Ebisu Yusuke, Ishida Mitsuaki, Okano Kimiaki, 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 Dec;47(12):1297-1301. doi: 10.1002/dc.24298. Epub 2019 Aug 6.
Small-cell neuroendocrine carcinoma (NEC) of the endometrium is extremely rare, and demonstrates an aggressive clinical course. Since reports describing its cytological features are scarce, we aimed to retrospectively analyze these features. Patients with a histopathological diagnosis of NEC who underwent preoperative cytological examination, were enrolled in this study. The cytological features including the background, arrangement, and shape of the neoplastic cells, and the nuclear and cytoplasmic features were reviewed; six patients were enrolled. The conventionally stained, directly sampled cytological specimens showed small neoplastic cell clusters in all cases, as well as isolated neoplastic cells and large clusters in 3 and 2 cases, respectively, in inflammatory or necrotic backgrounds. These neoplastic cells had a high nuclear/cytoplasmic ratio, and round to oval nuclei with powdery chromatin, inconspicuous nucleoli, and scant cytoplasm. Nuclear molding was a characteristic finding. An adenocarcinoma component was also present in 3 cases. Initial cytodiagnosis revealed small-cell NEC and adenocarcinoma or suspected adenocarcinoma in 1 and 4 cases, respectively. The one remaining case was found to be negative and was considered as degenerated endometrial stromal cells. Primarily owing to overlooking this component, the initial cytodiagnostic accuracy of small-cell NEC was low, particularly in cases with coexisting adenocarcinoma. However, the cytological features of this tumor were characteristic. Therefore, although extremely rare, careful observation is essential for an early and accurate diagnosis and to prevent overlooking the small-cell NEC component.
子宫内膜小细胞神经内分泌癌（NEC）极为罕见，且临床病程具有侵袭性。由于描述其细胞学特征的报告较少，我们旨在对这些特征进行回顾性分析。本研究纳入了术前接受细胞学检查且组织病理学诊断为NEC的患者。对肿瘤细胞的背景、排列、形态以及细胞核和细胞质特征等细胞学特征进行了回顾性分析；共纳入6例患者。常规染色的直接取样细胞学标本在所有病例中均显示有小的肿瘤细胞簇，在炎症或坏死背景下，分别有3例和2例出现孤立的肿瘤细胞和大的细胞簇。这些肿瘤细胞的核质比高，细胞核呈圆形至椭圆形，染色质呈粉末状，核仁不明显，细胞质稀少。核型是一个特征性表现。3例还存在腺癌成分。初始细胞学诊断分别在1例和4例中显示为小细胞NEC和腺癌或疑似腺癌。剩下的1例结果为阴性，被认为是退化的子宫内膜间质细胞。主要由于忽视了这一成分，小细胞NEC的初始细胞学诊断准确性较低，尤其是在合并腺癌的病例中。然而，该肿瘤的细胞学特征具有特异性。因此，尽管极为罕见，但仔细观察对于早期准确诊断以及防止忽视小细胞NEC成分至关重要。
