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TVCS G ynae Cytology Workshop 12 th July 2005

TVCS G ynae Cytology Workshop 12 th July 2005. Cytology Department QEII Hospital WGC. Case 1. Age 54 Heavy discharge 2 previous inadequate smears 1. Inadequate smear. No endocervical cells or squamous metaplasia.

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TVCS G ynae Cytology Workshop 12 th July 2005

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  1. TVCS Gynae CytologyWorkshop12th July 2005 Cytology Department QEII Hospital WGC

  2. Case 1 • Age 54 • Heavy discharge • 2 previous inadequate smears • 1. Inadequate smear. No endocervical cells or squamous metaplasia. • 2.Thick smear, clumps of endometrial like cells – probably related to HRT. Advise repeat mid-cycle

  3. Screener’s opinions ? degenerate endometrial cells ? ovarian Cytology report issued A poor specimen consisting mainly of superficial squamous cells. There are a few groups of degenerate endometrial like cells present not consistent with date in cycle. A gynaecological referral is advised to exclude any endometrial pathology. Case 1

  4. Case 1 outcome • Referred to another hospital • Repeat smear – negative • 3 months later • TAH & BSO • Malignant neoplasm of the ovary • moderately differentiated serous papillary cystadenocarcinoma

  5. Case2 • Age 50 • Erosion • 2 slides ; 3 months apart

  6. Case 2 outcome • Cytology report • Single and groups of malignant cells consistent with adenocarcinoma • Histology • Well differentiated early invasive papillary endocervical adenocarcinoma

  7. Case 3 • Age 54

  8. Case 3 outcome • Cytology report Malignant cells present – undifferentiated carcinoma. • Histology report of vaginal biopsy • Cellular tissue, glands and papillae from a metastatic ovarian carcinoma • Previous cystadenocarcinoma of ovary one year previously

  9. Case 4 • Age 72 • Tumour in vagina • Discharge

  10. Case 4 outcome • Additional information • Known Ca bladder • Cytology report • Malignant cells present, the morphology is consistent with a bladder primary. • Direct tumour spread from bladder to vagina

  11. Case 5 • Age 43 • POP • No periods • History of fibroids • Contact bleed • Ectropion

  12. Case 5 outcome • Cytology report • Endocervical dyskaryosis present consistent with CGIN. • Histology • High grade CGIN, few strips of squamous epithelium with CIN1 and HPV changes. • Invasion cannot be assessed as much of the dysplastic epithelium is without stromal tissue.

  13. Case 6 • Age 40 • No LMP given • Previous unsuitable smear • Ectropion

  14. Case 6 outcome • Screener comments • Vacuolated glandular groups ?endometrials • No LMP given ?significant. • Checker comments • Found on computer records that products of conception were received in histology, and this smear was taken 14 days later! • ? Are these 3D vacuolated groups due to the above. • See Pg 669 - Diagnostic Pathology - Gray &McKee • Cytology report • Unsuitable for a reliable assessment. • Numerous endometrial glandular cell groups present together with an inflammatory exudate. • Advise repeat smear

  15. Case 7 • Age 51 • Polyp in Os

  16. Case 7 outcome • Cytology report • Vacuolated malignant glandular cells present suggestive of metastasis from large intestinal carcinoma. • Histology • Caecal biopsy : moderately differentiated adenocarcinoma • 2/12 later • Cervical biopsy: lakes of mucin with 2 atypical glands, highly suspicious of mucinous adenocarcinoma

  17. Case 8 • Age 35 • TAH for CIN3 15 months previously • Ovaries left in situ • Vaginal smear

  18. Case 8 outcome • Cytology report • Numerous severely dyskaryotic squamous cells and small bizarre forms of keratinized squamous cells present. • Pattern is suspicious of invasion • Histology • (R) fornix bx – VAIN 3, evidence of invasion which has reached the margin • Vaginal wall bx – focal VAIN 3, no invasion. • Capillary proliferation and inflammation in the wall.

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