Adenocarcinoma cells in Pap smears

Adenocarcinomas of the cervix, endometrium, fallopian tube and ovary may present with malignant cells in a Pap smear. In contrast, carcinomas arising outside the female genital tract only rarely present in Pap smears and signs and symptoms of disseminated malignancy are usually evident. Rare isolated metastases to the uterus have been reported and a high index of suspicion is required in such instances. The cell arrangement, pattern of cell spread and the smear background reflect the pathway by which the malignant cells involve the cervix. Recognition of any specific diagnostic features coupled with judicious use of ancillary tests can be of inestimable value. Adequate clinical information, review of past medical history and all previous smears and biopsies form an integral part of the investigation. Consideration of all of these points in conjunction with an appreciation of the classical cytomorphology of endometrioid, serous and clear cell carcinomas should allow a correct diagnosis of extrauterine adenocarcinoma with a high degree of probability.