Cytology of clear-cell adenocarcinoma of genital tract in young females: review of 95 cases from the registry.

Abstract

The role of cytology in detection of clear-cell adenocarcinoma (CCA) was determined by analysis of cytologic studies of 95 patients registered with the disease. Morphology of CCA was also delineated. Positive or suspicious smears from 11 patients taken before the tumor was detected clinically provided the 1st suggestion of malignancy. 5 of these patients were asymptomatic and had had smears as part of a routine examination. 49/65 smears obtained after the tumor had been detected clinically or by biopsy were positive. Once the primary tumor had been treated vaginal smears were made as part of routine follow-up; in 5 instances the cytologic findings provided the 1st clue that the tumor had persisted or recurred. Morphologic characterization showed that tumor cells occurred singly and in clumps and in general resembled endocervical cells (29 figures included). The nuclei were usually large and contained a prominent nucleolus. Bare nuclei were frequent. Variations included occasional slight nuclear atypicality and rare bizarre nuclei. Cytoplasm was usually delicate. Cytologic diagnosis was difficult because of the following occurrences: 1) absence of tumor cells; 2) presence of numerous inflammatory cells; and 3) the high degree of differentiation of the tumor cells in some cases. Vaginal cytology however in young girls with abnormal bleeding or a history of stilbestrol exposure in utero may provide the 1st indication of the presence of CCA.