Cytology suggestive of glandular neoplasia: outcomes and suggested management

Abstract

Eighty-three cases having a cervical smear result showing abnormal glandular cells were identified and matched up with the diagnostic histology result. Thirty-four (41.0%) were associated with malignancy and 26 (31.3%) with a cervical intraepithelial lesion without invasion. Thirty-eight (45.8%) had conditions of the cervix as follows: 12 cases had invasive disease of the cervix; nine (10.8%) adenocarcinoma of cervix and three (3.6%) squamous carcinoma of cervix. Nineteen (22.9%) had cervical intraepithelial neoplasia (CIN/SIL) alone and seven (8.4%) had cervical glandular intraepithelial neoplasia (CGIN) +/- CIN. There were 16 (19.3%) cases with malignancies of the uterine corpus and six (7.2%) had a malignancy arising from another primary site. Twenty-three (27.7%) had no malignant or pre-malignant condition. The risk of malignancy was related to age and ranged from 18.2% in those under 35 years to 67.9% in those 55 years and over. A protocol for the management of these cases is described.

Atypical glandular cells in conventional cervical smears: Incidence and follow-up

“…Indeed, 33% of the patients with an endocervical AC and 56% with an endometrial AC were asymptomatic (Table 3). These observations are in contrast to the findings of Hare et al [29] who describe 28.3% asymptomatic patients with invasive endocervical AC diagnosed with the cytobrush technique. All of there 15 endometrial AC were symptomatic.…”

“…In the current study (Table 2) we found 261 'new' AGC-NOS cases diagnosed by cervico-vaginal cytology in our population, representing an AGC rate of 0.05% and increasing from 0.01% in 1990 to 0.09% in 1999. Other laboratories reported AGC rates ranging from 0.09% to 2.5% [8,18,20-22,27-29]. The reason why the prevalence of AGC in our series is considerably lower than that reported in other studies may be due to the exclusion of 25 cases with atypical ' epithelial ' cells at the beginning of the 1990's.…”

“…In analogy to the guidelines for managing women with AGC issued in 2001 by the American Society for Colposcopy and Cervical Pathology (ASCCP), we recommend today a complete and careful evaluation [39-41]. According to Soofer et al [18] and Hare et al [29] and in order to avoid an inappropriate patient management due to a misleading qualification (endocervical versus endometrial origin; squamous or glandular cell type; cell atypias favouring a reactive or neoplastic etiology) we support a step-by-step approach of each AGC-NOS diagnosis, including colposcopic examination, followed by a curettage of the cervix and of the corpus to obtain an unequivocal histological diagnosis.…”

Prediction of high-grade cervical disease with human papillomavirus detection in women with glandular and squamous cytologic abnormalities

“…This feature of the disease poses another clinical problem, especially when the physician is confronted with an AGC Pap smear and an insufficient colposcopy. Many such women may have no cervical neoplasia, as reported previously (8)(9)(10) and corroborated in this sample. In this study, 26 (51%) out of 51 women with AGC were proven to have no clinically significant histologic lesion.…”

Prediction of high-grade cervical disease with human papillomavirus detection in women with glandular and squamous cytologic abnormalities

“…Most diagnoses of squamous and glandular cervical neoplasias are obtained with cervical cytology (Pap smears). Although squamous abnormalities in Pap smear strongly correlate with histopathologic squamous histologic findings, glandular abnormalities pose significant clinical problems because of their poor correlation with final histopathology (8–10) . The clinical significance of atypical glandular cells (AGC), an uncommon cytologic diagnosis defined in the last revision of the Bethesda System (2001), is still under debate.…”