Cytologic features of high‐grade squamous intraepithelial lesions involving endocervical glands on ThinPrep® cytology

Abstract

Usage of liquid-based cytology has resulted in better cellular preservation with enhancement of nuclear features. The purpose of this retrospective 2-yr study (January 1999 through December 2000) was to evaluate the cellular features of endocervical gland involvement by a high-grade squamous intraepithelial lesion (HSIL) vs. endocervical adenocarcinoma in situ (AIS) on cell samples processed by the ThinPrep method as compared to conventional smears. Of the 97 cases of CIN III diagnosed on cytology, 52 (54%) showed surface endocervical gland involvement by CIN III and form the basis of this study. There were also six cases of endocervical AIS diagnosed on histology with prior cytology. The architectural features of HSIL involving endocervical glands and AIS were similar to those previously reported on conventional smears. A consistent finding of HSIL involving endocervical glands was the loss of central cell polarity and piling within cell groups, a finding not present in AIS. Central cell polarity was maintained in cellular groupings of AIS. In addition to the cellular feature present on conventional smears, micronucleoli were clearly visualized in cells of HSIL involving endocervical glands and prominent nucleoli were present in AIS. Apoptosis and mitoses were clearly visualized in both entities. Endocervical gland involvement by HSIL has characteristic cell patterns and features on liquid-based/thin-layer cytology that permit their distinction from AIS.

Glandular epithelial abnormalities on thinprep® pap tests: Clinical and cytohistologic correlation

“…9 In the majority of these studies, the mean age of the women ranged from 41 to 44 years. 25 All of the papanicolaou tests diagnosed as endocervical endocarcinoma in situ showed endocervical glandular lesions on histology. Within this group, 18 (72%) of the women were postmenopausal, 14 (78%) of whom presented with vaginal bleeding.…”

Cytohistological correlation of endocervical gland involvement with high-grade squamous intraepithelial lesions

“…[9–12] However, the results of two of these authors differed from those of the others; they did not confirm the increased frequency of EGI on SCBs of patients with cytological HSIL-EGI diagnoses. [1314] Selvaggi[911] defined the cytological criteria of HSIL-EGI with a particular emphasis on patterns A and B. Round to oval “syncytial” clusters with smooth cellular borders, central whorling and peripheral flattening of small dysplastic cells were designated as “pattern A,” and sheets of abnormal columnar vacuolated cells with peripheral palisades and nuclear pseudostratification were designated as “pattern B.” We actually experienced difficulty in understanding and recognizing the cell clusters of patterns A and B.…”

High-risk human papillomavirus DNA testing: A marker for atypical glandular cells

“…This often results from HSIL involving endocervical glands 27 rather than a true glandular lesion. Criteria for differentiating HSIL involving glands and AIS have been defined, 28,29 but the rate of misinterpretation remains high, inflating the AGC category. So, although a positive HPV result does not distinguish AIS from HSIL, it selects and prompts a thorough investigation of HSILs, which have a propensity to persist or progress to carcinoma rather than regress.…”