Exfoliative cytology of a lymphoepitheliomalike carcinoma in a cervical smear - A case report

BACKGROUND: Lymphoepitheliomalike carcinoma of the cervix (LELC) is cytolog ically identical to its counterpart at other sites, such as the nasopharynx . LELC can be suspected on a cervical cytologic smear. The differential dia gnosis includes nonkeratinizing squamous cell carcinoma with prominent stro mal inflammation, carcinoma with intense stromal eosinophilia, glassy cell carcinoma, malignant lymphoma (especially lymphoepitheloid-Lennerts lymphom a) and metastatic Schmincke-Regaud tumor. CASE: A 55-year-old female presented with an ulcerated endophytic tumor in the cervix. Exfoliative cytology showed uniform, large tumor cells, often a ssociated with inflammatory cells, with the round or oval nuclei and one or more prominent nucleoli. The cytoplasm was finely granular to flocculent, and the nuclei were uniformly vesicular. the chromatin was peripherally mar ginated. The cell orders were indistinct. There was no evidence of dyskerat otic or keratinized cells, koilocytes or glandlike formations. These findin gs were highly suspicious for LELC and were confirmed by biopsy. Flow cytom etry showed DNA aneuploidy, with a DNA index of 1.08. In situ hybridization was negative for human papillomavirus 16 and 18. CONCLUSION: LELC of the uterine cervix has cytologic features that are suff iciently characteristic for a specific cytologic diagnosis. The diagnosis n evertheless has to be proven by histology.