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Objective: To determine the significance of pregnancy-related cells in endometrial smears., Study Design: Pregnancy-related cells in 4429 endometrial smear samples were retrospectively analyzed and evaluated for clinicopathologic and cytomorphologic features., Results: Of the 4429 endometrial smears taken for cancer screening, pregnancy-related cells were detected in 12 cases (0.3%). They were estimated cytologically as negative or suspicious and confirmed as cases ofspontaneous abortion (8 cases), placental site nodule (3 cases), and partial hydatidiform mole (1 case). Decidual cells were observed in all cases, and some of these showed atypia. Trophoblasts were observed in 5 (41.7%) of the 12 cases. Syncytiotrophoblasts were observed in 1 case (8.3%) and nonsyncytiotrophoblasts in 5 (41.7%) of the 12 cases. Pregnancy-related cells were observed in an endometrial smear in 7 cases; other cases were missed during cytologic examination and were retrospectively identified., Conclusion: Pregnancy-related cells are likely to be missed because they are difficult to identify or are surrounded by a cluster of endometrial cells. The decidual cell is a key cell for the cytologic diagnosis of pregnancy-related cells. Determining the existence of pregnancy-related cells in endometrial smears is important for the further assessment of patients and the differential diagnosis of several endometrial lesions.

Objective: Endometrial cytology in nine cases of ectopic pregnancy was examined in order to elucidate the cellular characteristics of the Arias-Stella reaction and decidual change., Study Design: The cellular findings of epithelial and stromal cells were compared with histologic findings in each case. Furthermore, the immunocytochemical reactivity of each type of cell cluster-epithelial cells without atypia, epithelial cells with atypia, deep stromal cells and sheetlike stromal cells-to epithelial membrane antigen (EMA) or vimentin was investigated and compared with cytologic findings in smears stained with Papanicolaou stain., Results: The distribution of each type of cell cluster correlated fairly well with the histologic findings on the endometrium. Immunocytochemical examination revealed that EMA expression coincided with cell origin identified by Papanicolaou stain. Epithelial cells with atypia, probably corresponding to the Arias-Stella reaction, frequently showed positive reactivity to antivimentin antibody as well as anti-EMA antibody. Endometrial stromal cells usually indicated negative reactivity to anti-EMA antibody. Deep stromal cells expressed vimentin, but sheetlike stromal cells, thought to be decidual cells, infrequently expressed vimentin., Conclusion: The Arias-Stella reaction may be the result of the regenerating and proliferating activity of endometrial glands. It is still controversial whether sheet-like stromal cells are identical to decidual cells.

The cytomorphologic observations of ascites from three patients with ovarian dysgerminomas are presented. As compared with those in adenocarcinoma, the cytologic findings in this rare malignant ovarian tumor showed more cells lying isolated or in sheetlike arrangements, fewer cells with discrete cytoplasmic vacuoles, less frequent thickening of the nuclear membrane and more frequent multinucleolation.

The cytologic features of six cases of stomach cancer metastatic to the uterine cervix are presented. Atypical cells were found in cytology samples from four patients. Fewer atypical cells, larger cellular and nuclear areas, more discrete vacuoles, increased frequencies of thickening of the nuclear membrane and more coarsely granular chromatin patterns were the characteristic cytologic findings of metastatic cervical adenocarcinoma as compared with primary endocervical adenocarcinoma.

To establish the differential diagnosis of repair cells from malignant cells, 624 repair cells from 11 cases, 547 cells derived from 8 adenocarcinomas and 593 cells from 8 squamous-cell carcinomas were analyzed, with stress on the morphology of the nucleoli. Such planimetric data as mean cellular areas, mean nuclear areas, mean nucleolar areas, nuclear-cytoplasmic ratios and nucleolar-nuclear ratios were fairly similar among the three cell groups. However, the even distribution of nucleoli in the nuclei, the decrease in C-type nucleoli and nucleoli consistently linked with nucleolus-associated chromatin were noted to be reliable criteria for the diagnosis of repair cells along with such well-known morphologic characteristics as the sheetlike arrangement of repair cells, the lack of isolated forms, the finely granular chromatin pattern and the round, smooth nuclear configuration with a thin nuclear membrane.

The cytologic findings in 15 endometrial hyperplasias were compared with those of normal endometrium and well-differentiated endometrial adenocarcinoma. Differences in tumor diathesis, hypercellularity, uneven internuclear distance, severe piling up of nuclei, anisokaryosis, nuclear size and macronucleoli were the main cytologic findings that were noted among the three conditions. These features varied in the different types of endometrial hyperplasia. It is not clear that these cytologic findings can be used to cytologically diagnose endometrial hyperplasia because some of the findings involve subjective judgments by different cytologists. Further studies on larger series of cases will be necessary to establish the cytologic criteria for the correct interpretation of endometrial abnormalities.

The nuclear DNA content of trophoblasts was measured in 25 cases of normal pregnancy, 46 cases with hydatidiform mole, ten cases with destructive mole and six cases of chorionepithelioma (choriocarcinoma). In normal pregnancy, DNA distribution in syncytiotrophoblasts and cytotrophoblasts showed a sharp peak at the diploid region, although a few cytotrophoblasts with increased DNA content were observed in the first trimester. In chorionepithelioma the DNA content of the trophoblastic cells showed extremely wide distribution without any special peak. In destructive mole, although a wide distribution was observed, the sharp peak was usually noted at the diploid range. Cases with hydatidiform mole were divided into two categories according to the DNA distribution patterns. Type I showed the patterns similar to the first trimester of normal pregnancy and type II resembled the patterns of destructive mole. In hydatidiform mole of type II, subsequent progress towards destructive mole was frequently encountered.