Uterine adenosarcoma detected by conventional papanicolaou smear: A case report with emphasis on integrating the immunocytochemical staining

Abstract

Adenosarcoma is a rare uterine malignant tumor composed of benign to atypical epithelial element and a usually low-grade sarcomatous component. Although it is well known histologically, its cytological features are rarely described in the literature. We report a case of uterine adenosarcoma being the first one that was accurately diagnosed before operation by the conventional Papanicolaou (Pap) smear with emphasis on the contribution of the integrated immunocytochemical staining. A 46-year-old woman with abnormal vaginal bleeding and a protruding mass from her cervical os. Her Pap smear revealed: (a) presence of endometrial necrotic debris in the background, which indicated the presence of an endometrial lesion, (b) presence of both abnormal endometrial glandular cells (compact and tight clusters with slight hyperchromasia, increased nucleus/cytoplasm (N/C) ratio, apparent nucleoli and moderate vimentin stain) and abnormal stromal cells (loose aggregates of spindle to polygonal cells with hyperchromasia, increased N/C ratio and very strong vimentin staining). The characteristic degenerative necrotic debris indicating endometrial lesion plus the application of immunocytochemistry, which can increase the detection rate of endometrial lesion by the Pap smears. Awareness of the cytological findings of adenosarcoma can aid to make a correct preoperative diagnosis of this rare disease.