Adenocarcinoma in situ of the uterine cervix

Abstract

BACKGROUND.Little attention has been given to the reasons for failure to detect adenocarcinoma in situ (AIS) of the uterine cervix in Papanicolaou (Pap) smears. In the current study, the authors examined a series of screening or diagnostic errors in cases in which the final histologic diagnosis was either AIS or AIS combined with a high-grade squamous intraepithelial lesion (AIS ϩ HSIL). METHODS.Smears obtained in the 3 years before histologically proven AIS or AIS ϩ HSIL was diagnosed and within a specified 6-year period (1993)(1994)(1995)(1996)(1997)(1998) were reviewed and reclassified. All were conventional Pap smears. The smears studied were those with a review diagnosis of possible or definite high-grade epithelial abnormality that initially were reported by a cytotechnologist to be negative (screening error) or that were reported by a pathologist to be negative, unsatisfactory, or indicative of a low-grade epithelial abnormality (diagnostic error). A semiquantitative, blinded assessment of the frequency of cytologic criteria for the diagnosis of AIS was made for smears with erroneous diagnoses compared with a series of smears that yielded true-positive findings. CONCLUSIONS. Sampling errors were the main cause of false-negative reports in cases of AIS and AIS ϩ HSIL. The primary factors that contributed to screening or diagnostic errors in AIS were minimal, poorly preserved abnormal material and an overly conservative approach to the assessment of unusual large sheets or aggregates of glandular cells. With regard to AIS ϩ HSIL, most laboratory errors were related to the presence of crowded groups of squamous epithelial cells. There were fewer errors in the last 3 years of the study, raising the possibility of improvement over time. RESULTS.

Detection ofin situand invasive endocervical adenocarcinoma on ThinPrep Pap Test: Morphologic analysis of false negative cases

“…With respect to both of these instances, neoplastic cells with small “endometrioid” type features as well as these resembling reactive endocervical cells may be mistaken for benign glandular epithelium and thus become a factor in decreased sensitivity of the TPPT. [141518] As seen in our TPPT re-classified as AIS, the presence of many benign-appearing HCG exhibiting only a few features overlapping with those of neoplastic glandular lesions may mask the presence of HCGs with overt neoplastic changes. In particular, the thick cell clusters and tissue fragments may obscure neoplastic cytologic findings.…”

“…Ruba et al . [15] reported CS sensitivity for EGN as 54% and have defined three types of errors that affect the diagnosis of adenocarcinoma in cervical specimens. These errors include sampling, screening, and diagnostic errors.…”

TP53 Mutation-driven Stratified Mucin-producing Carcinoma Coexisting With Squamous Cell Carcinoma of the Vulva: A Case Study

“…SMILE is a well-established subtype of cervical in situ adenocarcinoma associated with high-risk HPV infection and has been thought to represent a form of adenosquamous cell carcinoma in situ Pathology of the Lower 18 . The lesion consists of stratified epithelial cells with cytoplasmic mucin throughout the entire epithelial layers often with peripheral palisading of basaloid cells Pathology of the Lower 19 .…”

“…In the cervix, SMILE is associated with invasive carcinoma in 10% to 50% of the reported cases and most of the carcinomas are cervical adenocarcinoma including ISMC, squamous carcinoma, or adenosquamous carcinoma Pathology of the Lower 14,24 . Notably, all reported cases of SMILE or ISMC in the cervix are considered HPV-associated neoplastic processes, and HPV-independent counterparts have not been described Pathology of the Lower 18 . In this vulvar case, both the ISMC-like and squamous cell carcinoma components demonstrate an abnormal diffuse p53 immunostaining pattern and a patchy p16 expression, consistent with the TP53 mutation-driven process.…”

HPV DNA Status and Clinical History of Patients are Supplements for Accurate Reporting of the Cytological Pap Smear.

“…In many studies, the sensitivity of the Pap smear was found to be <70% [2][3][4], and consequently, in some of the cases, cervical cancer was diagnosed as cervical dysplasia when screened by Pap smear method. Error in the sample collection is a big issue because it is difficult to reach an adequate level of coverage, [5][6][7] another issue is optimal collection of samples & lack of well-trained persons for drawing the sample. [8] Interpretation of cytology is very subjective despite the presence of abnormal cells [9][10] therefore frequent repeated screening is recommended.…”