Cytologic criteria of hyperplastic lesions in endometrial samples obtained by the endocyte sampler

The present investigation attempted to identify useful parameters for the cytologic diagnosis of endometrial hyperplasias in samples obtained with the Endopap endometrial sampler. A clinical and morphological classification dividing hyperplasia into benign simple hyperplasia (BSH); benign complex hyperplasia (BCH); and endometrial intraepithelial neoplasia (EIN) has been suggested by Meisels, et al. based on five valuable cytologic criteria. To these we added six of our own and applied them to 1.172 cases, 432 of which had a previous histologic diagnosis of normal proliferative endometrium (NPE); 462 were BSH, 210 were BCH, and 14 fit the EIN pattern. The cytologic criteria evaluated were overlapping cells, enlarged nuclei, aniso karyosis, granularity of chromatin, stromal cells, branching glandular structures, and moruloid or papillary-like cellular aggregates, dilated glandular borders in cellular sheets, nuclear clearing, clumped chromatin, and enlarged eosinophilic cytoplasm. Our results are consistent with the following findings: (1) there is no useful parameter for cytologic differentiation between NPE and BSH; (2) BCH is characterized by cellular aggregates, dilated glandular borders in cellular sheets, and branching glandular structures; (3) EIN is characterized by nuclear clearing, clumped chromatin, and anisokaryosis; and (4) enlargement of nucleoli and eosinophilic cytoplasm alone is not sufficient for the diagnosis of EIN.