Cytology of benign cystic uterine adnexal masses.

The findings from a cytologic examination of 26 surgically removed cystic adnexal masses (1-11.5 cm) aspirated with a 22-gauge needle were correlated with the histopathologic findings. The mean age of the patients was 48 years. Examination of the Papanicolaou-stained cytospin preparations showed that all but three were cellular. Benign epithelial cells were identified in fluid aspirated from the mass from one patient with hydrosalpinx and from three with paramesonephric and one with simple cysts; they were also found in aspirated samples from three patients with serous cystadenoma and one with serous cystadenofibroma. Masses from the five patients with follicle cysts and cystic follicles contained numerous granulosa cells. Ciliated cells or ciliated cytoplasmic fragments were found in all aspirated samples except those from patients with follicle cysts, cystic follicles or endometriosis. In two patients, one with endometriosis and one with serious cystadenoma, the epithelial cells were atypical, with a high nuclear/cytoplasmic ratio, hyperchromasia, nuclear molding and large nucleoli. These results could be misinterpreted as indicating malignancy. In summary, the vast majority of aspirated samples (91%) contained benign cells. However, caution should be exercised in the interpretation of possibly misleading cytologic findings in patients with endometriosis or cystadenoma.