Cytologic diagnosis of peritoneal fluids. Applicability to the laparoscopic diagnosis of endometriosis.

OBJECTIVE: To determine the accuracy of cytologic examination of laparoscopically obtained peritoneal fluid in the diagnosis of endometriosis. STUDY DESIGN: This investigation analyzed 50 laparoscopic fluid specimens received over a three-year period. Retrospective cytologic findings were correlated with clinical history and laparoscopic diagnoses. Touch preparations were also collected from necropsies to develop cytologic criteria necessary to distinguish endometrial cells from mesothelial cells. RESULTS: The presence of hemosiderin-laden macrophages in peritoneal fluids was more specific but less sensitive than the presence of endometrial cells for the diagnosis of endometriosis. CONCLUSIONS: In women undergoing laparoscopy to detect endometriosis, the identification of endometrial cells alone in peritoneal fluids may not be sufficient to render a definitive diagnosis of endometriosis. However, the presence of hemosiderin-laden macrophages in this population should alert the cytologist to that possibility.

Herpesvirus mimics. A potential pitfall in endocervical brush specimens.

The recent media focus on inadequacies in cervical smear collection and interpretation has resulted in improved collection methods, such as endocervical brushes, as well as closer scrutiny of morphologic criteria. However, endocervical cell artifacts may be associated with these endocervical brushes. Recently in our laboratory a case of reactive-atypical endocervical cells that resembled the cytologic changes associated with Herpes simplex virus (HSV) infection resulted in a false-positive diagnosis of HSV infection. Of 14,622 gynecologic specimens accessioned over 14 months, 459 cases with reactive endocervical cells and 117 with atypical endocervical cells were reported. These cases were reviewed by two independent observers with no knowledge of the prior diagnoses and were evaluated for four cytologic criteria considered diagnostic of HSV infection: multinucleation, margination of nuclear chromatin, ground glass chromatin and intranuclear inclusions. Nineteen cases were diagnostic/suggestive of HSV; 19 additional cases were identified as herpesvirus mimics. The original diagnoses, demographics, clinical data and method of collection were reviewed. In all but three cases an endocervical brush was the method of collection. Of the four criteria studied, only ground glass chromatin had both high sensitivity (95%) and specificity (95%). Intranuclear inclusions, while pathognomonic, had low sensitivity (42%). Altered endocervical cells that mimic herpesvirus are a potential pitfall in the diagnosis of HSV infection. Use of strict criteria, knowledge of the collection method and clinical history will avoid misdiagnosis.