The cytologic findings in choroid plexus carcinoma: report of a case with differential diagnosis.

Choroid plexus carcinoma is a rare tumor of the choroid plexus that shows frank cytologic features of malignancy including frequent mitoses, increased cellularity, nuclear pleomorphism, loss of papillary architecture, and necrosis. It occurs predominantly in the pediatric population and is associated with a poor prognosis. We report the cerebrospinal fluid and intraoperative squash preparation cytologic findings of a case of choroid plexus carcinoma arising in the lateral ventricle of a 16-year-old girl who developed tumor recurrence in cerebrospinal fluid 6 years after initial resection. To the best of our knowledge, there are only a few reports in the English literature describing the cytologic features of choroid plexus carcinoma. Relevant differentials and the usefulness of ancillary studies in diagnosis are also discussed.

Calretinin immunostaining as an adjunct in the diagnosis of Hirschsprung disease.

Historically, the diagnosis of Hirschsprung disease was made by evaluating multiple hematoxylin and eosin-stained slides and performing acetylcholinesterase histochemical staining. Recently, calretinin immunohistochemical staining has been reported and found to be superior to acetylcholinesterase staining in the confirmation of aganglionosis. We retrieved tissue blocks from 23 patients with proven Hirschsprung disease from the archives of the Medical College of Georgia. In addition, we selected 23 control patients with ganglion cells. All cases were stained with calretinin, and the presence or absence of both intrinsic nerve fibers (INFs) and ganglion cells was scored by 4 pathologists with fairly strong agreement (κ = 0.858). All cases of proven Hirschsprung disease were negative for INFs. Eighty-three percent of non-Hirschsprung patients were positive for INFs. Based on statistical analysis, the association between disease status and pathologist rating was statistically significant (P < .0001). We also found calretinin immunostaining to be a useful adjunctive modality in the diagnosis of Hirschsprung disease.

Chromosomal abnormalities in renal cell carcinoma variants detected by Urovysion fluorescence in situ hybridization on paraffin-embedded tissue.

Urovysion fluorescence in situ hybridization (UVFISH) identifies malignant cells in urine by detecting specific urothelial carcinoma-related chromosomal abnormalities. Some renal carcinomas (RCCs) share overlapping chromosomal aberrations with urothelial carcinoma. Malignant renal cells that are shed in urine can potentially cause a positive UVFISH result. We evaluated UVFISH in RCCs to determine its potential applicability to the diagnosis and grading of RCCs. Paraffin blocks from 39 RCCs (25 clear cell, 9 papillary, 2 chromophobe, and 3 sarcomatoid) and 15 controls (5 renal oncocytomas and 10 urothelial carcinomas) were tested. Of the RCCs, 15 (40%) were UVFISH-positive (9/25 [40%] clear cell, 3/9 [30%] papillary, 1/2 [50%] chromophobe, and 2/3 [67%] sarcomatoid carcinoma) and 24 (60%) were negative. Of the 15 controls, 8 (∼50%) were UVFISH-positive (2/5 [40%] oncocytomas and 6/10 [60%] urothelial carcinomas) and 7 (∼50%) were UVFISH-negative. Polysomy of chromosome 17 showed a statistically significant correlation with RCC subtype, being absent in most of the clear cell RCCs (P = .0096) compared with other RCCs. Polysomy of chromosome 7 was more frequent in high-grade than low-grade RCC (P = .0197) and more likely in high-grade clear cell than low-grade clear cell RCC (P = .0120). In conclusion, we showed that RCC has overlapping chromosomal abnormalities with urothelial carcinoma and can cause a positive UVFISH result. This has implications for the interpretation of Urovysion in patients whose urine contains malignant cells but who have negative cystoscopy and a concomitant renal mass. The chromosomal abnormalities observed in RCC are not distinct from those in urothelial carcinoma; therefore, UVFISH cannot distinguish these tumor types, nor can it type or grade RCC.

Granulosa cell tumor of the ovary: cytologic findings.

OBJECTIVE: To describe the cytologic findings in 6 adult variants of granuloma cell tumors (AGCTs) and 1 juvenile variant (JGCT), emphasizing differences between recurrent/metastatic (REC AGCT) and nonrecurrent tumors (NED AGC7). STUDY DESIGN: Imprints and fluids were evaluated for: hypercellularity, Call-Exner bodies (CEB), sheets, single cells/naked nuclei, nuclear grooves, single cell necrosis and established histologic criteria of atypia in AGCT (>3 mitoses, pleomorphism, hyperchromasia, prominent nucleoli). RESULTS: All AGCTs and JGCT showed hypercellularity, clusters, sheets, single cells and naked nuclei. CEBs and grooves were seen only in AGCTs. Fluids had less cellularity than imprints, fewer clusters, grooves, single cells/naked nuclei and no sheets, CEBs, necrosis or vacuoles. Hyperchromasia and nucleoli were more striking in JGCT than AGCTs. All REC AGCTs had cytoplasmic vacuoles, while NED AGCTs did not. Prominent nucleoli were 3 times more common in REC AGCTs than NED AGCTs. Increased mitoses and necrosis were seen in 1 REC AGCT. CONCLUSION: CEBs and grooves are not seen in JGCT. JGCT shows more striking cellular atypia than AGCT (REC AGCTs and NED AGCTs). When evaluating pelvic washes/ascitic fluid a high index of suspicion is necessary, as tumor cells can be overlooked. AGCTs showing cytoplasmic vacuoles, prominent nucleoli, mitoses and necrosis are suggestive of aggressive behavior, and that information should be conveyed in cytology reports.

Fine needle aspiration cytology of an endotracheal mass: report of a case with an unusual presentation of anaplastic large cell lymphoma.

BACKGROUND: Anaplastic large cell lymphoma (ALCL) is an uncommon hematolymphoid neoplasm characterized by malignant lymphocytes of T-cell phenotype. It usually affects young patients and may involve a variety of tissues and organs. We herein describe a case of ALCL that presented as an endotracheal mass with associated hilar lymphadenopathy. To the best of our knowledge this is the first case in the literature arising in the trachea. In this location the diagnosis of ALCL can be especially difficult as its pleomorphic cytomorphology mimics that of a carcinoma, which is a more typical neoplasm arising in the trachea. CASE: A 26-year-old male presented with hemoptysis and paroxysmal chest pain. Imaging revealed an endotracheal mass and multiple lytic bone lesions. Fine needle aspiration biopsy of the endotracheal mass revealed discohesive malignant cells with abundant, pale cytoplasm and cerebriform, donut-shaped and horseshoe-shaped nuclei. Immunohistochemical studies confirmed the diagnosis of ALCL. CONCLUSION: ALCL may have an unusual presentation and involve diverse sites, including the trachea. While its cytologic features are straightforward, a high index of suspicion is necessary to ensure accurate diagnosis when it presents in unusual locations.

Utilization of peripherin and S-100 immunohistochemistry in the diagnosis of Hirschsprung disease.

Evaluation of rectal biopsies for ganglion cells is performed for patients suspected of having Hirschsprung disease. At times, identification of ganglion cells can be difficult, especially in newborns. To assist in diagnosis, frozen tissue can be collected for acetylcholinesterase histochemical staining. At our institution, we developed a protocol using peripherin and S-100 immunostaining as an adjunct to hematoxylin and eosin (H&E) for the identification of ganglion cells. Further, at the time of frozen section, we performed Diff Quik staining to highlight ganglion cells. One hundred and thirty eight rectal biopsies submitted for evaluation of Hirschsprung disease were compiled from the archives of the Medical College of Georgia from 2002 to 2009. Initial evaluation consisted of eight levels of H&E-stained slides and two unstained slides each for immunostaining with peripherin and S-100. If on initial evaluation, ganglion cells were not identified, additional H&E and peripherin immunostains were performed. Peripherin immunostaining was unequivocally identified in the cytoplasm of ganglion cells of patients at all ages. Of the 136 patients with diagnostic biopsies, 80% had ganglion cells. Of these, 93% of cases were diagnosed on the original eight levels. Twenty-seven cases were devoid of ganglion cells, and of these, 81% showed submucosal neural hypertrophy on S-100 staining. Twenty-six patients had confirmed aganglionic segments at the time of colonic resection. One patient had colostomy only. A total of 54 frozen sections were performed on 25 patients over this same period of time. Diff Quick staining was found to be very useful. In this study, our protocol proved to be very sensitive, specific, and efficient for the diagnosis of Hirschsprung disease.

Interobserver and intraobserver variability in the calculation of the lipid-laden macrophage index: implications for its use in the evaluation of aspiration in children.

The lipid-laden macrophage index (LLMI) is a semiquantitative test used to evaluate aspiration in children. We assessed the reliability and reproducibility of LLMI by calculating interobserver and intraobserver variability among pathologists, with and without expertise in cytopathology. Forty-nine bronchoalveolar washes/lavages were blindly reviewed by four reviewers and assigned an LLMI. Three pathologists (two cytopathologists, one pathology fellow) reviewed slides twice and one cytotechnologist reviewed them once. Intraclass correlation coefficient (ICC) with 95% confidence interval (C.I.) was used to measure overall intraobserver and interobserver agreement. Interobserver agreement was also calculated separately for each pair of reviewers. ICC values did not indicate an acceptable level of interobserver agreement among pathologists, with (ICC = 0.67, 95% C.I.: 0.56-0.77) and without (ICC = 0.77, 95% C.I.: 0.61-0.84) the cytotechnologist included in the analysis. An ICC of 0.84 (95% C.I.: 0.78-0.89) indicated an acceptable level of intraobserver agreement among pathologists. When calculated separately for each pair of reviewers, all but two ICC values for interobserver agreement were less than 0.75 (the minimally acceptable value for a reliable clinical measurement), and the lower confidence limit of each of the 95% C.I. was far below the 0.75 cutoff. Using Lin's coefficient, intraobserver variability was only acceptable for two pathologists. Our study highlights the lack of precision and subjectivity of the LLMI, as well as the significant inter and intraobserver bias that may occur among experienced and inexperienced pathologists, and cytotechnologists. Clinicians and cytopathologists alike should be mindful of this potential pitfall and interpret LLMI scores with caution.

Fine needle aspiration findings in malignant ameloblastoma: a case report and differential diagnosis.

We present a case of malignant ameloblastoma presenting in the posterior mandible and cervical lymph nodes of an African American child. This case is somewhat unusual in that the patient was an adolescent and presented with metastatic disease. This partly clinical as well as cytologic diagnosis was facilitated by the presence of typical ameloblastoma cytology in multiple cervical lymph nodes adjacent to the histologically confirmed intraosseous ameloblastoma. Although cytology is helpful in diagnosing ameloblastoma, its features are by no means definitive as there are several cytologic mimics. A high index of suspicion is therefore necessary to confirm or exclude ameloblastoma when evaluating any jaw lesion and/or adjacent enlarged lymph nodes by cytologic examination. Adequate sampling is paramount to accurate diagnosis, and is especially important when attempting to distinguish ameloblastoma from ameloblastic carcinoma.

The use of Urovysion fluorescence in situ hybridization in the diagnosis and surveillance of non-urothelial carcinoma of the bladder.

Urovysion fluorescence in situ hybridization (FISH) is a sensitive and specific test used to diagnose urothelial carcinoma in urine. It detects aneuploidy of chromosomes 3, 7 and 17, and loss of both 9p21 loci in malignant urothelial cells. We evaluated Urovysion FISH in non-urothelial carcinoma involving bladder to determine its possible application to their diagnosis and surveillance. Paraffin blocks from 31 non-urothelial bladder carcinomas, 12 pure urothelial carcinomas and 2 urothelial carcinomas with squamous differentiation were tested according to Vysis-Abbot Laboratories' recommended standards. Cases included 15 primary squamous carcinoma, 2 urothelial carcinoma with squamous differentiation, 4 primary adenocarcinoma, 5 colonic, 4 prostatic and 1 cervical adenocarcinoma. Total 60% of squamous, 83% of pure urothelial, 100% of urothelial carcinoma with squamous differentiation and 100% of primary and secondary adenocarcinomas hybridized successfully; 2/10 (11%) squamous carcinomas and 11/14 (79%) primary and secondary adenocarcinomas were Urovysion FISH-positive with primary adenocarcinomas accounting for 75% (3/4), colonic, 80% (4/5), prostatic, 75% (3/4) and cervical, 100% (1/1) positivity. Total 70% (7/10) of pure urothelial carcinomas and 100% (2/2) of urothelial carcinomas with squamous differentiation were Urovysion FISH-positive. In conclusion, we found that chromosomal abnormalities tested for by Urovysion FISH may be seen in non-urothelial carcinomas of bladder. These false-positive results were frequent in primary and secondary adenocarcinoma and rare in squamous carcinoma. This has significant implications for the accurate diagnosis and management of patients with urinary tract cancer. Urovysion FISH cannot be used to definitively diagnose squamous carcinoma or adenocarcinoma nor can it be used to differentiate the two from urothelial carcinoma. However, it may be useful as a surveillance tool in established primary and secondary bladder adenocarcinoma. Cytopathologists and urologists should correlate Urovysion FISH results with cytomorphology and clinical information.

Plasmablastic lymphoma: CNS involvement, coexistence of other malignancies, possible viral etiology, and dismal outcome.

The clinical and pathological findings of plasmablastic lymphoma (PBL) have been described in the literature but the etiology is not well established, and treatment options are poorly defined. We reviewed patients with PBL in our institution to characterize the clinicopathologic features in our patient population. In this retrospective analysis from a single academic institution, five patients with PBL were identified and analyzed. Human immunodeficiency virus and human herpesvirus 8 (HHV-8) were identified in 40% (two out of five) and 80% (four out of five) of these patients, respectively. Central nervous system (CNS) involvement was identified in four out of five (80%) patients. Interestingly, three out of five patients had a concurrent or preceding second primary malignancy including small lymphocytic lymphoma, endometrial cancer, and nonsmall cell lung cancer. Most of the patients had advanced disease and a poor performance status at diagnosis. Only two of the patients received systemic chemotherapy with an initial partial response. All five patients died; the median overall survival was 1 month. Our experience in patients with PBL indicates that CNS involvement is more common than reported in the literature. Coexistence of a second primary malignancy may be frequent, and prognosis remains dismal with standard lymphoma therapy. Lastly, the role of HHV-8 in the etiopathogenesis needs further trials.

Cytologic features of mixed papillary carcinoma and chronic lymphocytic leukemia/small lymphocytic lymphoma of the thyroid gland.

We report a case of papillary thyroid carcinoma (PTC) and chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma of the thyroid gland. To the best of our knowledge, this is the first such case to be reported in the cytology literature. An 81-year-old male with known CLL presented for routine physical examination and was found to have a left-sided thyroid nodule. Thyroid ultrasound showed a calcified nodule. Fine-needle aspiration biopsy (FNAB) was performed and revealed PTC and an atypical lymphoid infiltrate that was suspicious for lymphoma. A partial thyroidectomy was performed and confirmed PTC with concurrent gland involvement by chronic lymphocytic leukemia/small lymphocytic lymphoma (SLL).

Metastatic hepatocellular carcinoma with CD138 positivity: an unusual mimic of multiple myeloma?

CD138 is a monoclonal anti-syndecan-1 antibody that is often used to identify plasma cells in the bone marrow of patients with multiple myeloma (MM). Several carcinomas may also express CD138 including prostate, colon, renal cell, and hepatocellular carcinoma (HCC). We report a case of metastatic HCC that presented as a soft tissue mass on the back of a 67-year-old male. Based on the clinical and radiologic findings, MM was strongly suspected. In addition, fine-needle aspiration biopsy (FNAB) of the mass revealed neoplastic cells that were positive for CD138, both by immunohistochemistry (IHC) and flow cytometry. The cytomorphologic features however did not support a diagnosis of MM, but were consistent with metastatic HCC. Our case highlights the potential problems that may arise by over-reliance on IHC and flow cytometry. Careful morphologic assessment as well as clinical and radiologic correlation are very important when evaluating any CD138-positive neoplasm. This approach should improve diagnostic accuracy and reduce the risk of erroneous interpretation of aberrant IHC results. In addition, we examined the expression of CD138 in known cases of HCC.

Plasmablastic lymphoma: Cytologic findings in 5 cases with unusual presentation.

BACKGROUND: Plasmablastic lymphoma (PBL) is a rare form of non-Hodgkin lymphoma that was once believed to occur primarily in the oral cavity of human immunodeficiency virus-positive individuals. Numerous extraoral sites have also been reported to date. To the authors' knowledge, however, only 3 reports in the literature describe its cytologic features. In the current study, the cytologic findings in 5 additional patients are reported, 3 of whom had concomitant second malignancies. The goal of the current study was to define the cytomorphologic features that may help to distinguish PBL from other mimics. METHODS: Five cases were identified from the pathology files for which cytology was available. The presence of the following was evaluated: cellularity, plasmablastic cells, background necrosis (BN), single-cell necrosis (SCN), lymphoglandular bodies (LGB), tingible-body macrophages (TBM), 3-dimensional clusters/sheets, and cytoplasmic vacuoles. RESULTS: The patients included 3 women and 2 men with an age range of 40 to 57 years. Two patients had the acquired immunodeficiency syndrome and 3 had second non-PBL related malignancies including endometrial carcinoma, lung adenocarcinoma, and small lymphocytic lymphoma. The most common cytologic features were hypercellularity (80%), plasmablastic cells (73%), SCN (73%), BN (87%), and LGB (66%). TBMs (33%) and clusters/sheets (47%) were the least common features. CONCLUSIONS: Although no 1 cytologic feature is diagnostic of PBL, a constellation of findings should raise suspicion. These include hypercellular specimens with abundant plasmablastic cells, LGB, SCN, and BN. However, although these findings may suggest PBL, a definitive diagnosis requires adjunctive studies including immunohistochemistry and flow cytometry. As with any lymphocyte-rich aspirate, additional material should be collected for these studies. Over-reliance on adjuvant studies is discouraged because the PBL immunophenotype is not considered standard.

Imprint cytology of high-grade immature ovarian teratoma: a case report, literature review, and distinction from other ovarian small round cell tumors.

Immature ovarian teratoma (IOT) is a rare and aggressive malignant neoplasm characterized by immature neural tissue. The cytomorphologic features have only rarely been described. We herein describe an additional case and review the literature regarding this entity. To the best of our knowledge, this is the first reported case with imprint cytology. A 35-year-old woman presented with a pelvic mass which was resected and sent for frozen section evaluation. Imprint smears and frozen section of the mass were diagnostic of IOT. IOT has diagnostic cytologic features which show complete concordance with histology. Differential diagnoses include other small round cell neoplasms such as ovarian neuroblastoma, small cell carcinoma of hypercalcemic type, primitive neuroectodermal tumor, Wilm's tumor, desmoplastic small round cell tumor, and Non-Hodgkin lymphoma. Distinguishing IOT from these tumors can be challenging however if diligent morphologic study and/or ancillary studies are performed accurate diagnosis is possible.

Atypical squamous cells, cannot exclude high grade intraepithelial lesion (ASC-H): does HPV matter?

The role of human papillomavirus (HPV) in cases diagnosed as atypical squamous cells, cannot exclude high squamous grade intraepithelial lesion (ASC-H) in cervical specimens is not well established. The objective of this study is to evaluate the role of HPV status in cases of ASC-H in a major cancer center. One hundred thirty-two patients with a diagnosis of ASC-H were identified over a 4-yr period in our institution. Forty-four of 132 cases were evaluated for high-risk HPV and had biopsy follow-up. The positive predictive value (PPV) of ASC-H for high-grade squamous intraepithelial lesions overall was 32% while PPV of ASC-H with associated HR HPV was 42%. This increase was statistically significant with P = 0.003 and suggest that HPV testing might be useful to increase the PPV of ASC-H.

Fine needle aspiration biopsy of primary mucinous carcinoma of the skin: a case report.

BACKGROUND: Primary mucinous carcinoma of the skin is a rare neoplasm of sweat gland origin. To date there are only 2 case reports in English describing its features on fine needle aspiration biopsy (FNAB). We describe an additional case and review the literature regarding this entity. To the best of our knowledge, this is the first reported case with a sentinel lymph node biopsy. CASE: A 78-year-old woman presented with a 3-cm left scalp mass at an outside institution. Following incomplete excision, multiple subcentimeter nodules developed in the skin adjacent to the biopsy site. FNAB of the nodules confirmed a recurrence of mucinous carcinoma. Clinical examination and extensive radiographic studies did not reveal primary disease elsewhere, thus supporting a diagnosis of primary mucinous carcinoma of the skin. At the time of wide excision of the residual tumor, sentinel lymph node biopsy revealed a single focus of micrometastasis. The patient declined adjuvant therapy and was disease free 6 months after the initial diagnosis. CONCLUSION: Cutaneous mucinous carcinoma is a tumor characterized by bland histocytologic features and abundant extracellular pools of mucin. Without a high index of suspicion, this rare entity may be overlooked or misdiagnosed. Numerous benign and malignant mucin-producing primary and secondary mimics exist, and immunohistochemistry offers limited benefits in differentiating them. Cytologic diagnosis of primary mucinous carcinoma of the skin is possible; however, correlation of clinical, radiologic and pathologic features is necessary to arrive at an accurate diagnosis.

Cytomorphologic features of papillary lesions of the male breast: a study of 11 cases.

BACKGROUND: Breast masses occur in men far less commonly than women and are infrequently subjected to fine-needle aspiration (FNA) biopsy. Papillary lesions of the male breast are rare and are comprised of a spectrum of lesions ranging from papillary hyperplasia in gynecomastia to invasive papillary carcinoma. The following study describes the cytomorphology of papillary breast lesions in 11 men. The patients ranged in age from 23 to 78 years old and each presented with an unilateral subareolar or periareolar breast mass that varied in size from 0.5 to 3 cm. Two patients presented with bloody nipple discharge. METHODS: Archival material (8-year period) from FNA biopsies of papillary lesions of the male breast was reviewed. The reviewed cases were correlated with appropriate clinicopathologic follow-up. RESULTS: The smears had variable cellularity but all showed papillary clusters of mammary epithelial cells with and without fibrovascular cores. Single epithelial cells with a high nuclear-to-cytoplasmic ratio and eccentric nuclei were seen in all smears; however, these were more numerous in cases of adenocarcinoma. Hemosiderin-laden macrophages were present in all cases. Nipple discharge was seen only in the 2 benign lesions. All adenocarcinomas occurred in older men. CONCLUSIONS: The only cytologic criteria that differentiated benign from malignant papillary lesions were marked cellularity and the presence of abundant 3-dimensional clusters. To the best of the authors' knowledge, the current series is the largest in the English literature to date that examines the cytomorphologic features of papillary breast lesions in men.

Immunophenotypic diversity of endometrial adenocarcinomas: implications for differential diagnosis.

Many endometrial adenocarcinomas, particularly those of endometrioid type, express estrogen receptors (ERs), progesterone receptors (PRs), and vimentin. This typical immunophenotype is frequently considered a standard against which others are compared when immunohistochemistry is used for differential diagnosis. We tested large numbers of endometrial cancers, enriched for high-grade tumors, to determine whether this reported immunophenotype was valid and whether expression differences between types of endometrial carcinoma could be exploited for diagnostic purposes. Immunohistochemical stains were performed on the following types of endometrial cancers using established methodology: International Federation of Gynecology and Obstetrics (FIGO) grades 1 and 2 endometrioid-42; FIGO grade 3 endometrioid-40; serous-24; clear cell-11; carcinosarcoma-9. In total, 92% of serous carcinomas expressed p16 strongly compared to weak-to-moderate expression of p16 in 7-67% of other tumors (FIGO grades 1 and 2 carcinoma and carcinosarcoma, respectively). A total of 84% of FIGO grades 1 and 2 carcinomas expressed ER compared to 9-54% of other tumors (clear cell and serous carcinomas respectively); 83% of FIGO grades 1 and 2 expressed PR compared to 11-54% of other carcinomas (carcinosarcoma and serous carcinoma, respectively). Most carcinomas were negative for monoclonal carcinoembryonic antigen (mCEA), and those that were positive showed mostly only focal membrane expression. Vimentin was expressed in nearly every tumor. Most tumors were diffusely vimentin positive, but a large range of expression patterns, from focal to diffuse and from weak to strong, was noted. Only 70% of FIGO grades 1 and 2 endometrioid carcinomas and 26% of grade 3 endometrioid carcinomas possessed the reportedly characteristic endometrial cancer immunophenotype p16 (-), ER (+), PR (+), mCEA (-), and vimentin (+). Endometrial cancers demonstrate substantial immunophenotypic diversity that remained apparent even within groups of similar histologic subtype and grade. ER, PR, and p16 expression was more illustrative of tumor type and degree of differentiation than they were of endometrial origin. In contrast, the vimentin-positive/CEA-negative phenotype remained the most constant among all endometrial cancers.

Capillary hemangioma of the endometrium: a case report and review of the literature.

A 39-year-old woman with menorrhagia of 7 years' duration was found to have a capillary hemangioma of the endometrium. Initial diagnosis by curettage was considered questionable but was later confirmed at hysterectomy. A thorough search and review of the literature was performed.