Gynecologic Cytology, Non-Pap Smear Based
摘要
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. The International System for Reporting Serous Fluid Cytopathology (TIS) is a diagnostic and reporting system developed for diagnostic criteria, standardized reporting and clinical management strategies for serous fluid cytopathology.