Glandular lesions of the uterine cervix: the present state of our knowledge

Wells, Michael; Brown, Laurence

doi:10.1111/j.1365-2559.1986.tb02578.x

Cited by 48 publications

(23 citation statements)

References 49 publications

(17 reference statements)

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“…9 The extent of these areas was not stipulated by the authors. While we certainly do not deny the existence of glandular atypias of lesser grade than adenocarcinoma in situ, we-have not been able to confirm such atypia commonly occurring adjacent to areas of adenocarcinoma in situ, which usually distinctly abut on adjacent histologically normal glands.…”

Section: Discussionmentioning

confidence: 99%

Nucleolar organiser regions in adenocarcinoma in situ of the endocervix.

1989

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SUMMARY The AgNOR technique was used to analyse 11 cases of adenocarcinoma in situ of the endocervix and five examples of healthy cervices to assess whether areas of "increased nuclear activity" could be located adjacent to the malignant tissue. Areas of adenocarcinoma in situ had significantly more AgNOR staining dots than apparently normal bordering areas ("transitional areas") and areas of endocervical epithelium remote from adenocarcinoma in situ. There were no significant differences between AgNOR counts in transitional areas and areas remote from adenocarcinoma in situ, and between these areas and histologically normal cervices.These observations provide no support for the hypothesis that areas of glandular atypia of lesser severity or zones of "increased nuclear activity" exist adjacent to adenocarcinoma in situ.Adenocarcinoma in situ is believed to be a precursor of invasive cervical adenocarcinoma. It is an uncommon lesion, although its true incidence has probably been underestimated.' Various authors have found that glandular atypia of the cervix was strongly associated with cervical squamous intraepithelial neoplasia (CIN),2 and one group observed glandular atypia of lesser severity than adenocarcinoma in situ in crypts adjacent to areas of CIN3 in 15% of cases.3 Although we have not observed such a high incidence of cervical glandular atypia in association with CIN3, we might have overlooked most glandular atypias. Given the observation by the same workers that adenocarcinoma in situ was found separated from normal crypts by intervening areas of lesser grades of atypia, we investigated whether there are areas adjacent to adenocarcinoma in situ which show differences in the numbers of nucleolar organiser regions (NORs), as measured by the silver impregnation (AgNOR) method. For if it could be shown that there was a measurable change in nuclear "activity", this might support the concept of the existence of a transitional zone of pre-neoplastic mucosa which is not easily recognisable on routine histological staining. We also felt that it would be useful to determine whether the preferred sites for neoplastic transformation-that is, the crypts adjacent to the squamocolumnarjunctiondiffered from the rest of the endocervix by using the same technique in healthy cervices.Accepted for publication 27 July 1989 Material and methods Cases ofclassic adenocarcinoma in situ were identified by one of us (TPR) from the pathology files of the Birmingham and Midland Hospital for Women.Sections 3 gm thick were cut from routinely processed paraffin wax blocks. These were dewaxed in xylene and hydrated through ethanols to double distilled deionised water. A staining solution was prepared which consisted of gelatin dissolved in 10 g/l aqueous formic acid at a concentration of 20 g/l, mixed with 500 g/l aqueous silver nitrate (1 volume gelatin/formic acid to 2 volumes silver nitrate). This mixture was poured over tissue sections which were left in a humidity chamber in the dark for one hour at room temperature. The silv...

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Section: Discussionmentioning

confidence: 99%

Nucleolar organiser regions in adenocarcinoma in situ of the endocervix.

1989

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“…Complete agreement on the diagnosis of ACIS was reached in 96 patients (91%), according to the criteria of Brown and Wells. The criteria of Brown and Wells take architectural (glandular irregularity and complexity) and cytological criteria (nuclear enlargement, hyperchromasia, pseudostratification of nuclei, increased or abnormal mitoses) into account (Wells and Brown, 1986). The three pathologists reached no consensus on the diagnosis of ACIS in nine patients, and these patients were excluded.…”

Section: Glandular Lesionsmentioning

confidence: 99%

Coexisting high-grade glandular and squamous cervical lesions and human papillomavirus infections

Bekkers¹,

Bulten²,

Tilburg

et al. 2003

Br J Cancer

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The frequency of high-risk human papillomavirus (hr-HPV) genotypes in patients with adenocarcinoma in situ (ACIS) with coexisting cervical intraepithelial neoplasia (CIN), ACIS without coexisting CIN, and high-grade CIN (CIN II/III) was studied, in order to gain more insight into the relation between hr-HPV infections and the development of coexisting squamous and glandular lesions. The SPF 10 LiPA PCR was used to detect simultaneously 25 different HPV genotypes in biopsies obtained from 90 patients with CIN II/III, 47 patients with ACIS without coexisting CIN, and 49 patients with ACIS and coexisting CIN. hr-HPV was detected in 84 patients (93%) with CIN II/III, 38 patients (81%) with ACIS without CIN, and in 47 patients (96%) with ACIS and coexisting CIN. A total of 13 different hr-HPV genotypes were detected in patients with CIN II/III, and only five in patients with ACIS with/without coexisting CIN. HPV 31, multiple hr-HPV genotypes, and HPV genotypes other than 16, 18, and 45 were significantly more often detected in patients with CIN II/III, while HPV 18 was significantly more often detected in patients with ACIS with/without CIN. There were no significant differences in the frequency of specific hr-HPV genotypes between patients with ACIS with or without coexisting CIN. In conclusion, the frequency of specific hr-HPV genotypes is similar for patients with ACIS without CIN and patients with ACIS and coexisting CIN, but is significantly different for patients with CIN II/III without ACIS. These findings suggest that squamous lesions, coexisting with highgrade glandular lesions, are aetiologically different from squamous lesions without coexisting glandular lesions. . Numerous studies have suggested that the development of squamous cervical carcinoma is preceded by cervical intraepithelial neoplasia (CIN) (Wright et al, 2002;Bosch et al, 2002).The frequency of hr-HPV genotypes in CIN lesions has been studied previously and its detection rate rises with increasing severity of the CIN lesion (Bekkers et al, 2002a;Bosch et al, 2002;Wright et al, 2002). Only limited studies are available on the frequency of hr-HPV genotypes in premalignant glandular lesions and the number of patients in most studies is rather low (see Table 1) (Colgan and Lickrish, 1990;Leary et al, 1991;Higgins et al, 1992;Duggan et al, 1995;Anciaux et al, 1997;McLachlin et al, 1997;Pirog et al, 2000;Riethdorf et al, 2000Riethdorf et al, , 2002Madeleine et al, 2001). High-risk human papillomavirus was detected in 66 -100% of patients with ACIS (Anciaux et al, 1997;Riethdorf et al, 2000). Approximately 48% of all women diagnosed with ACIS have coexisting squamous lesions (Colgan and Lickrish, 1990;Leary et al, 1991;Higgins et al, 1992;Duggan et al, 1995;Anciaux et al, 1997;McLachlin et al, 1997;Pirog et al, 2000;Riethdorf et al, 2000Riethdorf et al, , 2002Madeleine et al, 2001), but the frequency of specific hr-HPV genotypes in patients with ACIS has not been studied in relation with the presence or absence of coexisting CIN lesions. In this stu...

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“…12 The potential for mistaking tubal metaplasia for adenocarcinoma is well described. 6,10,[12][13][14][15] In the experience of Novotny et al, 12 tubal metaplasia was the most common entity misinterpreted as AIS on cervical smears. When considering the possibility of tubal metaplasia vs. adenocarcinoma on cytologic material, identification of cilia is regarded as a valuable feature in support of a benign diagnosis.…”

Section: Discussionmentioning

confidence: 99%