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Cervix-Cytology

Normal cells / non-neoplastic findings

Post-hysterectomy

Reviewer: Farnaz Hasteh, M.D., UCSD Medical Center (see Reviewers page)
Revised: 7 December 2010, last major update December 2010
Copyright: (c) 2006-2010, PathologyOutlines.com, Inc.

Definition
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● Vaginal vault smears are obtained for routine follow up
● Routine vaginal cuff cytology screening tests may not need to be performed if hysterectomy was performed for benign uterine conditions (J Am Board Fam Pract 2000;13:233)

Epidemiology
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● Benign glandular cells are present in up to 13% of posthysterectomy specimens (Cytopathology 2004;5:195)

Etiology
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Differential diagnosis of glandular cells posthysterectomy (DeMay: The Pap Test: Exfoliative Gynecologic Cytology (1st Ed); ASCP, 2005)

● False history of hysterectomy
● Vaginal adenosis (Eur J Gynaecol Oncol 2000;21:43)
● Therapy induced metaplasia (Int J Gynecol Cancer 2006;16:670)
● Atrophic cells
● Goblet like cells
● Fallopian tube cells due to prolapse after hysterectomy
● Endometriosis
● Fistula
● Mesonephric duct remnants
● Adenocarcinoma

Case reports
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● 76 year old woman with post-hysterectomy fallopian tube carcinoma presenting with positive cervicovaginal smear (Obstet Gynecol 1999;94:834)

Cytology description
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● Vaginal vault smears contain glandular cells with delicate cytoplasm and a honeycomb arrangement of cells (atrophic parabasal cells)
● Vaginal vault smears may contain columnar or metaplastic cells (Cytopathology 1999;10:122)
● Intracytoplamic mucin (endocervical cells) may be present (Acta Cytol 1998;42:1403)
● Often features of inflammation / repair in background

Cytology images
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Glandular and squamous cells

End of Cervix-cytology > Normal cells / non-neoplastic findings > Post-hysterectomy

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