NILM

 Think over this case and read the photos again.

TCT=ThinPrep cytology  test. I am confused by the stain. The color of ThinPrep Pap test should not be like these. These photos look like DQ stain.

Mostly they are endometrial origin, but I am not sure. It may be easy to interpretate if you have good Pap stains. They may be just normal endometrial cells. So must know the LMP of the patient.

Again I will call AGC if I do not know any history.

We as pathologists have our limitaion especially for the interpretaion of Pap tests.

 This is a difficult case. I feel uncomfortable to call NILM. I want to know the history and patient's LMP if it were my case. The Pap smear demonstrates three-dimensional groups of small cells with crowded round nuclei. They look like endometrial cells. However, the relative abundant cytoplasm of the cells make you think they are clusters of endocervical cells.

If patient is in the day 1-12 of menstrual cycle, I will report endometrial cells consistent wit the cycle.

If I know nothing about history and LMP, I will call AGC (or endometrial cells). Patient will get cervical and endometrial sampling. Patient (>40 yr) will get endometrial sampling if you report endometrial cells without consistent with cycle.  If you joined my talk yesterday, you will know more than 70-80% of women with AGC will not have neoplastic lesoins. This case demonstrates that the agreement for the dx of AGC is very poor.   See above dx: NILM, AGC, HSIL, endocervical cells, endometrial cells.

Anyway I will not call NILM for this case even though mostly it is a NILM case.

颈管柱状上皮。