Exfoliative cytology of lymphoepitheliomalike carcinoma of the uterine cervix - A report of two cases

BACKGROUND: Lymphoepitheliamalike carcinomas (LECs) are morphologically sim ilar to undifferentiated nasopharyngeal carcinoma but occur at sites other than the nasopharynx. They rarely occur in the uterine cervix. Sixty-five c ases of LEC of the cervix have been published to date, and the pitfalls of histopathologic interpretation have been discussed. This undifferentiated c arcinoma with a prominent lymphocytic infiltrate represents a challenge for the pathologist examining a scant cervical biopsy or Pay smear. Distinguis hing LEC as a separate entity is important. Despite the fact that the epith elial component is poorly differentiated, this neoplasm is associated with a lower frequency of lymph node metastases, is potentially radiosensitive a nd has a better prognosis. Although mentioned in passing in several papers, the exfoliative cytology of this cervical neoplasm has not been adequately discussed.. We report the cytologic features of LEC in cervical smears obt ained from two patients. CASES: The first patient presented with menometrorrhagia and postcoital ble eding. The cervical smear taken at the time of presentation was reported as unsatisfactory for evaluation. ASCUS was diagnosed on a vaginal smear obta ined one year evaluation. The second patient presented with a complaint of postcoital bleeding. A cervical smear and the cervical biopsy taken at the tin-re of presentation were reported as ASCUS and high grade dysplasia vers us carcinoma, respectively. A retrospective review of the cervical smears r evealed rare malignant cells occurring singly or in small groups. The tumor cells had a high nuclear/cytoplasmic ratio, irregular nuclear membrane and hyper-cromatic nuclei with coarse chromatin and were obscured by heavy inf lammation and blood. The background resembled that of a menstral smear. CONCLUSION: The diagnosis of LEC of the cervix is often made on a loop elec trical excision procedure or on a hysterectomy specimen. The presence of he avy inflammation and blood, which can obscure the malignant nature of the c ells, presents the cytopathologist with a challenging diagnosis of LEC in c ervical smears. In view of the prognostic implications, it is desirable for the pathologist to classify LEC as a distinct entity.