Endometrial cells on a cervical smear

Endometrial cells in a cervical sample can be:

• atypical endometrial cells -
  • if a cervical sample shows 'atypical cells of endometrial origin' the patient should be referred to a gynecologist urgently (within 2 weeks of referral) regardless of the menopausal state or whether or not she has irregular vaginal bleeding
  • histological follow up in one third of women with atypical endometrial cells have reveled that it was associated with significant uterine disease. These atypical cells may indicate:
    • endometrial polyp
    • chronic endometritis
    • intrauterine contraceptive device
    • endometrial hyperplasia or carcinoma
• benign endometrial cells
  • referral to colposcopy or gynaecology is not necessary in women under 40 years with benign endometrial cells
    • there is evidence of a higher prevalence of benign endometrial cells in cervical samples taken using liquid based cytology (LBC). In women under 40 their presence has no significance and should not be reported or acted upon (1)
  • in women over 40, the significance of the presence of endometrial cells varies with the phase of the menstrual cycle, the use of some hormones and the patient's clinical history
    • after the 14th day of the menstrual cycle, the presence of normal endometrial cells in a cervical sample may indicate endometrial pathology
      • exceptions are when women are receiving oral contraceptives, hormone replacement therapy or tamoxifen, or are fitted with an IUCD
        • if this information is provided on the request form, an annotation or educational note should be made in the free text section of the report
        • provided there is no other clinical symptomatology to suggest endometrial disease, no further clinical action is required
    • normal endometrial cells identified in a sample from a woman 40 years or older should always be reported if the menstrual, drug and contraceptive history is unknown or if the woman is postmenopausal
    • if the sample is otherwise negative it should be reported as negative but the report should include a note to the effect that
      • endometrial cells are present in a woman aged over 40. Such cells may be associated with endometrial pathology, particularly if out of phase or after the menopause
    • referral for a gynaecological opinion should be considered in the light of the menstrual, drug and clinical history. If this history suggests that an opinion is necessary, such cases should be seen urgently, within two weeks of referral

Reference:

• 1. NHS Cancer Screening Programmes 2010. Colposcopy and programme management. Guidelines for the NHS cervical screening programme 2nd edition