2017 Volume 56 Issue 1 Pages 33-38
Background : The term undifferentiated uterine sarcoma (UUS) was first proposed in the 2014 WHO classification. It is difficult to make an accurate diagnosis of UUS. In the preoperative diagnostic studies in our case, endometrial liquid based cytology (LBC) indicated “sarcoma suspicion” and endometrial biopsy suggested “undifferentiated cancer (UC)”. We report the reason why endometrial cytology was more useful than endometrial histology for the accurate diagnosis of UUS.
Case : A 52-year-old woman was admitted with a history of abnormal genital bleeding. The cytological findings revealed loosely arranged cells, with the nuclei containing dense chromatin, although the chromatin was more finely granular than that in cancer cells. Histology revealed that almost the entire tumor showed hemorrhage and necrosis ; only a few tumor cells in the remaining part of the tumor, with the cells appearing to be arranged in tight clusters. Therefore endometrial cytology by LBC was more useful for the diagnosis of UUS.
The reasons why cytology was more useful are as follows :
1. The tumor cell details could be observed without any interference from the hemolyzed blood cells.
2. Immunostaining of the tumor cells confirmed their mesenchymal differentiation.
Conclusion : For accurate diagnosis of UUS, which is a bulky tumor with bleeding and necrosis, our experience suggests that endometrial LBC is more useful than endometrial histopathology.
