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Title: |
Observation of Epithelial Atypia Associated with Intranuclear Inclusions in Ovarian Endometriosis | |||||||||||||||||||
| Authors: | Tadao K. Kobayashi, Ph.D., C.F.I.A.C., and Hajime Okamoto, M.D., Ph.D. | |||||||||||||||||||
| To the Editors: We read with great interest the article by Sakaki and colleagues on ovarian endometriosis with the Arias-Stella reaction1 and would like to comment on their cytologic findings in this case. These authors recognized that the epithelial atypia associated with nuclear pleomorphism and intranuclear cytoplasmic inclusions is difficult to separate from that of adenocarcinoma cells. They suggested that clear nuclei with a positive immunoreaction for biotin were helpful in identifying Arias-Stella cells. The figures in the report show epithelial cells with enlarged nuclei and ground glass-like intranuclear inclusions. These cells are extremely important to recognize because they may be diagnosed erroneously, especially as evidence of a glandular neoplasm. In our experience these epithelial changes may be from Arias-Stella cells and closely resemble those of naked nuclei with homogeneous chromatin, as shown in earlier papers of ours.2,3 These changes mimic those found in atypical epithelial cells, and great care must be taken in the interpretation of cytologic findings in patients who are on an assisted reproductive technology regimen that involves the use of hormonal drugs. If one makes preparations by imprinting from the cut surface of the ovarian cystic mass, the smear usually provides excellent cytologic detail with minimal deterioration in quality, such as chromatin clumping and clearing, and uneven thickening of the chromatin rim. If these cells are found exfoliated, they might be very similar to those seen in vaginal smears in cases of abortion and ectopic pregnancy. | ||||||||||||||||||||
| Keywords: | endometriosis, ovarian diseases, epithelial atypia, intranuclear inclusions | |||||||||||||||||||
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