Table 4.

Characteristics of cases with undercalled ThinPrep®Pap tests

No	Patient	Pap Diagnosis	Histology	Grade	Size (cm)	HPV	Comment
1	36 Y/O WF G0	Unsatisfactory	Clear cell adenocarcinoma, Stage 1B1	NA	1.0	NEG	Excess blood and very low cellularity. Several large cell groups present (>30 cells) in bloody rim were all monomorphic- a clue that this was not a normal cell population.
2	35 Y/O WF G3	NILM	Cervical adenocarcinoma, usual type, Stage 1B1	1	1.0	16,18	Very scant tumor cells; small lesion; tightly cohesive cell groups with overlapping nuclei
3	57 Y/O WF	NILM	Cervical adenocarcinoma, usual type, Stage 1B1	2	1.4	16	The most prominent part of this case is the light diathesis in the background. Rare large groups of glandular cells with rim of ghost rbc.
4	67 Y/O WF	ASC with obscuring inflammation	Poorly differentiated carcinoma, concerning for carcinosarcoma	3	3.0	NEG	Only rare epithelial cells present with a rim of mostly neutrophils. The epithelial cells do not show definite malignant features. Some laboratories could call unsatisfactory.
5	54 Y/O	ASC-US	Cervical adenocarcinoma, usual type, Stage 1B1	1	1.0	16	Sheets of atrophic squamous cells are distractors; Some large 3-D groups of small glandular cells with tight overlapping nuclei; little atypia. Rare apoptotic cells present
6	35 Y/O	ASC-H	Cervical adenocarcinoma, usual type, Stage 1B1	1	1.2	18	Many of the tumor cells have bland chromatin and multiple small nucleoli; Oval cytoplasm; some with tails; Although many tumor cells are enlarged; others are overlap with normal size nuclei; Prominent neutrophils in background. Several cell groups have definite mucin globules with signet ring features. Diathesis inconspicuous in this case although a few aggregates of ghost rbcs are present.
7	35 Y/O	ASC-H	Mixed cervical adenocarcinoma, usual type and small cell neuroendocrine, Stage 4B	1	Not done	16	At low power the background looks clean. But at higher power, aggregates of ghost rbcs can be seen. Very rare, small, highly cohesive cell groups are present that can be easily overlooked. Small coagulum of fibrin, PMNs and occasional small epithelial cells are unusual.

HPV - Human papillomavirus; Y/O - year old; WF - white female; NA - not applicable; NILM - negative for intraepithelial lesion or malignancy; rbc - red blood cell; ASC-US - atypical squamous cells of undetermined significance; ASC-H - atypical squamous cells cannot exclude a high-grade squamous intraepithelial lesion