Malignant lymphoma of the uterine cervix. Cytologic diagnosis of a case with immunocytochemical corroboration

The cytologic findings in a case of primary malignant lymphoma of the uterine cervix initially suggested the presence of a malignant neoplasm. By the use of immunologic methods, the lymphoma cells were shown to possess the nature of B lymphocytes. The need for cytochemical study to make a definitive diagnosis of this rare condition is emphasized. The cytologic findings are compared with those of cytologically similar conditions in the cervix: reticulum-cell sarcoma, chloroma and endometrial stromal sarcoma.     

Primary malignant lymphoma of the uterine cervix: report of a case with cytologic and immunohistochemical diagnosis

A non‐Hodgkin's lymphoma initially diagnosed on the cervical smear in a 69‐year‐old asymptomatic female is described. The cytologic findings strongly suggested the presence of a malignant lymphoid neoplasm: neoplastic cells were round, loosely arranged, with scanty cytoplasm and cleaved nuclei. Histological evaluation of the cervical biopsy revealed a diffuse lymphoid proliferation of mononucleated cleaved cells beneath an ulcerated epithelium. Immunohistochemically, the tumour cells were positive for B cell markers. Reports on cytologic features of primary malignant lymphoma of the cervix are not frequent in the literature. We emphasize the importance of their recognition and the differential diagnosis of cervical lymphoma from other neoplastic and non‐neoplastic lesions.     

Primary malignant lymphoma of the uterine corpus diagnosed by endometrial cytology. A case report

BACKGROUND: A relatively small number of cases of primary malignant lymphoma of the uterine corpus have been reported, and it is rare for cases to be preoperatively diagnosed by cytology. CASE: A 59-year-old female experienced abnormal uterine bleeding of two months' duration. Preoperative evaluation of endometrial cytology revealed malignant cells. These cells demonstrated a rather round or oval configuration, with a markedly increased nuclear/cytoplasmic ratio, and were isolated and scattered in an inflammatory background. The nuclei were round or oval, and macronucleoli were marked. The cytologic diagnosis was malignant lymphoma. Postoperative histologic evaluation verified the presence of a primary malignant lymphoma in the uterine corpus, with a B-cell phenotype. CONCLUSION: Preoperative endometrial cytology correctly demonstrated malignant lymphoma of the uterine corpus.     

Glassy cell carcinoma of the uterine cervix. Report of a case with cytohistologic and immunohistochemical study

BACKGROUND: Glassy cell carcinomas of the uterine cervix are poorly differentiated carcinomas composed of cells with a large, round to oval nucleus containing one or multiple prominent nucleoli, finely vacuolated eosinophilic to amphophilic cytoplasm and distinct cell borders. These cells occur in sheets and chords, with fibrovascular septae presenting a mixed inflammatory infiltrate. This neoplasm has a poor response to radiotherapy and a worse prognosis than the usual types of adenocarcinoma and squamous cell carcinoma. There are few reports on the cytologic and histopathologic features of this neoplasm. CASE: A 56-year-old woman presented with a large, exophytic cervical tumor. Exfoliative cytology showed clusters of cells and single cells with large, round to oval nuclei, with one or multiple nucleoli and moderate to large, finely granulated cytoplasm with distinct cell borders. The background of the smears had a polymorphous inflammatory infiltrate, necrotic debris and proteinaceous material. A high mitotic rate was observed, as were rare bizarre and atypical multinucleated cells. There was no evidence of koilocytes. These findings were highly suggestive of glassy cell carcinoma and were confirmed by the histologic and immunocytochemical findings, with positivity for cytokeratin (MNF116), vimentin and carcinoembryonic antigen and negativity for HMB-45. CONCLUSION: Glassy cell carcinoma of the cervix presents a cytologic picture that can be highly suggestive of the diagnosis in typical cases; however, in difficult cases ancillary techniques, such as immunocytochemistry, as well as histologic findings might confirm the diagnosis.     

The role of cytology in the detection of malignant lymphoma of the uterine cervix.

The success of cytologic examination in the diagnosis of malignant lymphoma of the cervix is at present limited. The generally accepted cytologic criteria for the identification of malignant lymphoma may have to be applied with caution when examining material obtained by abrasive technique; the diagnosis should not be entirely excluded, even in the presence of cell aggregates.     

Cytologic detection of malignant lymphoma cells with a hairy appearance in ascitic fluid. Report of a case with immunofluorocytometric analysis

Neoplastic lymphocytes with a hairy appearance were detected in the ascitic fluid from a case of retroperitoneal malignant lymphoma. Although the tumor cells resembled those of hairy-cell leukemia (HCL), no leukemic change was observed, and the anatomic location of the neoplastic cells was different from that seen in HCL. The tumor cells were positive for some immunohistochemical markers of HCL (i.e., CD1 9 and SIg) but were negative for others (CD11c, CD25 and tartrate-resistant acid phosphatase). Immunocytofluorometric and postmortem histologic studies showed the lesion to be a well-differentiated B-cell lymphocytic lymphoma with plasmocytic differentiation in some cells.     

Establishment and characterization of human malignant lymphoma cell line derived from uterine cervix

Human uterine cervical malignant lymphoma (B-cell type) was cultured and the cell line (HIUML) was newly established. The HIUML cells were round in shape and had a tendency to make floating clusters. The cells had a smooth surface or protrusion on the margin of the cytoplasm, and proliferate in floatation. The population doubling time was about 32 hours and 42 or more passages were successfully observed in two years. The HIUML cells were not transplantable into nude mice but were successfully done in the cheek pouch of hamster with formation of malignant lymphoma. Epstein-Barr virus was detected in the HIUML cells.     

Detection of malignant melanoma of the uterine cervix from Papanicolaou smears. A case report

A case of malignant amelanotic melanoma of the uterine cervix in a patient presenting with right hemiparesis and enlarged lymph nodes was diagnosed in Papanicolaou-stained cervical smears showing many melanoma cells. Melanoma cells with bizzare nuclear and cytoplasmic abnormalities, rarely seen in other tumors, helped to establish a positive diagnosis. The diagnosis was confirmed by histopathologic study of the endocervical surgical specimen, including a positive immunoperoxidase staining for S-100 protein.     

Primary malignant lymphoma cutis.

Between 1934 and 1975, 16 patients with primary malignant lymphoma cutis were seen at the Ottawa clinic of the Ontario Cancer Foundation. The lesions were purplish, firm, dermal or hypodermal (or both) nodules, tumours and plaques. In all 16 the histopathologic diagnosis was diffuse non-Hodgkin''s lymphoma; 12 were considered to have prognostically bad lymphomas. However, the prognosis of primary malignant lymphoma cutis is significantly more favourable than is implied by the stage IV designation that such localized extranodal involvement would have required under the Rye clinical staging classification.     

Pemphigus vulgaris with subclinical involvement of the uterine cervix. Report of a case with persistence of abnormal Papanicolaou smears posthysterectomy

A case of pemphigus vulgaris is reported in which abnormal Papanicolaou smears continued prior to and after hysterectomy despite a normal pelvic examination. Microscopic foci of cervical pemphigus were found only in a retrospective study of the surgical material. Subclinical involvement of the cervicovaginal area with pemphigus, especially in a patient whose disease is apparently under control with steroids, can be a source of atypical Papanicolaou smears. The importance of careful colposcopic examination and clinical history is stressed for the gynecologist and cytopathologist, respectively.     

Primary cecal lymphoma. Report of a case with preoperative diagnosis by fine needle aspiration and immunocytochemistry.

Fine needle aspiration of a cecal mass was performed on a patient with a cecal tumor and iron-deficiency anemia. Cytologic studies of the air-dried smears showed large cell lymphoma. The diagnosis of large cell lymphoma of the B-cell type was affirmed by immunocytochemical studies and at laparotomy and resection of the tumor. Even under unusual circumstances, the diagnosis of such a rare abdominal lesion as primary cecal lymphoma can be made with certainty by cytologic and immunologic studies of fine needle aspirates.     

Malignant melanoma of the cervix. Report of a case

A malignant melanoma of the cervix, a rare neoplasm, was found to have an unusual cytologic pattern, similar to that of a leiomyosarcoma. A biopsy sample was diagnosed as cervical malignant melanoma of the spindle cell type. Some neoplastic cells in the tissue contained melanin pigment, whereas none of the abnormal cells in the cervical scrapes, except for an abnormal giant cell, had visible cytoplasmic pigment. The abnormal cells in the cervical scrape specimen were spindle-shaped, as were their nuclei, which is why the cytologic pattern was interpreted as that of a leiomyosarcoma. Evidence from this and previously reported cases shows that malignant melanoma must be considered as a possible source of exfoliated abnormal nonpigmented spindle-shaped cells in a cervicovaginal cell sample.     

Primary malignant melanoma of uterine cervix: a rare entity diagnosed on fine needle aspiration cytology – report of a case

Primary malignant melanoma of uterine cervix is a rare neoplasm. Its diagnosis on cervical fine needle aspiration cytology, a first of its kind in the literature, has been reported. Although cervix is a rare site for melanoma, cytopathologists should be familiar with it and be able to diagnose this entity on cervical cytology when pigment containing tumour cells are present. In a patient with visible growth on cervix, fine needle aspiration cytology may prove to be a useful diagnostic tool, especially when cervical smear/scrape cytology is non-diagnostic.     

Sarcoma botryoides of the cervix. Report of a case with cytopathologic findings.

BACKGROUND: Cytologic findings of sarcoma botryoides were still equivocal because sarcoma botryoides of the uterine cervix is an extremely rare neoplasm, and few cases have been reported to date. CASE: A 17-year-old female was diagnosed with sarcoma botryoides of the uterine cervix. The entire vaginal canal was occupied with polypoid masses, which arose from the anterior lip of the uterine cervix, and the tumor was classified as group I (Intergroup Rhabdomyosarcoma Study). After wedge resection and six courses of combination chemotherapy, the tumor recurred in the same location of the cervix as the primary lesion. Touch smear of the polypoid mass formed loose clusters and also showed short spindle cells in a necrotic background. The nucleus of the tumor cells had a thin nuclear membrane, fine chromatin pattern and partly clear nucleolus, showing mild nuclear atypia. Immunohistochemically, some of the tumor cells showed positive staining for myoglobin and desmin. CONCLUSION: The cytologic findings of sarcoma botryoides of the female genital tract are typical features of nonepithelial malignant tumor. Immunohistochemical study is useful for the diagnosis of rhabdomyosarcoma.     

Association of body cavity-based lymphoma and human herpesvirus 8 in an HIV-seronegative male. Report of a case with immunocytochemical and molecular studies

BACKGROUND: Recently lymphomas arising primarily in serosal surfaces have been found in patients with advanced acquired immunodeficiency syndrome (AIDS), but they very rarely seem to occur in human immunodeficiency virus (HIV)-negative patients. Studies on a subset of these lymphomas suggested that they represent a distinct entity associated with Kaposi's sarcoma-associated herpesvirus or human herpesvirus 8 (HHV-8). CASE: An 83-year-old, HIV-negative male was admitted to the hospital with a massive pleural effusion. Abdominal and chest computed tomographic scanning was normal. Cytologic analysis of the pleural effusion revealed a large cell, non-Hodgkin's lymphoma. Polymerase chain reaction analyses on genomic DNA from the pleural effusion demonstrated the presence of HHV-8 sequences in the absence of Epstein-Barr virus. CONCLUSION: It is possible and advantageous to diagnose body cavity-based lymphoma with a combination of cytologic, immunocytochemical and molecular studies of the pleural effusion in conjunction with clinical and radiographic information.     

Verrucous carcinoma of the uterine cervix. A case report

The cytohistopathologic features of a verrucous cervical carcinoma are reported. The presence in a cervical smear of two distinct types of dyskaryotic cells, with regularity of size and shape, and of occasional vacuolated cells set in a bright, eosinophilic background should suggest the lesion. With the cytologic suggestion and the typical warty clinical appearance of the tumor, an accurate preoperative diagnosis may be established.     

Malacoplakia of the uterine cervix. Histologic, cytologic and ultrastructural study of a case

A rare case of malacoplakia of the uterine cervix is described. The histologic, histochemical and ultrastructural findings in this case were typical of this entity. The typical Michaelis-Gutmann bodies were quite easily identified in the cervicovaginal smear with the use of the Von Kossa stain. This method can be an important diagnostic aid in cytologically differentiating this lesion from neoplastic or parasitic processes.     

Thin-layer cytology findings of papillary adenosquamous carcinoma of the cervix. Report of a case with histologic correlation and molecular analysis

BACKGROUND: Papillary squamotransitional cell carcinoma of the lower female genital tract is a rare form of malignancy with distinctive histologic features. To my knowledge, its adenosquamous counterpart has not been reported before. CASE: A 69-year-old woman presented with postmenopausal bleeding due to a bulky cervical tumor. The thin-layer cytology preparation (Autocyte, TriPath Imaging, Burlington, North Carolina, U.S.A.) was of high cellularity and contained multiple small, papillary clusters of basaloid to columnar cells. Discernible fibrovascular cores were noted. In the background were many loosely dispersed, bland-looking columnar cells as well as cells of high grade squamous intraepithelial lesion (CIN 3). On a diligent search, scattered adenocarcinoma cells containing distinct intracytoplasmic vacuoles were found. There were a small number of dyskaryotic squamous cells with bizarre shapes, assuming "tadpolelike" morphology. Histologic examination of the tumor biopsy showed a papillary tumor with central fibrovascular cores covered with mitotically active, poorly differentiated squamous cells that imperceptibly merged with abortive glandular structures. Molecular analysis using the polymerase chain reaction and restriction fragment length polymorphism revealed the presence of human papillomavirus type 16 DNA in the liquid-based cytology sample. CONCLUSION: Papillary adenosquamous carcinoma of the cervix shares some morphologic and even histogenetic overlaps with papillary squamotransitional cell carcinoma and, to a lesser extent, conventional endocervical adenocarcinoma. It may pose certain diagnostic dilemmas for the unwary. In view of its distinctive cytohistologic features, this tumor warrants greater recognition in gynecologic pathology.