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Australian Society of Cytology

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Glandular Lesions of the Endocervix

High Grade Epithelial Abnormalities

Marilyn Betchley
Senior Cytotechnologist
ClinPath Laboratories
Adelaide, Australia 5000

This lecture describes the cytological features of high grade glandular lesions of the endocervix. This category includes Adenocarcinoma-in-Situ of the endocervix (AIS) and Invasive neoplasia.

Adenocarcinoma-in-situ (AIS)

ais1 The cytological diagnosis of AIS is primarily made by recognising the architecture of endocervical sheets and clusters on low power magnification.

This is in contrast to the diagnosis of squamous lesions on cytology which is very much dependant on higher power scrutiny of individual cells. Recognition of disturbed architectural pattens is an important aspect in the diagnosis of AIS (Cooper 1995; Kummins et al, 1977; Pacey et al, 1988).

The main architectural features which are helpful in recognising AIS are:

ais2 Tightly crowded sheets with overlapping nuclei and 'ragged edged' borders. The honeycomb pattern and palisade edge seen in clusters of normal endocervical cells are absent.

ais3 Clusters of endocervical cells showing pseudostratification. Nuclei are seen at different levels within the groups. However, polarity of cells is maintained.

Short strips of cells showing pseudostratification.

Rosettes. Cells are arranged in a circular pattern with peripheral location of nuclei.

Gland openings within sheets.

ais4 Feathering. At the edge of groups, cells have attenuated nuclei, but lack cytoplasm. Feathering is a distinctive feature of AIS.
(Ayer et al, 1987; Cooper, 1995; Lee et al, 1991; Betsill and Clarke, 1986; Clarke and Betsill, 1986).

Cell size does not necessarily increase with AIS. The cells may even present as smaller than normal endocervical cells. The nuclei have granular chromatin which is evenly distributed. Nucleoli may be present but are usually small and inconspicuous.

The background of the smear may show inflammatory cells and/or blood. There is no tumour diathesis.

Degeneration, often associated with inflammation, may hinder initial recognition of disturbed architecture.

On high power magnification, nuclei are seen to have evenly distributed granular chromatin. Nucleoli may be present but they are usually small and inconspicuous.

A number of authors have classified AIS into well and poorly differentiated lesions on the basis of cytology (Ayer et al, 1988; Pacey, 1991). This distinction, however, has no clinical significance nor does it affect treatment or prognosis. There are however some characteristics which have been described.

Well differentiated AIS has a tendency to present as small, tightly packed cells with hyperchromatic and sometimes elongated nuclei. The chromatin is evenly distributed and moderately granular. A small nucleolus may be present.

Poorly differentiated lesions present as more loosely arranged cells with larger pleomorphic nuclei which appear less hyperchromatic than those seen in well differentiated lesions. The chromatin is evenly distributed and mild to moderately granular. A nucleolus is present.

Invasive Adenocarcinoma of the Endocervix.

Many of the features seen in AIS may also be apparent in invasive endocervical lesions.

ais5 Cells may present as syncytial and irregular sheets of cells, papillary groups or as acinus-like groupings.

The cells tend to show more dissociation than that seen in AIS and the background is usually inflammatory, bloodstained or necrotic.

Most tumours are of mucinous or endometriod type. The former may be confidently predicted on cytology but more accurate classification is achieved by histological examination (Pacey 1991; Cooper 1995; Koss 1969; Lee et al, 1991; Keyhani-Rofagha et al, 1995).

Invasive adenocarcinoma of the endocervix may be classified on cytology into well and poorly differentiated tumours. Click here to view a table outlining cytological features helpful in diagnosis.

References

  • Ayer et al. The Cytological Diagnosis of Adenocarcinoma in Situ of the Cervix Uteri and Related Lesions 1. Adenocarcinoma in Situ. Acta Cytol.1987. 31:397-411.
  • Ayer et al. The Cytological Diagnosis of Adenocarcinoma in Situ of the Cervix Uteri and Related Lesions 2. Microinvasive Adenocarcinoma. Acta Cytol.1988. 32:318-324.
  • Betsill WL, Clark AH. Early Cervical Glandular Neoplasia I. Histomorphology and Cytomorphology. Acta Cytol.1986. 30:115-126.
  • Clark AH, Betsill WL. Early cervical Glandular Neoplasia II. Morphometric Analysis of the Cells. Acta Cytol. 1986. 30:127-134.
  • Cooper P. Glandular Neoplasms of the Uterine Cervix. Chapter 31. Diagnostic Cytopathology by Winifred Gray. 1995.
  • Keyhani- Rofphga et al. Comparative Cytological Findings of In-Situ and Invasive Adenocarcinoma of the Uterine Cervix. Diagn Cytopathol. 1995. 12:120-125.
  • Krummins et al. The Cytological Diagnosis of Adenocarcinoma In Situ of the Cervix Uteri. Acta Cytol. 1977. 21:320-329.
  • Koss LG. Adenocarcinoma and Related Tumours of the Uterine Cervix. Diagnostic Cytology. 3rd Edition. 1969.
  • Lee et al. Comparative Cytologic features of Adenocarcinoma In Situ of the Uterine Cervix. Acta Cytol. 1991. 35:117-124.
  • Mulvaney N, Oster A. Microinvasive Adenocarcinoma of the Cervix: A Cytohistopathologic Study of 40 Cases. Diagn Cytopathol. 1997. 16:430-436.
  • Pacey et al. The Cytologic Diagnosis of Adenocarcinoma In Situ of the Cervix Uteri and Related Lesions III. Pitfalls in Diagnosis. Acta Cytol. 1988 32:325-330
  • Pacey NF. Glandular Neoplasms of the Uterine Cervix. Chapter 10. Comprehensive Cytopathology by Marluce Bibbo. 1991.

 

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