Cervicovaginal cytology and diagnosis of ovarian or peritoneal cancer: case report and literature review

Primary peritoneal low-grade serous carcinoma detected in cervical smear: Pitfalls mitigated by clinicocytopathologic clues and cellblock immunocytochemistry

Pap smears play a role in detecting extrauterine serous tumours in asymptomatic women. Certain cytopathologic and histopathologic findings combined with relevant clinical and radiologic findings indicate the possibility of primary peritoneal serous tumours. Cellblock immunohistochemistry is a valuable confirmatory diagnostic tool.

Early-Stage, BRCA-Associated Ovarian Cancer Detected by Papanicolaou Smear: A Case Report

Historically known as a "silent killer", ovarian cancer is often diagnosed at an advanced stage. We describe an unusual case of stage I, ovarian, high-grade serous carcinoma detected by a routine Papanicolaou (PAP) smear, with no abnormal physical, imaging, or laboratory findings. A 53-year-old woman with newly diagnosed triple-negative breast cancer received a screening Pap smear, which showed malignant cells not coming from the breast or uterine cervix. Pelvic examination, cervical biopsy, and gynecologic ultrasonography found no abnormality. Endometrial curettage yielded free-floating adenocarcinoma cells. The immunohistochemical stain result indicated ovary or fallopian tube cancer. Complete cytoreductive surgery was performed, and high-grade serous carcinoma of bilateral ovaries, FIGO stage IB, was diagnosed. Although extremely rare, when malignant cells not originating from the uterine cervix are detected on a Pap smear, it may lead to an early diagnosis of ovarian cancers, and this warrants further comprehensive workup.

Positive Rate of Malignant Cells in Endometrial Cytology Samples of Ovarian Cancer, Fallopian Tube Cancer, and Primary Peritoneal Cancer Patients: A Systematic Review and Meta-Analysis

To estimate the feasibility of diagnosing ovarian cancer, fallopian tube cancer, and primary peritoneal cancer through endometrial cytology, we performed a systematic review and meta-analysis to calculate the pooled positive rate of malignant cells in endometrial cytology samples. We queried PubMed, EMBASE, Medline, and Cochrane Central Register of Controlled Trails from inception to November 12, 2020 for studies estimating positive rates of malignant cells in endometrial cytology samples from patients with ovarian cancer, fallopian tube cancer, and primary peritoneal cancer. The positive rates of the included studies were calculated as pooled positive rate through meta-analyses of proportion. Subgroup analysis based on different sampling methods was conducted. Seven retrospective studies involving 975 patients were included. Pooled positive rate of malignant cells in endometrial cytology specimens of ovarian cancer, fallopian tube cancer, and primary peritoneal cancer patients was 23% (95% CI: 16% - 34%). Statistical heterogeneity between the included studies was considerable (I2 = 89%, P < 0.01). The pooled positive rates of the group of brushes and the group of aspiration smears were 13% (95% CI: 10% - 17%, I2 = 0, P = 0.45) and 33% (95% CI: 25% - 42%, I2 = 80%, P < 0.01), respectively. Although endometrial cytology is not an ideal diagnostic tool for ovarian cancer, fallopian tube cancer, and primary peritoneal cancer, it is a convenient, painless, and easy-to-implement adjunct to other tools. Sampling method is one of the factors that affect the detection rate.

Delayed diagnoses of cervical intraepithelial neoplasia and cancer after negative evaluation for atypical glandular cell pap smear: does age matter?

OBJECTIVE

At initial evaluation, 1 in 6 women with atypical glandular cells (AGCs) on Pap smear has cervical intraepithelial neoplasia (CIN) or cancer. Years later, a greater-than-expected incidence of "significant delayed diagnoses" has been reported in women who had negative initial evaluation results. This study aimed to test the premise that AGC represents a lesser future risk for CIN 2/CIN 3/carcinoma in situ (CIS) and cancer after negative evaluation results in a population diagnosed at a young age (<35 years).

MATERIALS AND METHODS

Cohort study consists of 43,000 community health center patients who had 83,542 Pap smears (1997-2010); 213 were diagnosed with AGC, and 117 met inclusion criteria. Completed evaluation was consistent with American Society for Colposcopy and Cervical Pathology guidelines without finding CIN 2/CIN 3/CIS or cancer. Follow-up lasted for longer than 1 year. Categorical data were evaluated with χ.

RESULTS

During the follow-up period that averaged for 85.3 months, the cohort had 4.5 mean Pap smears and reported 46 cytological diagnoses of low-grade squamous intraepithelial lesions, 3 diagnoses of high-grade squamous intraepithelial lesions, and 10 repeated diagnoses of AGCs. Two CIN 2/CIN 3/CIS lesions, 1 cervical cancer, and 1 endometrial intraepithelial neoplasia were confirmed on biopsy. Average age of patients at index Pap smear was 34.2 years (range = 15-64 years). Compared with a published report where the average age at index Pap smear was 41.5 years, our cohort developed a total of 4.3% significant delayed diagnoses versus 10.8% (significant difference, p = .046).

CONCLUSIONS

During a 7-year follow-up, this cohort of 117 women with AGC and negative initial evaluation findings developed fewer significant delayed diagnoses than expected when compared with an older reported group and had no new extragynecological cancers. Age seems to be a risk factor for delayed diagnoses in patients with AGC.