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Endometrial-Type Cells in Cervico-Vaginal Smears: Clinical Significance and Cytopathologic Correlates

Endometrial-Type Cells in Cervico-Vaginal Smears: Clinical Significance and Cytopathologic Correlates. Baktiar o. Karim , CT(ASCP),BVMS , Frances H.Burroughs , SCT(ASCP) , Dorothy L . Rosenthal, MD , and Syed Z. Ali, MD.

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Endometrial-Type Cells in Cervico-Vaginal Smears: Clinical Significance and Cytopathologic Correlates

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  1. Endometrial-Type Cells in Cervico-Vaginal Smears:Clinical Significance and Cytopathologic Correlates Baktiar o. Karim, CT(ASCP),BVMS,Frances H.Burroughs, SCT(ASCP), Dorothy L. Rosenthal, MD, and Syed Z. Ali, MD

  2. ETC are usually present in CV smears during the proliferative phase of the menstrual cycle.Most of the previous studies have suggested that the presence of ETC in the second half of the menstrual cycle and in PM women is abnormal.

  3. In a 3-yr period (1997-1999) at the Johns Hopkins Cytopathology Laboratory, 1162/21057 CV smears with endometrial-type cells (ETC) were found in patients 45 yr and older.

  4. Table I. Type of Follow-up of ETC

  5. Table 2. Histopathologic Follow-up of ETC

  6. The cytologic characteristics evaluated included: • Number of endometrial cells • Type of endometrium: epithelial type, stroma or the so-called histiocyte-type, and mixed (epithelial and stromal) • Cellular atypia: high N/C ratio, presence of nucleoli, hyperchromasia, vacuolated cytoplasm • Associated inflammation (including PMNs) • Smear background: presence or absence of necrosis, serum and/or blood • Associated estrogen effect in the squamous epithelium

  7. Table 3. Cytologic Characteristics of ETC

  8. Table 4. Clinical Data of Patients With ETC

  9. Tumor Diathesis in Adenocarcinoma • Extrauterine cancer 19.7% • Endocervical cancer 85.0% • Endometrial cancer 92.5% (Acta Cytologica 18 108-117, 1974)

  10. 病因 • 未有生育婦女 • 不孕或月經不順者 • 停經年齡延後者(大於52歲) • 肥胖之婦女 • 卵巢腫瘤而導致動情素增高者如多囊性卵巢，特殊性卵巢瘤 • 停經婦女單一使用動情素未合併黃體素作更年期HRT者 • 糖尿病或高血壓者。 • 使用抗癌藥物Tamoxifen者

  11. 約翰．李（JohnLee,M.D.）講述在他的著作《WhatYourDoctorMayNotTellYouAboutMenopause》有詳細的說明。以下是他在亞特蘭大對五百名女性演講的摘要。黃體素，這種天然的黃體素可以從野生的山藥、黃豆或五千種不同的植物中提煉出，黃體素在全身均扮演重要的角色,人造的仿黃體素便失去了天然黃體素的許多功能，相對增加了不少副作用，藥商更用此分子製造許多荷爾蒙相關的藥。Provera正是這種產物，對人體有很多的副作用，卻是目前醫生大量使用的藥物之一.約翰．李（JohnLee,M.D.）講述在他的著作《WhatYourDoctorMayNotTellYouAboutMenopause》有詳細的說明。以下是他在亞特蘭大對五百名女性演講的摘要。黃體素，這種天然的黃體素可以從野生的山藥、黃豆或五千種不同的植物中提煉出，黃體素在全身均扮演重要的角色,人造的仿黃體素便失去了天然黃體素的許多功能，相對增加了不少副作用，藥商更用此分子製造許多荷爾蒙相關的藥。Provera正是這種產物，對人體有很多的副作用，卻是目前醫生大量使用的藥物之一.

  12. Endometrial adenocarcinoma • Detection Rate • Cervical scraping only: 15 percent • Vaginal pool smear and cervical scraping: 45percent • Endocervical aspiration and vaginal pool smears:65 percent 4. Intrauterine and endocervical aspiration and lavage: 90 percent

  13. 子宮內膜受雌激素(estrogen)影響而增殖，長期單獨使用雌激素則子宮內膜癌的發生率會子宮內膜受雌激素影響而增殖，長期單獨使用雌激素則子宮內膜癌的發生率會增加，因此使用雌激素時必須配合使用適當量的黃體素(progesterone)以保護子宮內膜，避免發生子宮內膜癌。子宮內膜受雌激素(estrogen)影響而增殖，長期單獨使用雌激素則子宮內膜癌的發生率會子宮內膜受雌激素影響而增殖，長期單獨使用雌激素則子宮內膜癌的發生率會增加，因此使用雌激素時必須配合使用適當量的黃體素(progesterone)以保護子宮內膜，避免發生子宮內膜癌。 • 陰道式超音波檢查或許是將來可採行之篩選工具。 • 子宮內膜切片或D&C(子宮頸口擴張及括除術)可達90-98%之正確診斷。 • 子宮頸抹片檢查：　　主要目的是為子宮頸癌的篩檢，對子宮內膜癌的發覺率不高，很多人誤認只要作抹片為陰性，而認為無其他婦女癌症，因而延誤診斷。 • 若有異常出血先作陰道超音波檢查，再作子宮內膜切片：因陰道超音波很容易看到子宮內膜之厚薄及異常，若內膜增厚到一定程度，立即採子宮內膜切片既方便又正確而合於經濟原則。 • 子宮內視鏡檢查：因費用較高，而且不普遍，通常保留在特殊情況下才使用，如切片檢查為陰性，仍然出血者，無法用一般方法取得標本者，子宮鏡是檢查子宮內膜瘜肉及子宮內膜肌瘤的好方法。 • 血清中CA125之檢測：若增加太多則顯示內膜癌轉移到子宮體外，可作將來手術治療之參考。

  14. Discussion • ETC in CV smears, especially in PM patients with vaginal bleeding, must be evaluated by tissue examination. • In our study we found 22.2% of PM women with EACA were asymptomatic. • 99% of women on hormonal replacement therapy were found to have benign endometrium on histopathologic follow-up. • The presence of large numbers of ETC predominantly mixed epithelial and stroma type, cellular atypia, estrogen effect, and a dirty smear background is more significant for EACA than EHP and benign endometrium.

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