Endometrial cells in pap smears of postmenopausal women: cytohistologic correlation

To evaluate the significance of endometrial cells in Papanicolaou (Pap) smears of postmenopausal women.

We reviewed all Pap smears of postmenopausal women from 1992 to 1999. Follow-up endometrial tissue obtained within 1 year of any Pap smear containing benign endometrial cells or foamy histiocytes was also reviewed.

A total of 159 Pap smears containing benign endometrial cells or foamy histiocytes were identified. Fifty-six patients were excluded; 34 patients had no histiologic follow-up; 12 had insufficient tissue on endometrial sampling; and 10 had atypical glandular cells on cytologic analysis. Endometrial pathologic features were identified in 31 patients (30%), including 21(20%) with polyps, six (6%) with endometrial hyperplasia, and four (4%) with adenocarcinomas. Hormonal replacement therapy was not a factor associated with these endometrial adenocarcinomas. Six of the 10 patients with significant endometrial pathologic features (simple and complex endometrial hyperplasia or adenocarcinomas) were referred for evaluation based solely on their cytologic abnormality showing benign endometrial cells or foamy histiocytes.

Both benign endometrial cells and foamy histiocytes on Pap smears in postmenopausal women are associated with endometrial pathologic features. Benign endometrial cells may carry a greater risk than foamy histiocytes.