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Gynecologic Cytology

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Gynecologic and Obstetric Pathology, Volume 2

Abstract

The American Cancer Society’s estimates about 12,820 new cases of invasive cervical cancer will be diagnosed each year in the United States. About 79 million Americans are infected with HPV. The Bethesda System for reporting cervical cytology has forged our understanding of HPV biology and provides an infrastructure for systematic and evidence-based cervical cancer screening and management guidelines. Direct detection of HPV, e.g., by testing for HPV DNA or HPV-produced mRNA of known oncogenic genes, has found its place in new screening strategies. HPV 16 and 18 being the most prevalent and most oncogenic HPV types resulted in need for HPV genotyping.

HPV DNA detection-based methods are currently the most suitable way of approaching this issue and have led to the development of different platforms. Testing for HPV status in formalin-fixed, paraffin-embedded histological samples, mainly for prognostic reasons (but also as an aid in differential diagnosis), is mainly done using either DNA in situ hybridization or p16 immunohistochemistry.

Pelvic washings (PW) are now routinely performed for staging of gynecologic malignancies, and results are significant component of the final pathologic and clinical stage of ovarian cancers.

Cytologic evaluation of PW starts with clinical history. As pelvic washings are routinely performed in patients who present with known gynecologic malignancy or with imaging findings of a “lesion or mass” in gynecologic tract, it is essential that the pathologist interpreting washing cytology is familiar with the clinical findings, histologic tumor types that occur in various parts of the gynecologic tract, corresponding surgical specimen, and benign pitfalls and mimickers. The peritoneal surface in women can give rise to various benign Mullerian lesions. It is important to be familiar with the cytomorphologic characteristics of these lesions to avoid misinterpreting them as malignant. Primary peritoneal lesions of the pelvic peritoneum encountered in gynecologic pathology include various benign, low malignant potential, and malignant tumors of both mesothelial and Mullerian origin. Interpretation errors can be significantly reduced if immunohistochemical stains are applied to aid in the identification of malignant cells. The best and most helpful antibody panel in the diagnostic workup of pelvic washings should include stains that can identify a second population of cells, characterize them, and localize or suggest a primary site. Minimally invasive surgical procedures (robotic and laparoscopic hysterectomy) have been associated with various histologic artifacts due to “displacement” of tissue fragments of endometrial cancer into vascular channels and possibly through the fallopian tubes into peritoneal surfaces and therefore are detected in pelvic washings.

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Authors and Affiliations

  1. Emory University Hospital, Atlanta, GA, USA

    Uma Krishnamurti, Marina Mosunjac & Krisztina Z. Hanley

  2. University of Utah School of Medicine, Salt Lake City, UT, USA

    Georgios Deftereos

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  1. Uma Krishnamurti
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  2. Marina Mosunjac
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  3. Georgios Deftereos
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  4. Krisztina Z. Hanley
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Correspondence to Krisztina Z. Hanley .

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Editors and Affiliations

  1. Department of Pathology, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Wenxin Zheng

  2. Department of Pathology, University of California San Diego, San Diego, CA, USA

    Oluwole Fadare

  3. Department of Pathology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    Charles Matthew Quick

  4. Department of Pathology, Peking University People’s Hospital, Beijing, China

    Danhua Shen

  5. Department of Obstetrics and Gynecology, Tianjin Gynecologic and Obstetrics Central Hospital, Tianjin, China

    Donghui Guo

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Krishnamurti, U., Mosunjac, M., Deftereos, G., Hanley, K.Z. (2019). Gynecologic Cytology. In: Zheng, W., Fadare, O., Quick, C., Shen, D., Guo, D. (eds) Gynecologic and Obstetric Pathology, Volume 2. Springer, Singapore. https://doi.org/10.1007/978-981-13-3019-3_17

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