Okano Kimiaki, Ishida Mitsuaki, Sandoh Kaori, Mizokami Tomomi, Kita Masato, Okada Hidetaka, Tsuta Koji
Department of Pathology and Laboratory Medicine, Kansai Medical University, Osaka, Japan.
Department of Obstetrics and Gynecology, Kansai Medical University, Osaka, Japan.
Diagn Cytopathol. 2019 Jun;47(6):547-552. doi: 10.1002/dc.24152. Epub 2019 Feb 1.
Carcinosarcoma of the endometrium is a relatively rare but aggressive neoplasm. Endometrial cytological features of this type of tumor have been rarely reported. This study aimed to clarify the usefulness of endometrial cytological examination in the diagnosis of endometrial carcinosarcoma.
Patients histopathologically diagnosed with endometrial carcinosarcoma who underwent preoperative endometrial or endocervical cytological examination were enrolled. The endometrial and/or endocervical specimens were conventionally stained with Papanicolaou stain, and the cytological characteristics, including arrangement and shape of the neoplastic cells, and the nuclear and cytoplasmic features were reviewed.
Twenty patients were enrolled in the study. In the endometrial specimens, carcinomatous component was detected in almost all cases (94.4%), including those suspicious of carcinoma despite a small volume of carcinomatous cells. Sarcomatous component was observed in 6 of 18 cases (33.3%) and was significantly more frequently detected in the heterologous type (5 of 9 cases) compared to the homologous type (1 of 9 cases) (P = 0.046). In the endocervical specimens, carcinomatous component was present in 76.5% of cases, but sarcomatous component was detected in only 17.6% of cases.
Although endocervical cytology can detect the carcinomatous component in more than 50% of endometrial carcinosarcoma cases, it has lesser capability to detect sarcomatous component. In conclusion, endometrial cytological examination is a more useful and accurate method to detect sarcomatous component of endometrial carcinosarcoma, particularly in the heterologous type, compared to endocervical cytological examination.
子宫内膜癌肉瘤是一种相对罕见但具有侵袭性的肿瘤。关于这类肿瘤的子宫内膜细胞学特征鲜有报道。本研究旨在阐明子宫内膜细胞学检查在子宫内膜癌肉瘤诊断中的作用。
纳入术前接受过子宫内膜或宫颈细胞学检查且经组织病理学诊断为子宫内膜癌肉瘤的患者。子宫内膜和/或宫颈标本采用巴氏染色进行常规染色，并对肿瘤细胞的排列、形态以及细胞核和细胞质特征等细胞学特征进行回顾性分析。
本研究共纳入20例患者。在子宫内膜标本中，几乎所有病例（94.4%）均检测到癌性成分，包括那些虽癌细胞数量少但可疑为癌的病例。18例中有6例（33.3%）观察到肉瘤成分，与同源型（9例中的1例）相比，异源型（9例中的5例）中肉瘤成分的检出频率显著更高（P = 0.046）。在宫颈标本中，76.5%的病例存在癌性成分，但仅17.6%的病例检测到肉瘤成分。
尽管宫颈细胞学检查能在超过50%的子宫内膜癌肉瘤病例中检测到癌性成分，但检测肉瘤成分的能力较弱。总之，与宫颈细胞学检查相比，子宫内膜细胞学检查是检测子宫内膜癌肉瘤肉瘤成分，尤其是异源型肉瘤成分更有用且准确的方法。
