Classification of benign endometrial glandular cells in cervical smears from postmenopausal women

The Bethesda System recommends reporting benign endometrial cells in cervical smears from postmenopausal (PMP) women as a glandular cell abnormality. However, PMP women on hormone replacement therapy (HRT) sometimes may experience endometrial shedding. The significance of such a finding has not been investigated in detail.

The authors evaluated 85 PMP women with cervical smears that contained benign endometrial glandular cells. Clinical information, including vaginal bleeding and the use of HRT or tamoxifen, was recorded, and follow-up was obtained.

Thirty-three PMP women were not on HRT, and 11 women were symptomatic. Twenty women underwent endometrial biopsy: Two symptomatic patients had endometrial adenocarcinoma, and 3 symptomatic patients and 1 asymptomatic patient had endometrial polyps. The frequency of abnormal findings was 18%. Forty-seven PMP women received HRT; 15 were symptomatic. Twenty-two patients underwent endometrial biopsy: 1 symptomatic patient had cystic hyperplasia, and 2 symptomatic patients and 1 asymptomatic patient had an endometrial polyp. The frequency of abnormal findings was 8.5%. No one type of HRT was correlated with specific findings. Five PMP women were on tamoxifen, and two of them were symptomatic. Four patients underwent endometrial sampling: Two of them had an endometrial polyp, which was symptomatic in one patient.

These data confirm that benign endometrial glandular cells in cervical smears from PMP women may indicate endometrial pathology, especially if vaginal bleeding is present. Although atypical endometrial hyperplasia or carcinoma was not identified in the group of PMP women on HRT, endometrial abnormalities of a lesser degree were present in 8.5% of patients. Thus, the authors favor continued classification of benign endometrial glandular cells in cervical smears of PMP women, whether or not they are on HRT, as a glandular cell abnormality.