The cellular cytologic preparations contained irregularly shaped groups of atypical endometrial cells with slight cellular dyshesion (Fig. 1, Papanicolaou Stain). In some of the cell groups small glandular lumens were apparent (Fig. 1 and 2, Papanicolaou stain). Occasional papillae and papillary tufts were present (Fig. 3, Acid Hematoxylin). The nuclei of the individual cells within these groups were enlarged and hyperchromatic with irregular nuclear contours. The nuclear membranes were irregularly thickened and some cells had prominent nucleoli. There was a slight to moderate amount of cytoplasm (Fig. 2 and 3).
The cell block preparation was also highly cellular with groups of neoplastic cells arranged in short coarse papillae (Fig. 4, Hematoxylin & Eosin), papillary tufts, cribriform structures (Fig. 5, Hematoxylin & Eosin), and irregular glands (Fig. 6, Hematoxylin & Eosin). The papillae were lined by stratified layers of cells with high grade nuclei (Fig. 4). The enlarged and hyperchromatic nuclei varied in size and shape. The nuclear contours were irregular with occasional notches and shallow clefts. Prominent eosinophilic nucleoli were present (Fig. 6). An immunohistochemical stain for p53 revealed strong nuclear positivity (Fig. 7).
The papillae in papillary endometrioid adenocarcinoma most often are long and slender and may show branching. Papillary tufts, which lack a stromal core, are usually absent. Papillary endometrial adenocarcinomas also generally have low grade nuclei (grade 1 or 2) which are negative for p53. In contrast, serous carcinomas have high grade nuclei (grade 3) and the papillary processes are usually short and coarse. Papillary tufts are often present and the nuclei are strongly positive for p53.
Serous Carcinoma