THE CYTOLOGY OF TUMORS OF THE OVARY AND FALLOPIAN TUBES

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Abstract
It is probable that the normal epithelial cells lining the fallopian tubes and cells from the ovarian surface exfoliate and reach the posterior fornix but remain unrecognized in vaginal smears. Malignant cells derived from tumors in these sites may, however, be recovered and identified. Cells from adenocarcinomas of the tube appear singly or in small clusters in vaginal smears. Their cytological characteristics are identical with those of adenocarcinoma cells from other sites. The diagnosis of carcinoma of the tubes may be suspected if vaginal smears contain adenocarcinoma cells and endome-trial curettage proves negative for malignancy. Benign ovarian tumors (pseudomucinous cystadenomas, serous cystomas, fibromas and dermoid cysts) cannot be detected by vaginal cytology. The presence of malignant tumors of the ovary such as serous cystadenocarcinoma, pseudomucinous carcinoma and anaplastic carcinoma may be suspected when only a few singly arranged cancer cells are found in vaginal smears often associated with a high karyopyknotic index. Exfoliation of ovarian cancer cells can only occur when the tumor has reached the ovarian surface. It is assumed that these exfoliated malignant cells travel through the tubes and endometrial cavity, pass through the endocervical canal and finally reach the posterior fornix pool. Since this route is long, only few cells will succeed in reaching the end point of the journey and be still recognisable. The scarcity of cancer cells in vaginal smears is regarded as a feature distinguishing ovarian from endometrial carcinoma. With the exception of the dysgerminomas special tumors such as granulosa cell carcinomas, arrhenoblastomas and thecomas are usually hormone producing. Smears from women suffering from such tumors are dominated by the effects of the excess hormone but show no specific cell pattern.

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