LAUSR

We report a case of collagen balls found on a routine gynecological cervical exam. The patient was a 45-year-old perimenopausal woman, with a history of Graves’ disease, who presented for routine screening. She did not complain of abnormal vaginal bleeding and her physical examination was unremarkable. She had a remote history of caesarean section and her medications included oral contraceptives. A ThinPrep slide of her cervical Pap smear showed a single, pale, green-blue, smooth, three-dimensional pseudo-papillary ball like structure, with a central hyalinized core, surrounded by benign flat to oval cells, presumably of mesothelial origin (Figure 1A,B). The appearance of this collagen ball was similar to that seen in the previously described peritoneal washing samples. The Pap smear was initially screened as atypical glandular cells of endometrial origin in a woman 45 years but was ultimately reported as negative for intraepithelial lesion. No endometrial cells were identified. Collagen balls are found in up to 50% of peritoneal washings and range from 1 to 20 per sample. The origin of the collagen balls from peritoneal washings has evolved through the years. Early reports suggested these structures are related to inflammation induced by surgical intervention. Others postulated collagen balls as originating from the surface of the ovaries in peritoneal washings obtained at laparotomy, from women undergoing surgery for neoplasms of the genital tract. However, collagen balls in cervico-vaginal specimens is a rare finding. Sahoo et al. suggested that collagen balls from cervical smears are exfoliated from serosal surfaces of pelvic and peritoneal organs and transported through the fallopian tube into the uterine cavity. Collagen balls within cervical cytology can be misinterpreted as fragments of atypical glandular cells of endometrial origin, as was initially screened in this case, and also as papillary serous neoplasm, or FIGURE 1 Collagen ball with three-dimensional spherical shape at 320 A, and at 360 B, Papanicolaou stain ThinPrep