The present study aimed to determine the histopathological correspondence of the diagnosis of atypical squamous cells of uncertain significance (ASCUS) in the absence of squamous intraepithelial neoplasia (SIL) in loop electrical excision procedure (LEEP) products. Retrospective histopathological analysis of 70 LEEP products preceded by ASCUS was consistently detected by two consecutive Pap smears. The presence or absence of several histopathological findings in cases with (23/70) and without (47/70) histological diagnosis of SIL were compared. Immature squamous metaplasia, severe cervicitis, and tube-endometrial metaplasia were found with similar frequency on positive and negative neoplastic disease specimens. Reactive squamous atypia, keratosis, atrophy, glandular reactive/inflammatory atypia, tunnel clusters, and microglandular hyperplasia were less frequently found in LEEP specimens presenting with SIL. Reactive squamous atypia and keratosis were consistently associated with SIL absence and appear to be responsible for the cytological diagnosis of ASCUS (P < 0.05).
The present study aimed to determine the histopathological correspondence of the diagnosis of atypical squamous cells of uncertain significance (ASCUS) in the absence of squamous intraepithelial neoplasia (SIL) in loop electrical excision procedure (LEEP) products. Retrospective histopathological analysis of 70 LEEP products preceded by ASCUS was consistently detected by two consecutive Pap smears. The presence or absence of several histopathological findings in cases with (23/70) and without (47/70) histological diagnosis of SIL were compared. Immature squamous metaplasia, severe cervicitis, and tube-endometrial metaplasia were found with similar frequency on positive and negative neoplastic disease specimens. Reactive squamous atypia, keratosis, atrophy, glandular reactive/inflammatory atypia, tunnel clusters, and microglandular hyperplasia were less frequently found in LEEP specimens presenting with SIL. Reactive squamous atypia and keratosis were consistently associated with SIL absence and appear to be responsible for the cytological diagnosis of ASCUS (P < 0.05).
A wide array of immunohistochemical markers have been evaluated with respect to their specificity in staining dysplastic cervical cells in cervical biopsies and cervical cytological smears. However, there is still a significant demand for better biomarkers to identify neoplastic cervical glandular and squamous epithelial cells precisely. The CDKN2A gene, located on chromosome 9p21, encodes the tumour suppressor protein, p16INK4A, which decelerates the cell cycle by inactivating CDK4 and CDK6. The aim of this study was to compare and contrast the expression pattern of p16INK4A in benign and neoplastic glandular lesions and tubo-endometrioid metaplasia. All cases in each category displayed some p16INK4A expression. Adenocarcinoma and in situ cases showed a combination of intense nuclear and cytoplasmic staining. It was observed that all cases of tubo-endometrioid metaplasia showed occasional nuclear positivity and definite cytoplasmic staining. These findings may have important implications for the potential utility of p16INK4A as a biomarker for glandular dysplastic lesions. While p16INK4A has been demonstrated to be an excellent marker of cervical dysplasia in squamous neoplastic lesions of the cervix, it has potential pitfalls in cervical glandular lesions that may limit the utility of this biomarker in resolving the nature of suspicious glandular lesions, particularly in cytopathology.
Clinical and morphologic features as well as immunohistochemistry results should be used in conjunction in the differential diagnosis of glandular proliferations of the cervix, as correct interpretation has major clinical consequences for the patient in most instances (especially benign versus malignant). Immunohistochemical markers should be used as part of a panel of antibodies, as exceptions may occur to the usual pattern of staining, and if used singly, they may mislead the pathologist to establish a wrong diagnosis.
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