Fine-needle aspiration cytology of ovarian follicle cysts with cellular atypia from reproductive-age patients.

The cytologic features of four luteinized ovarian follicle cysts with cellular atypia, obtained by fine-needle aspiration, are presented and discussed. The three patients, ages 31, 32, and 34, underwent laparoscopy for workup of unilateral or bilateral ovarian cysts. In each case, the aspirates were cellular and composed of atypical cells arranged in glandular clusters and papillary configurations. The cells showed an increased nuclear/cytoplasmic ratio and contained nuclei with prominent chromocenters, granular chromatin, and prominent nucleoli, some irregular in shape. Cell borders were indistinct, and the cytoplasm was finely vacuolated. In each case, the smears were interpreted by the cytotechnologist as showing cellular features compatible with malignancy. In addition to the atypical cells, the cytopathologist noted a few sheets of well-preserved small granulosa cells. A thorough review of the clinical histories revealed the patients to be 8, 6, and 6 mo postpartum, respectively, at the time of needle aspiration. In conjunction with the clinical histories, the cytologic findings supported a diagnosis of follicle cysts containing atypical luteinized granulosa cells. It is postulated that hormonal stimulation may have played a role in the development of the cellular atypia present within the luteinized cells. When analyzing ovarian cyst fluid from reproductive-age patients, this entity should be considered so as not to make an erroneous diagnosis of malignancy.