Adenocarcinoma of the cervix

Abstract

BACKGROUND.The current study examines 1) the sensitivity of detection of invasive adenocarcinoma of the cervix in a routine cervical screening service, and 2) the frequency in smears of cytologic criteria previously found to be useful in diagnosis. METHODS. RESULTS.Thirty-six smears from 24 women were reviewed. Of those, 58.3% had been reported as a possible or definite high grade epithelial abnormality (HGEA). On review it was thought that this could be improved to 77.8%. The screening or diagnostic error was thus 19.4% and the sampling error 22.2%. The likelihood of an individual woman receiving a report of a possible or definite HGEA in the three years before biopsy was 83.3%. In retrospect this could have been improved to 91.7%. Heavy bloodstaining with abundant abnormal glandular epithelium (14 smears) and small three-dimensional or papillary clusters (16 smears) were the most frequent clues to invasion.Tumor necrosis/diathesis was present in eight smears, but easily seen in only four, while marked nuclear pleomorphism and macronucleoli were seen in three and one smears respectively. In cases with a discrepancy between the initial and the review findings, very small amounts of abnormal material (three smears), a resemblance to endometrial cells (one smear), and an unusual appearance of folded monolayered sheets (three smears) contributed to the difficulty of diagnosis.CONCLUSIONS. There were significant sampling and screening/diagnostic errors (22.2% and 19.4%, respectively). Screening and diagnostic errors could perhaps be reduced by a greater awareness of the range of cytologic changes, but these may be subtle. Heavy bloodstaining with abundant abnormal glandular material may be a useful clue to invasive, rather than in situ, adenocarcinoma, even in the absence of tumor diathesis or fully malignant nuclear criteria. Cancer (Cancer Cytopathol) 2002;96:5-13.

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“…A limited number of smears did contain focal background debris, but none exhibited widespread diathesis. In contrast to previously examined invasive carcinomas,37 only one case exhibited marked blood staining, reinforcing the value of this criterion in suggesting invasion. However, other features that are characteristic of invasive tumors, such as small papillary or three‐dimensional groups, were seen in some cases and were prominent in a small number of smears.…”

“…This change in policy would have led to the sending of only one additional case out of the eight in question for gynecologic review. The main objective of our studies of glandular lesions of the endocervix6, 37 has been to increase diagnostic skills within the laboratory, and there were some signs of an improvement in approach over the course of the study. Only 2 of the 8 errors described above occurred in the last 3 years of the study period.…”

Severe cervical glandular cell lesions and severe cervical combined lesions

“…Other published results26–35 indicate that glandular cell abnormalities were frequently overlooked or underestimated in the cytologic specimen. This most likely is due to glandular abnormalities being less common than cervical squamous cell lesions.…”

“…The studies26–35 addressing the prediction of severe cervical GCLs on cervical Pap smears indicated great differences with regard to predictive accuracy. Gornall et al31 performed a retrospective review of 150 women with glandular cell abnormalities (mild, moderate, and severe) reported on Pap smear.…”