Pap Test Cytology in a Postmenopausal Woman with Vaginal Bleeding
Susan Geddes, CT(ASCP)
Qing Kay Li, MD, PhD
Presentation Date: September 2014; Expires September 2017
The patient was a 79-year-old, para 2-0-0-2, with a one-month history of postmenopausal vaginal bleeding. The patient had been postmenopausal for 16 years and presented with spotting and dark red blood per vagina for the last several weeks. She denied any abdominal pain or other complaints at the time of the clinic visit. The patient had a MRI which revealed a large circumscribed heterogeneous enhancing mass centrally located within the uterus, measuring 11.1 x 6.2 x 7 cm. The clinical differential diagnoses were a large endometrial polyp versus degenerated submucosal fibroid versus cystic polypoid adenomyosis, although a carcinoma could not be excluded. Her ovaries were unremarkable bilaterally. No free fluid was detected in the pelvis. No pathologically enlarged lymph nodes were noted. Subsequently, the patient had a Pap test and an endometrial biopsy. The Pap smear revealed atypical cells with the absence of the transformation zone. The endometrial biopsy revealed a high-grade neoplasm with both epithelial and mesenchymal components. The endocervical curettage revealed fragments of benign squamous epithelium and scant fragments of benign endocervical glands.