79 Collagen Balls on Routine Cervical Screening: A Case Report. (11th January 2018) - Patel, Ami
Abstract: Background: A collagen ball is a common incidental finding in peritoneal washings. Its presence in gynecological cervical screening samples (Pap test) is rare. The significance of this finding is unknown, but it can be misinterpreted as atypical or neoplastic cells. We report a case of collagen ball, found on a ThinPrep (TP) slide on a routine cervical Pap test. Case Description: The patient was a 45-year-old, peri-menopausal woman with a history of Graves disease, who presented for routine screening for cervical dysplasia or carcinoma. She did not complain of abnormal vaginal bleeding, and her physical exam was unremarkable. She is currently on oral contraceptives. Her surgical history is significant for a remote caesarean section. Results: A ThinPrep slide of her cervical pap smear, showed a pale green-blue, three-dimensional, smooth, homogeneous papillary fragment of collagen surrounded by benign flat to oval cells, presumably of mesothelial origin. An adjacent crowded cluster of cells with a similar morphology were also identified. The appearance of the collagen ball in the cervical Pap smear ThinPrep, was similar to that seen in previously described peritoneal washing samples. The Pap smear was initially screened as atypical glandular cells of endometrial origin in a woman ≥45 years old but ultimately reported as negative for malignant cells. Discussion: Collagen balls within peritoneal washings can be misinterpreted as fragments of atypical glandular cells, as was initially screened in our case, and also as papillary serous neoplasm or mucin distended cells exfoliated from a neoplasm. The crowded clusters of mesothelial cells could mimic hyperchromatic crowded groups of high-grade squamous intraepithelial lesion, leading to a misinterpretation. An awareness of this entity while screening cervical samples will help avoid such misdiagnosis.