Kuebler D L, Nikrui N, Bell D A
Division of Cytopathology, James Homer Wright Pathology Laboratories, Massachusetts General Hospital 02114.
Acta Cytol. 1989 Jan-Feb;33(1):120-6.
Endometrial papillary serous carcinoma (EPSC) is an uncommon variant of endometrial carcinoma that histologically resembles ovarian serous carcinoma and has an aggressive clinical course. The cytomorphologic features of 17 patients with histologically confirmed EPSC of the endometrium were reviewed and compared with those of 20 patients with histologically typical endometrial adenocarcinoma (TEC). Preoperative cervicovaginal Papanicolaou smear results were available from 14 of the 17 patients with EPSC; 10 (71%) were positive, 1 (7%) was suspicious and 3 (21%) were negative for malignancy. Initial cervicovaginal smear results were available from all 20 patients with TEC; 7 (35%) were positive, 4 (20%) were atypical or suspicious and 9 (45%) were negative for malignancy. Twelve patients with EPSC had peritoneal washings or fluids examined; seven were positive and five negative. Twelve patients with TEC had peritoneal washings or fluids examined; two (17%) were positive and ten (83%) were negative. The cervicovaginal smears from patients with EPSC revealed numerous large tumor cells (with prominent nucleoli) frequently arranged in papillary clusters with background necrosis and, in two cases, amorphous material suggestive of psammoma bodies. In contrast, the smears of patients with TEC showed small to medium-sized cells with extensive phagocytosis and many background histiocytes. The diagnosis of EPSC should be considered when the cervicovaginal smear contains numerous papillary groups of large tumor cells with macronucleoli but without prominent phagocytosis, especially when structures suggestive of psammoma bodies are present. The peritoneal fluids in these patients are more often positive than in patients with TEC, a finding consistent with the propensity of EPSC to involve peritoneal surfaces.
子宫内膜乳头状浆液性癌（EPSC）是子宫内膜癌的一种罕见变体，其组织学特征类似于卵巢浆液性癌，临床病程具有侵袭性。回顾了17例经组织学证实为子宫内膜EPSC患者的细胞形态学特征，并与20例组织学典型的子宫内膜腺癌（TEC）患者的特征进行了比较。17例EPSC患者中有14例可获得术前宫颈阴道巴氏涂片结果；其中10例（71%）为阳性，1例（7%）可疑，3例（21%）为恶性阴性。所有20例TEC患者均可获得初次宫颈阴道涂片结果；7例（35%）为阳性，4例（20%）为非典型或可疑，9例（45%）为恶性阴性。12例EPSC患者进行了腹水或腹腔冲洗液检查；7例阳性，5例阴性。12例TEC患者进行了腹水或腹腔冲洗液检查；2例（17%）阳性，10例（83%）阴性。EPSC患者的宫颈阴道涂片显示有许多大肿瘤细胞（核仁明显），常排列成乳头状簇，伴有背景坏死，在2例中可见提示砂粒体的无定形物质。相比之下，TEC患者的涂片显示为中小细胞，具有广泛的吞噬作用和许多背景组织细胞。当宫颈阴道涂片含有大量有大核仁但无明显吞噬作用的乳头状大肿瘤细胞群，尤其是存在提示砂粒体的结构时，应考虑EPSC的诊断。这些患者的腹腔冲洗液阳性率比TEC患者更高，这一发现与EPSC累及腹膜表面的倾向一致。
