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  • Title: Cytologic atypias in the uterine fluid of intrauterine contraceptive device users.
    Author: Kobayashi TK, Casslén B, Stormby N.
    Journal: Acta Cytol; 1983; 27(2):138-41. PubMed ID: 6573085.
    Abstract:
    A peculiar cell pattern, characterized as an atypical glandular cell cluster (AGCC), was found in the uterine fluid from women using intrauterine contraceptive devices (IUDs). This atypia can mimic adenocarcinoma. Since the atypical cells were present in much higher frequency in the uterine fluid than in the cervical mucus, it is suggested that they originated in the endometrium. In a current research program on intrauterine cytology, an effort was undertaken to describe and quantitate the atypical glandular cell cluster (AGCC) observed in uterine fluid from IUD users. Uterine fluid was sampled and cervicovaginal smears taken from 54 healthy women of reproductive age with regular menstrual periods. 34 of the patients had used an IUD (TCu 200, Recip, Sweden) for 1-1/2 to 3 years. 20 patients did not use IUDs or oral contraceptives (OCs). Within each group, samples were taken in the proliferative phase (8th-16th day of the cycle) and in the luteal phase (17th-30th day of the cycle). The uterine fluid was aspirated with a sterile pediatric feeding tube. A low aspiration vacuum minimized the trauma to the endometrial mucosa, and thus a blood free sample could be obtained. Papanicolaou, AGCCs were counted on both slides, and the sum was given as the number/mcl. The number of inflammatory cells/mcl of uterine fluid was also calculated for each sample. AGCCs were present in the uterine fluid smears from 22 of the 34 IUD users. They occurred similarly in the proliferative and luteal phases. In these 22 samples, a mean of 5.1 clusters/mcl was found. Each cluster consisted of 3-40 cells; the individual cells varied morphologically but were generally characterized by enlarged nuclei, with coarsely granular, irregularly distributed chromatin, occasionally a marked nuclear border, and conspicuous nucleoli. Some cells even revealed marked clumping of the chromatin and macronucleoli. It is thus understandable that these cells can mimic endometrial adenocarcinoma. This was further stressed by the inconstant presence of cytoplasmic vacuoles and signet ring cells. In May-Grunwald-Giemsa stained smears, many mononuclear cells revealed a considerable amount of reddish brown pigmentation, with granules about 1 mcm-2 mcm in diameter in thenucleus as well as in the cytoplasm. In the distinct macrophages, this finding was less common. The granules were not easily seen in Papanicolaou stained specimens. AGCCs were absent in all but 1 of the samples in the control group. Normal endometrial cells were found in all the other samples. ACGGs were present in the cervicovaginal smears from 2 of the 34 IUD users. AGCCs were also found in the uterine fluid from these 2 patients. AGCCs were not present in any of the 20 cervicovaginal smears from the control group. The data strongly suggest an endometrial origin for the AGCCs since they were found much more frequently in the uterine fluid than in the cervical mucus.
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