Cytodiagnostic problems in cervicovaginal smears from symptomatic breast cancer patients on tamoxifen therapy.
OBJECTIVE
To evaluate the effect of tamoxifen on cervicovaginal epithelium, identify tamoxifen-related changes that mimic cancer and detennine the morphologic features differentiating the 2 changes.


METHODS
Cervicovaginal smears from 153 conventionally treated primary breast cancer patients presenting with gynecologic symptoms were studied.


RESULTS
All 153 patients presented with menorrhagia or irregular periods. Of 4 patients with a cytodiagnosis of atypical glandular changes, 2 had negative histology; 1 each had a uterine leiomyoma and endometrial hyperplasia. Of the 6 cases reported as adenocarcinoma, 3 were histologically confirmed, and the others were false positives. Conversely, 1 false negative case histologically was an endometrioid carcinoma.


CONCLUSIONS
Our study revealed that reactive glandular cells are a cause of false positive diagnoses. Tamoxifen-associated cellular changes can mimic morphologic features of cancer. To avoid diagnostic errors, cervicovaginal smears should be repeated after discontinuing tamoxifen treatment. Clinical correlation is mandatory. Regular follow-up with cervicovaginal smears from patients on tamoxifen treatment is recommended.
Ajit
Dulhan
D
Division of Cytology, Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India. dulhan@gmail.com
Gavas
Sonali
S
Jagtap
Sangita
S
Chinoy
Roshni F
RF
D000230:Adenocarcinoma / Q000473:pathology; D000328:Adult; D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000009:adverse effects; D001943:Breast Neoplasms / Q000188:drug therapy; D002584:Cervix Uteri / Q000187:drug effects / Q000473:pathology*; D003937:Diagnosis, Differential; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008875:Middle Aged; D013629:Tamoxifen / Q000009:adverse effects*; D002583:Uterine Cervical Neoplasms / Q000139:chemically induced / Q000473:pathology*; D014621:Vagina / Q000187:drug effects / Q000473:pathology*; D014625:Vaginal Neoplasms / Q000139:chemically induced / Q000473:pathology*; D014626:Vaginal Smears
D018931:Antineoplastic Agents, Hormonal; D013629:Tamoxifen