This patient underwent total abdominal hysterectomy and bilateral oopherectomy due to endometrial complex hyperplasia with atypia, the left ovary showed a mass ” couldn’t resist the temptation of taking a smear for fast pap stain” which showed this spindle tumor with fasicular arrangement. the tumor later proved to be a fibrothecoma quit known to screte lots of estrogen that may lead to hyperplastic endometrium. strangly the cells on smears showed many grooves as on sections a feature seen in estrogen secreting granulosa cell tumor.
- The smears are hyper cellular.
- cells appear singly or in loose groups or pseudo rosettes.
- Three types of cell have been described:
- The first type is small to moderate-sized polygonal cells with finely granular cytoplasm and uniform roundor oval nuclei with granular chromatin and prominent chromocenters. These cells are the prototypic cells of neuroendocrine tumors.
- The second type is spindle cells with abundant cytoplasm, elongated nuclei, and coarse granular chromatin.
- large, myoid-like cells with eccentric large nuclei, prominent nucleoli, and abundant pale, finely granular cytoplasm.
The smears may be composed of a mixture of these cell types or one cell type may predominate. “M.BIBO 3rd ed”
Aspirating a pheochromocytoma is dangerous as it may precipitate a hypertensive crisis.
Remember the rule of 10% and multiple endocrine neoplasia association.