Exfoliated endometrial cell clusters in cervical cytologic preparations are derived from endometrial stroma and glands

Exfoliated endometrial cells are a common finding on Papanicolaou smears obtained during the menstrual period. They have a characteristic morphologic appearance, but whether they are of endometrial glandular, stromal, or mixed origin is still debated. Cervical ThinPrep (Cytyc, Marlboro, MA) slides obtained during menses from women younger than 40 years were immunostained for a stromal (CD10) and an epithelial (keratin proteins) marker. Endometrial cell clusters were scored as purely stromal (composed entirely of CD10+ cells), purely glandular (entirely keratin+ cells), or mixed stromal and glandular. Of the 59 endometrial cell clusters scored, 22 (37%) were purely stromal, 17 (29%) purely glandular, and 20 (34%) mixed stromal and glandular. Exfoliated endometrial cell clusters often are composed exclusively of stromal cells. Mixed stromal-glandular groups and entirely glandular groups also are common. The distinction between stromal and glandular cells is not always possible by conventional Papanicolaou staining but can be established by immunocytochemical study.