Contributed by Deepak Mohan, MD, Elise Hoff, MD, Mirka Jones, MD, David J Dabbs, MD
Published on line in March 2004
A woman in her 60s underwent a hysterectomy for high-grade cervical dysplasia and dysfunctional uterine bleeding.
INTRA OPERATIVE CONSULTATION:
Uterus, anterior cul-de-sac peritoneum, frozen section - 0.7 X 0.4 X 0.3 cm. Pink-yellow tissue:
Uterus with bilateral adnexa, 84 grams, 7.0 x 5.0 x 1.7 cm. The serosal surface is pink-tan and smooth with a mass located at the fundus measuring 3.5 x 3.0 x 2.0 cm. Sectioning reveals slightly yellowish-tan and hemorrhagic tissue. The endometrial cavity is approximately 4.0 x 2.0 cm. with a 0.1 cm. thick, tan-pink and focally hemorrhagic lining. The myometrium is 2.0 cm. in thickness with multiple firm pale nodules up to 1.5 cm. in greatest dimension. Sectioning reveals tan-whorled tissue pattern.
CYTOLOGY PELVIC WASH:
Small-round, spindle cells, with scant wispy cyanophilic cytoplasm "comet cells" as described by Kanbour et al, isolated or loose aggregates of cells with elongated or caudate shapes and cyanophilic cytoplasm Fig 1-8.
Figs. 1-8: Pelvic Wash Positive for Malignant Cells
Figs. 9-11: 1.5 cm whorled lesion
Figs. 12-23 Tan yellow areas with hemorrhage
Figs. 24 & 25: Desmin positivity in the spindle cells
Figs. 26 & 27: Smooth Muscle Actin Positivity in the spindle cells