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Detection of large histiocytes in pap smears: role in the prediction of endometrial pathology?

OBJECTIVE
The objective of this study was to clarify the prognostic significance of large histiocytes in Papanicolaou smears.


METHOD
During a 2-year period, 893 smears were assessed by the Cytology Laboratory of our Hospital. Twenty-one smears were reported including large histiocytes (2.4%). Colposcopy was also performed in all of these women.


RESULTS
9/21 of the women (43%) presented vaginocervicitis, whereas 3/21, 1/21, 1/21, 1/21 and 1/21 revealed endometrial polyps, complex hyperplasia with atypia, simple hyperplasia after tamoxifene use, submucosal myoma and endometrial carcinoma respectively. On the other hand, colposcopy revealed suspicious cervical areas in none of the patients. Therefore, the positive prognostic value for endometrial pathology was 7/21 (33.3%).


DISCUSSION
Various forms of histiocytes are found in inflammatory processes in vaginal and cervical smears. According to our results, large histiocytes could be considered as an indicator for endometrial pathology but not for endometrial cancer. However, when histiocytes are found, further clinical evaluation and work up should be done. Finally, in the present study, the detection of large histiocytes seems to be a good prognostic factor for cervical pathology (Ref. 10).