology.: Yoon Kyung Jeon, Ok Ran Kim, Ki Wha Park, Soon Beom Kang, In Ae Park; J Pathol Transl Med. 2004;15(1):33-39.

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Abstract PDF: We compared the diagnostic accuracy of liquid-based cervicovaginal cytology using MonoPrep2(TM) system (Monogen, Herndon, Virginia, USA), a manual system based on membrane filtration method, with conventional Pap smear. Study population included 92 patients visiting the gynecologic department under the suspicion of uterine cervical disease. In thirty of them, surgical biopsy was performed. MonoPrep2(TM) system provided well-preserved monolayer specimen with good nuclear morphology. However, about 19% of specimens were inadequate to interpret due to low cellularity. The detection rate of abnormal cells more than ASCUS (atypical squamous cells of unknown significance) was 23.9% and higher than 19.4 % of conventional Pap smear. Diagnostic concordance rate with conventional Pap smear was 81%, and severe discordance rate influencing on the management of patient was 7.6 %. Among these seven cases, MonoPrep2(TM) system was more diagnostic only in four. In comparison with histology, the sensitivity of diagnosis of MonoPrep2(TM) system was 78.9% and slightly higher than 73.5% of conventional Pap smear. However, the specificity was 81.1% and lower than 90.9% of Pap smear. In conclusion, MonoPrep2(TM) system provided diagnostic accuracies similar to the conventional Pap smear. The inexpertness of slide preparation and the low cellularity were considered to endow a limitation in more accurate evaluation.

Pregnancy-Related Cytologic Changes In Cervicovaginal Smears.: Yi Kyeong Chun, Hoi Sook Jang, Hye Sun Kim, Sung Ran Hong, Jong Sun Choi, Ji Young Park, Jung Sook Cho, Seok Ju Seong, Jae Hyug Yang, Hy Sook Kim; J Pathol Transl Med. 2004;15(2):92-100.

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Abstract PDF: Due to insufficient clinical information, most cervicovaginal smears from pregnant or postpartum women have been screened without regard to pregnancy-related cytological changes. Here, we have reviewed 116 abnormal cervicovaginal smears from 103 pregnant and postpartum women. Initial cytological diagnoses revealed the following: 9 cases of high-grade squamous intraepithelial lesions (HSIL), 8 cases of low-grade squamous intraepithelial lesions (LSIL), 85 cases of atypical squamous cells of undetermined significance (ASCUS), and 14 cases involving atypical glandular cells of undetermined significance (AGUS). 31 cases, upon review, involved pregnancy-related cytological changes, comprising 25 cases of decidua cells, 4 cases of Arias-Stella reaction, and 2 cases of decidual cells coupled with Arias-Stella reaction. Interpretation errors were detected in 14 cases: 13 cases of decidual cells interpreted as either ASCUS favor reactive or ASCUS ruled out HSIL, and one case of Arias-Stella reaction was interpreted as ASCUS ruled out HSIL. Decidual cells and degenerated glandular cells with Arias-Stella reaction can result in diagnostic mistakes. In order to avoid misdiagnosis and unnecessary surgeries, both clinicians and pathologists must be aware of the pregnancy-related cytological changes. The clinician should also always inform the pathologist on the pregnancy status of the patient.

Case Reports

Cytology of the Uterine Cervico-vaginal Smear of Clear Cell Adenocarcinoma in Uterine Cervix: Report of a Case.: Leeso Maeng, Kyoung Mee Kim, Anhi Lee, Chang Suk Kang; J Pathol Transl Med. 2004;15(2):116-119.

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Abstract PDF: Primary clear cell adenocarcinoma of uterine cervix is rare and cytomorphology in the vaginal smear have not been previously described in Korean literatures. The cytologic characteristics of clear cell adenocarcinoma of the uterine cervix include : malignant cells with abundant, finely vacuolated cytoplasm ; hobnail appearance ; and distinctive basement membrane-like hyaline materials within cellular aggregates. A 36-year-old woman presented with vaginal bleeding. Cytologic examination of vaginal smear and histopathologic examination of a radical hysterectomy specimen allowed the diagnosis of hemorrhagic tumor in the uterine cervix as a clear cell adenocarcinoma. Cytologic findings were very characteristic. The tumor cells had abundant, pale, finely vacuolated cytoplasm with indistinct cytoplasmic membrane. The nuclei were round to oval with finely dispersed chromatin. Extracellular basement membrane-like hyaline substance, which stained a light green color in Papanicolaou's preparation, was frequently observed within the cancer cell clusters.

Cytologic Features of Malignant Lymphoma of the Uterine Cervix: A case report.: Nam Hoon Kim, Chan Kum Park, Young Hyeh Ko, Moon Hyang Park, Jung Dal Lee; J Pathol Transl Med. 1995;6(1):76-79.

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Abstract PDF: The uterine cervix is an uncommon site of primary non-Hodgkin's lymphoma (NHL). Although the cytologic findings of NHLs are well known, most cervicovaginal smear of uterine NHLs give lower diagnostic yield than common epithelial malignancy because abnormal cells do not appear in the sample in the absence of surface ulceration. Herein, we describe cytologic findings of a case of uterine cervical NHL which was initially diagnosed by cervicovaginal smear. The tumor cells were relatively uniform, isolated, large-sized with scanty cytoplasm and round or indented nuclei. The nuclei had stippled chromatin and small nucleoli. Histologically and immunohistochemically the tumor was proven to be large cell lymphoma of T-cell lineage.

Original Articles

The Bethesda System(TBS): A New Reporting System of Cervicovaginal Smear.: Hy Sook Kim; J Pathol Transl Med. 1995;6(2):85-98.

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Abstract PDF: In 1989, the Bethesda System(TBS) was introduced as an attempt to standardize cervical/vaginal reporting systems. TBS nomenclature was created for reporting cytologic diagnoses to replace the currently used Cervical Intraepithelial Neoplasia(CIN) and Papanicolaou Class System which are deemed less reproducible. The name for preinvasive squamous lesions was changed to squamous intraepithelial lesion(SIL), subdivided into low-grade and high-grade type. TBS recommends a specific format for cytologic report, starting with explicit statement on the adequacy of the specimen, followed by general categorization and descriptive diagnosis. Pathologic and epidemiologic studies performed over last 10 years have provided evidence that human, papillomavirus(HPV) plays a significant role in the development of cervical neoplasia. TBS corresponds not only to currently held views of the behavior of preinvasive lesions and their HPV distribution, but also to the current guidelines for clinical management.

A Comparision of Surepath(TM) Liquid-Based Smear with a Conventional Smear for Cervicovaginal Cytology-with Reference to a Histological Diagnosis.: Kyung Chul Lee, Chan Kwon Jung, Ahwon Lee, Eun Sun Jung, Yeong Jin Choi, Jong Sup Park, Kyo Young Lee; J Pathol Transl Med. 2007;18(1):20-28.

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Abstract PDF: This study was performed to compare Surepath(TM) liquid-based smear and a conventional cervicovaginal smear with reference to a histological diagnosis. A hybrid capture test (HCII) was also performed and analyzed. We collected matched cases for cervicovaginal cytology- histology: 207 cases for conventional cytology (CC) and 199 cases for liquid-based cytology (LBC). HCII was performed in 254 patients. When a cytological diagnosis of ASCUS or above (ASCUS+) is classified as positive and a histological diagnosis of LSIL+ is classified as positive, the sensitivity and specificity for LBC was 91.7% and 75.9%, respectively and the sensitivity and specificity for CC was 62.6% and 96.1%, respectively. When a cytological and histological diagnosis of LSIL+ is classified as positive, the sensitivity and specificity for LBC was 77.5 and 96.6%, respectively and the sensitivity and specificity for CC was 49.7% and 100%, respectively. When a histological diagnosis of LSIL+ is classified as positive, the sensitivity and specificity for HCII was 78.9% and 78.1%, respectively. The concordance ratio between the cytological and histological diagnosis was 80.4% (kappa=76.0) for LBC and 56.5% (kappa=55.1) for CC. LBC is more sensitive and less specific then CC, as a cytological cutoff level of ASCUS, but more sensitive and equally specific, as a cytological cutoff level LSIL or HSIL. LBC is more reliable with a high concordance ratio between the cytological and histological diagnosis.

Radiation-Induced Changes in Cervico-vagical Smears of Uterine Cervical Cancer Patients.: Sung Hye Park, In Sun Kim, Seung Yong Paik, Hyo Sook Park, No Won Park; Korean J Pathol. 1988;22(3):268-276.

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Abstract PDF: Nowday, ionizing radiation is one of the methods eradicating the uterine cervical malignancy. However radiation alone or in combination with surgery have an effect on normal tissue as well as the malignant cells, and their changes have been well described in other countries. Unfortunately, the history of radiation modality for cancer treatment is relatively short and the reports about radiation induced changes are limited in our country. We evaluated the radiation-induced changes in cervico-vaginal smears of 107 uterine cervical cancer patients obtained from March, 1985 to October, 1987. Most patients had been received 5,400 Rads of external radiation and intracavitary radiation. Patient's age ranged from 30 to 67 years old. Of 107 cases, 24 cases were normal, 72 cases showed benign radiation changes, 7 cases revealed radiation dysplasia, and residual and recurrent carcinomas found in one and 3 cases, respectively. Cytoplasmic and nuclear enlargement were the most common and noted in 57 and 38 cases, respectively. Vacuolization and polychromasia of the cytoplasm were identified in 43 and 30 cases, respectively. The most common histiocytic change was multinucleation, which was found in about one third. The radiation changes of the cytoplasm and nuclear enlargement persisted for a long time after completion of radiation, however, nuclear degeneration and multinucleation gradually disappeared after 6 months. The inflammation in background prolonged for a long time but degeneration disappeared after 6 months. The biologic significance of post-radiation dysplasia could not evaluated because of short follow up period.

Cytologic Analysis of Adenocarcinoma of the Cervicovaginal Smears .: Jung Yeon Kim, Hye Jae Cho, Kyung Ja Cho, Hong Kyoon Lee; J Pathol Transl Med. 1998;9(2):147-154.

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Abstract PDF: We have investigated the cervicovaginal smears in order to define the cytologic features of uterine adenocarcinomas. Total 22 cases were reviewed(12 cases from the Sanggye Paik hospital, Inje university and 10 cases from the Korea Cancer Center Hospital) from January 1992 to December 1997. Five cases were endometrial adenocarcinomas and the remaining 17 cases were cervical adenocarcinomas. Se venteen cases of cervical adenocarcinomas were divided into endometrioid(6 cases), endocervical(7 cases), mixed endometrioid and endocervical(1 case), papillary (2 cases), and adenosquamous(1 case) carcinomas. The background of endocervical adenocarcinoma was hemorrhagic or inflammatory. The tumor diathesis was less prominent than that of the squamous cell carcinoma. The prominent features of the endocervical type adenocarcinomas were large and loose clusters, large intra cytoplasmic vacuoles, and prominent overlapping and peripheral palisading of nuclei. In contrast, the endometrioid adenocarcinomas showed small and compact clusters, and small intracytoplasmic vacuoles. The detection rate of endometrial adeno carcinoma was lower than that of the endocervical adenocarcinoma.

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