HPV DNA Testing as Triage for Unsatisfactory Liquid-Based Cervicovaginal Cytology Specimens

Abstract

Introduction: Malignant Mixed Mullerian Tumor/Carcinosarcoma (MMMT) is a clinically aggressive endometrial malignancy composed of mixture of carcinomatous and sarcomatous elements usually affecting postmenopausal women. As this tumor is relatively rare and morphologically diverse, the findings on cervicovaginal cytology, specifically liquid based “SurePath” cytology samples, are not well described. Here we describe the cytological features and correlation with histopathological and clinical findings of patients with MMMT. Material and Methods: A retrospective search (2001-2012) of patients with MMMT was performed. Available PAP smears, biopsies and surgical excisions were reviewed. Tumor characteristics including tumor size presence of heterologous elements, cervical involvement, lympho-vascular invasion (LVI) and tumor pathology staging were extracted from pathology reports and analyzed. Results: There were a total of 30 MMMT patients with available PAPs preceding surgery. All except two patients (28/30) were African American women with average age of 63.03. Ten patients (33.3%) had negative PAPs, eleven (36.7%) were diagnosed as malignant (carcinoma or adenocarcinoma) and nine (30%) as atypical (AGUS, ASCUS or squamous dysplasia). Patients with positive PAP smears had larger tumors and in almost all (90.9%) of the cases tumor showed cervical stromal involvement, and LVI (90.9%). Group with atypical pap smear result did not show correlation with any tumor characteristics or tumor stage. Negative results on PAP smears were seen more commonly in patients without cervical involvements (80%). Common cytology features were tumor diathesis, glandular atypia, squamous dysplasia, presence of nucleoli, multinuclear and anaplastic cells, while sarcomatous elements were rarely encountered. Conclusions: Two thirds of patients with MMMT had either positive or atypical PAPs prior to biopsy or surgery. Patients with cervical involvement of MMMT were more likely to have positive PAP smear independent of tumor staging.