Cytologically benign endometrial cells in the Papanicolaou smears of postmenopausal women

Objective. The objective of this study was to determine the clinical signif icance of the presence of benign endometrial cells in the Pap smears of pos tmenopausal women. Methods. A retrospective analysis of the clinical outcome of 297 postmenopa usal women containing benign endometrial cells in their Pap smears was perf ormed. All patients had subsequent endometrial biopsies or routine follow-u p for 1-5 years. In addition, Pap smears of 253 of the patients were review ed with particular reference to the morphology and type of the endometrial cells. Immunohistochemical staining with CD68 was performed in 15 selected cases to determine the origin of the stromal cells. Results. One hundred thirty-two (44%) women had endometrial biopsies while the remaining 165 (56%) were followed up by routine gynecologic examination s and repeat Pap smears. Endometrial lesions were detected in 14 patients o f whom only 3 had significant lesions (2 atypical hyperplasias and 1 adenoc arcinoma). Review of the Pap smears revealed benign superficial endometrial stromal cells in most cases (73%). Stromal cells showed CD68 positivity in dicating a histiocytic origin. Glandular cells were present in 27%, either alone or in association with stromal cells. Statistical analysis revealed t hat the presence of endometrial glandular cells in Pap smears was associate d with five times the likelihood of significant endometrial disease than fo und in women with normal Pap smears, although sensitivity and positive pred ictive value were very low (7.14 and 2.94%, respectively). Superficial endo metrial stromal cells were not useful in predicting endometrial pathology. Conclusion. Significant endometrial lesions were present in 1% of postmenop ausal women containing morphologically benign endometrial cells in the Pap smears. In the majority, the endometrial cells were of the superficial stro mal type, which were demonstrated immunohistochemically to be histiocytes. The presence of endometrial glandular cells correlated significantly with e ndometrial pathology. Such an association was not observed in cases with st romal cells only. (C) 2001 Academic Press.