Endometrial glandular and stromal breakdown, Part 3: Cytomorphology of “condensed cluster of stromal cells”

Abstract

The aim of this study was undertaken to clarify the cytological characteristic of the "condensed clusters of stromal cells," which may be recognized in endometrial glandular and stromal breakdown (EGBD) cases. The material consists of 60 cases of cytologic smears for which histopathological diagnosis was obtained by endometrial curettage; they comprised 30 cases of EGBD and 30 cases of endometrioid adenocarcinoma grade 1 (G1). The following parameters were examined for "condensed clusters of stromal cells" in EGBD and for "clumps of cancer cells" in G1, respectively: (1) the occurrence of "condensed clusters of stromal cells"; (2) the nuclear shape; (3) a longer/shorter axis ratio in cell nuclei; (4) the area of cell nuclei; (5) the presence of overlapping nuclei; (6) nuclear crowding; (7) immunostaining. (1)"Condensed clusters of stromal cells" were only observed in EGBD. (2) A reniform nuclear shape was observed in 100% EGBD (P < 0.0001) in comparison to G1 (3%). (3) The longer/shorter axis ratio in cell nuclei, G1 (1.37 +/- 0.2) was significantly lower in comparison to EGBD (1.53 +/- 0.12, P = 0.0005). (4) Nuclear area in G1 (51.6 +/- 11.9, P < 0.0001) was significantly higher in comparison to EGBD (24.3 +/- 3.9 microm(2)). (5) The score of overlapping nuclei in EGBD (2.5 +/- 0.49) was significantly higher in comparison to G1 (1.8 +/- 0.44, P < 0.0001). (6) The nuclear crowding score was the same both in EGBD (2) and G1 (2) and these findings were not statistically significant. (7) Both CD10 and Wilms' tumor protein 1 were positive in the "condensed clusters of stromal cells" in the EGBD. The anti-cytokeratin staining was positive in "clumps of cancer cells" in the G1. The evaluation of the immunocytochemical findings by combining the Wilms' tumor 1 protein, CD10, and the anti-cytokeratin with the considered cytomorphologic features (reniform nucleus) may be useful for a correct diagnosis of EGBD in endometrial cytology.