title: Endosalpingiosis in peritoneal washings in women with benign gynecologic conditions: thirty-eight cases confirmed with paired box-8 immunohistochemical staining and correlation with surgical biopsy findings.
abstract: BACKGROUND
  To better define the cytomorphologic spectrum of endosalpingiosis in peritoneal washings (PWs) and thereby facilitate their distinction from well differentiated serous carcinoma, the authors examined PWs from women who underwent surgery and pathologic staging of lesions other than Mullerian malignancies and correlated the findings with surgical specimens.
  
  
  METHODS
  This was a retrospective review of medical records and PW specimens from 100 consecutive patients who had PWs coded as both "endosalpingiosis" and "negative for carcinoma" between 2002 and 2012. Thirty-eight of these patients had no gynecologic malignancies. Specimens had been prepared using cytocentrifugation and were stained using the Papanicolaou method. The cytologic findings evaluated were cell arrangement, number of cell groups per case, cellular atypia, and psammoma bodies. Smears also were assessed for paired box-8 (PAX8) immunostaining. The authors compared patients' staging biopsy findings with the findings from a review of the PWs.
  
  
  RESULTS
  PW specimens from 35 of 38 patients (92%) exhibited classic endosalpingiosis features: tubular or small branching papillary structures, some with psammoma bodies. Specimens from the 3 remaining patients displayed nonclassic features consistent with dislodged fallopian tube epithelium or endometriosis. From 2 to 20 clusters per slide and from 4 to 50 groups per case were identified. In a few cases, some cell clusters exhibited up to moderate cytologic atypia. Surgical findings included endometriosis, endosalpingiosis, both endometriosis and endosalpingiosis (12 patients; 31.6%), and a variety of unrelated pelvic lesions. All cases were PAX8-positive, confirming their Mullerian origin.
  
  
  CONCLUSIONS
  Endosalpingiosis in PWs can be diagnostically challenging. Awareness of intraoperative techniques and correlation with surgical biopsy findings are necessary to avoid a misdiagnosis of malignancy.
authors.affiliation: Department of Pathology, Section of Cytology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Nour
authors.initials: N
authors.lastname: Sneige
authors.forename: Marilyn A
authors.initials: MA
authors.lastname: Dawlett
authors.forename: Teresa L
authors.initials: TL
authors.lastname: Kologinczak
authors.forename: Ming
authors.initials: M
authors.lastname: Guo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy; D018284:Cystadenocarcinoma, Serous / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D016889:Endometrial Neoplasms / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D004715:Endometriosis / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D005184:Fallopian Tube Diseases / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D007124:Immunoenzyme Techniques; D008875:Middle Aged; D009095:Mullerian Ducts / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D010051:Ovarian Neoplasms / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D000072636:PAX8 Transcription Factor; D051761:Paired Box Transcription Factors / Q000378:metabolism; D010533:Peritoneal Lavage; D011379:Prognosis; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000072636:PAX8 Transcription Factor; C083325:PAX8 protein, human; D051761:Paired Box Transcription Factors
keywords: Mullerian inclusions; Mullerian metaplasia; cytology; endosalpingosis; pelvic washings; peritoneal washings