J Korean Med Sci 2005; 20: 93-7 ISSN 1011-8934 Copyright The Korean Academy of Medical Sciences Cytologic Findings of Cervicovaginal Smears in Women with Uterine Papillary Serous Carcinoma The goal of this study was to evaluate the cytomorphologic features of histologically confirmed uterine papillary serous carcinomas (UPSC) of the endometrium. We reviewed cervicovaginal smears from 12 patients with UPSC who had done their cervical smears at six months to a year earlier before the time of diagnosis; nine smears (75%) were diagnosed as positive for malignancy and three smears (25%) were diagnosed as negative. The cervical smears of patients with UPSC revealed frequent papillary clusters that were composed of large pleomorphic tumor cells with prominent nucleoli in a background of necrosis. Other findings revealed from the tests were relatively frequent single malignant cells and bare nuclei. Although the Pap smear is not a sensitive screening test for endometrial carcinoma, we could depend on it to reveal the cytologic features of UPSC which are fairly characteristic and reliable for a preoperative diagnosis of UPSC. Preoperative identification of this poor prognostic variant of endometrial carcinoma may influence the surgical man- agement of these cases and the choice of adjuvant therapy. Key Words : Endometrial Neoplasms; Carcinoma, Papillary; Vaginal Smears Ji-Young Park, Hye Sun Kim, Sung Ran Hong, Yi Kyeong Chun Department of Pathology, Samsung Cheil Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea Received : 21 June 2004 Accepted : 12 October 2004 Address for correspondence Yi Kyeong Chun, M.D. Department of Pathology, Samsung Cheil Hospital, Sungkyunkwan University School of Medicine, 1-19, Mukjeong-dong, Jung-gu, Seoul 135-701, Korea Tel : +82.2-2000-7663, Fax : +82.2-2000-7779 E-mail : ykcmd.chun@samsung.com INTRODUCTION Uterine papillary serous carcinoma (UPSC) of the endome- trium has been recognized as an aggressive, high grade malig- nancy that morphologically resembles its ovarian counterpart (1-4). Like papillary serous carcinoma of the ovary, it has a propensity for vascular or lymphatic invasion and peritoneal dissemination as well as early, extensive myometrial invasion (2, 3). In contrast to typical endometrioid carcinoma (TEC) of the endometrium, UPSC is more likely to be identified in cervicovaginal smears (4). Identification of this variant of en- dometrial carcinoma is clinically valuable because of its aggres- sive course and poor prognosis. However, descriptions about the cytologic presentation of UPSC have been few and far between in literature. Here in our study, we have reviewed and described the cytologic features of UPSC. MATERIALS AND METHODS Twenty five cases of UPSC, dating from 1986 to 2004, were retrieved from pathology files at Samsung Cheil Hospital. The histology slides of these cases were reviewed and it was found that twenty two of the cases were diagnosed with pure UPSC. The remaining three cases were diagnosed with a mix- ed UPSC and endometrioid adenocarcinoma. Twenty three 93 cases had preoperative cervicovaginal smears submitted within one year of the time of the operation or at the time of the oper- ation. Twelve other cases that had cervicovaginal smears with a diagnosis of UPSC were reviewed for this study. All of twelve cases had preoperative endometrial biopsy or curettage to his- tologically confirm the diagnosis and eight of the patients had hysterectomy. Histologic samples were evaluated for histologic type, depth of invasion, lymph node and vascular involvement, involve- ment of the cervix, histologic metastasis and presence of malig- nant cells in the peritoneal washing fluid. Cervicovaginal smears were assessed for the presence of excessive blood and acute inflammation, necrosis and psam- moma bodies. Cellularity was recorded, as well as the pres- ence of papillae and flat sheets of tumor cells. The occurrence of single cells with intact cytoplasm and bare nuclei were noted. The nuclei of abnormal cells were evaluated for their size, pleomorphism, location and chromatin features. Cyto- plasm was evaluated for its amount, density and borders and for the presence of vacuolization and phagocytosis by neu- trophils. The amount of cellularity as shown in the cellular smear was subjectively assessed as low, moderate or high, and the remainders of other architectural features were recorded as either present or absent. The presence of psammoma bod- ies was also noted.