Dejmek Annika
Department of Clinical Pathology and Cytology, Lund University, Malmö University Hospital, S-205 02 Malmö, Sweden.
Acta Cytol. 2003 Nov-Dec;47(6):1059-62. doi: 10.1159/000326647.
Fine needle aspiration is a valuable tool in the diagnosis of ovarian cysts, especially in the young and when a nonneoplastic cyst is suspected. High cellularity, epitheliallike clusters and cellular atypia in aspirates from functional cysts are known features that may lead to an erroneous diagnosis of malignancy. Granulosa cells in ovarian cystic fluids may originate in follicular cysts or cystic granulosa cell tumors. In luteinized follicular cysts the cells usually have ample cytoplasm and tend to form clusters. This report draws attention to a case where abundant, dispersed cells lacking cytoplasm led to the incorrect diagnosis of a granulosa cell tumor.
In an ovarian cystic aspirate from a 34-year-old woman, the fluid was highly cellular, with a striking predominance of cells interpreted as granulosa cells. Granulosa cells are often found in aspirates from functional cysts, but striking cellularity, prominent nuclear grooves and lack of luteinization made us consider a granulosa cell tumor rather than a follicle-derived cyst. Surgery was performed, and histology revealed a benign serous cystadenoma but also numerous maturing follicles and follicular cysts with thick layers of granulosa cells. The aspirate obviously did not represent the cystadenoma but one of the prominent follicular cysts.
An understanding of the cytologic features of functional ovarian cysts, including the pitfalls, is necessary to avoid a false diagnoses of a neoplastic lesion. For a correct interpretation of the cytologic findings, close communication with the clinician and with the radiologist performing the aspiration is of vital importance.
细针穿刺抽吸是诊断卵巢囊肿的一项重要手段，尤其对于年轻患者以及怀疑为非肿瘤性囊肿的情况。功能性囊肿抽吸物中细胞数量多、上皮样细胞簇以及细胞异型性是已知的特征，这些特征可能导致对恶性肿瘤的错误诊断。卵巢囊液中的颗粒细胞可能来源于滤泡囊肿或囊性颗粒细胞瘤。在黄素化滤泡囊肿中，细胞通常具有丰富的细胞质并倾向于形成细胞簇。本报告提请注意一例因大量分散且缺乏细胞质的细胞而导致颗粒细胞瘤误诊的病例。
在一名34岁女性的卵巢囊肿抽吸物中，液体细胞含量很高，以被认为是颗粒细胞的细胞占主导。颗粒细胞常在功能性囊肿的抽吸物中发现，但显著的细胞数量、明显的核沟以及缺乏黄素化使我们考虑为颗粒细胞瘤而非滤泡来源的囊肿。进行了手术，组织学检查显示为良性浆液性囊腺瘤，但也有许多成熟卵泡和滤泡囊肿，伴有厚层颗粒细胞。抽吸物显然并不代表囊腺瘤，而是其中一个突出的滤泡囊肿。
了解功能性卵巢囊肿的细胞学特征，包括其中的陷阱，对于避免对肿瘤性病变的误诊是必要的。为了正确解释细胞学检查结果，与临床医生以及进行抽吸操作的放射科医生密切沟通至关重要。
