Cervical Pap test: Atypical and malignant glandular cells

Dr May Yu’s Teaching session for beginners and trainees.

2nd March, 2007.

Endocervical adenocarcinoma in situ

2 dimensional sheets, strips, 3 dimensional clusters, predominance of groups

marked hyperchromatism

altered nuclear polarity

--Combination of three features form striking and charactericstic scanning magnification: darkly stained, crowded cellular aggregates with altered nuclear polarity.

other features:

  • increased N/C ratio
  • feathering.
  • apoptosis
  • mitosis
  • individual (single) cells may be present but usually inconspicuous

Endocervical adenocarcinoma

Features of endocervical AIS+ evidence of invasion

Single cells

irregular chromatin distribution, parachromatin clearing

+/- Macronucleoli

+/- necrotic tumor diathesis

Endometrial adenocarcinoma

Cells occur singly or in small, loose clusters

Well differentiated - tumors: N slightly enlarged, becoming larger with increasing grade

Variation in nuclear size and loss of nuclear polarity evident

Particularly in higher grade tumors, nuclei display moderate hyperchromatism, irregular chromatin distribution, parachromatin clearing

Cytoplasm typically scant, cyanophilic, and often vacuolated

A watery, finely granular tumor diathesis is variably present.

Extrauterine adenocarcinoma

  • Clean background
  • Whenever morphological features unsual for tumors of cervix or uterus, think of extrauterine origin.

Atypical glandular cellsAGC, NOS

Ref: Bethesda 1994

N atypia exceeds obvious reactive or reparative changes but lack unequivocal features of adenocarcinoma

Note: reactive glandular cells: sheets, strips of glandular cells, may have

Mild nuclear overlap

Nuclear enlargement can be 3-5X

Mild variation in nuclear sizes and shapes

Slight hyperchromatism

Distinct nucleoli common, some may be prominent

N/C ratio usually preserved.

AGC, endocervical cells, NOS

-features of endocervical nature present, e.g., strips or honey comb sheets, columnar epithelial cells with abundant cytoplasm.

-

Atypical endometrial cells, NOS

-Cells in small groups, 5-10 cells per group

-N slightly enlarged

-+/- slight hyperchromatism

-+/- small nucleoli

-cell borders ill defined

-compared with endocervical cells, these cells have scant cytoplasm, which occasionally is vacuolated.

AGC, endocervical, favour neoplastic

-Atypical endocervical glandular cells with features suggestive but not sufficient criteria to reach adenocarcinoma or AIS

AGC, endometrial , favour neoplastic

-Atypical endometrial glandular cells with features suggestive but not sufficient criteria to reach endometrial adenocarcinoma.

AGC, favour neoplastic

-Atypical glandular cells with features suggestive but not sufficient criteria to reach adenocarcinoma or AIS.

Cannot further subclassify as endocervical or endometrial differentiation.