Objective: In routine screening, glandular lesions have high false-negative and false-positive rates. Our study sought to improve the cytological diagnoses and differentiation of glandular lesions. Study Design: A total of 24 cytology slides were retrospectively reviewed. Among these slides, 15 were confirmed via histology to have varying amounts of adenocarcinoma in situ (AIS) components. The other 9 cytology slides exhibited AIS mimics that had been originally considered to be AIS or atypical glandular cells (AGCs) and were selected for differentiation from AIS. Results: Overall, 12 of the 15 cytological slides exhibited significant atypical glandular features that met the criteria for AIS. However, the original cytological diagnoses included 2 cases of AIS, 3 AGCs-favor neoplasia (AGC-FN), 2 AGCs, 1 case that was not otherwise specified (AGC-NOS), 1 NILM (negative for intraepithelial lesion and malignancy), 3 HSILs (high-grade squamous intraepithelial lesions), and 2 ASC-Hs (atypical squamous cells, cannot exclude HSIL). The latter 9 cytological slides were subsequently histologically confirmed to be 2 metaplasias, 2 reactive lesions, 1 decidual change, 3 serous adenocarcinomas, and 1 SCNEC (small-cell neuroendocrine carcinoma). Conclusion: Cytological screening will be valuable for identifying glandular lesions as effectively as squamous lesions if the doubly high false rates can be decreased.

Keywords:
Cervix, Adenocarcinoma in situ, Cytology, Differential diagnosis
1.
Saslow D, Solomon D, Lawson HW, Killackey M, Kulasingam SL, Cain J, Garcia FA, Moriarty AT, Waxman AG, Wilbur DC, Wentzensen N, Downs LS Jr, Spitzer M, Moscicki AB, Franco EL, Stoler MH, Schiffman M, Castle PE, Myers ER: American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. Am J Clin Pathol 2012;137:516-542.
2.
Siegel R, Naishadham D, Jemal A: Cancer statistics, 2012. CA Cancer J Clin 2012;62:10-29.
3.
Slama J, Freitag P, Dundr P, Duskova J, Fischerova D, Zikan M, Pinkavova I, Cibula D: Outcomes of pregnant patients with Pap smears classified as atypical glandular cells. Cytopathology 2012;23:383-388.
4.
Australian Institute of Health and Welfare. Cervical Screening in Australia 2008-2009. Canberra, Australian Institute of Health and Welfare, 2011.
5.
Barroilhet L, Van Hanegem L, Bernstein M, Feldman S: Potential Effects of Updated Pap test screening guidelines and adenocarcinoma in situ of the cervix. Obstet Gynecol 2013;121:759-764.
6.
Ravarino A, Nemolato S, Macciocu E, Fraschini M, Senes G, Faa G, Negri G: CINtec PLUS immunocytochemistry as a tool for the cytologic diagnosis of glandular lesions of the cervix uteri. Am J Clin Pathol 2012;138:652-656.
7.
Apgar BS, Kittendorf AL, Bettcher CM, Wong J, Kaufman AJ: Update on ASCCP consensus guidelines for abnormal cervical screening tests and cervical histology. Am Fam Physician 2009;80:147-155.
8.
Tam KF, Cheung AN, Szeto E, Ngan HY: Atypical glandular cells diagnosed during pregnancy and the postpartum period: a retrospective analysis. Eur J Obstet Gynecol Reprod Biol 2011;155:213-216.
9.
Negri G, Bellisano G, Carico E, Faa G, Kasal A, Antoniazzi S, Egarter-Vigl E, Piccin A, Dalla Palma P, Vittadello F: Usefulness of p16ink4a, ProEX C, and Ki-67 for the diagnosis of glandular dysplasia and adenocarcinoma of the cervix uteri. Int J Gynecol Pathol 2011;30:407-413.
10.
Medeiros F, Bell DA: Pseudoneoplastic lesions of the female genital tract. Arch Pathol Lab Med 2010;134:393-403.
11.
Wright TC Jr, Massad LS, Dunton CJ, Spitzer M, Wilkinson EJ, Solomon D; 2006 American Society for Colposcopy and Cervical Pathology-sponsored Consensus Conference: 2006 Consensus guidelines for the management of women with abnormal cervical cancer screening tests. Am J Obstet Gynecol 2007;197:346-355.
12.
Covell JL, Wilbur DC, Guidos B: Epithelial abnormalities: glandular; in Solomon D, Nayar R (eds): The Bethesda System for Reporting Cervical Cytology: Definitions, Criteria and Explanatory Notes, ed 2. New York, Springer, 2004, pp 123-156.
13.
Wilbur DC, Mikami Y, Colgan TJ, Park KJ, Ferenczy AS, Ronnett BM, Hirschowitz L, Schneider A, Loening T, Soslow R, McCluggage WG, Wells M, Wright T: World Health Organization Classification of Tumors: WHO Classification of Tumors of Female Reproductive Organs. Lyon, International Agency for Research on Cancer, 2014, pp 183-184.
14.
Li S, Zhu H: Twelve cases of neuroendocrine carcinomas of the uterine cervix: cytology, histopathology and discussion of their histogenesis. Acta Cytol 2013;57:54-60.
15.
McCluggage WG, Hurrell DP, Kennedy K: Metastatic carcinomas in the cervix mimicking primary cervical adenocarcinoma and adenocarcinoma in situ: report of a series of cases. Am J Surg Pathol 2010;34:735-741.
© 2015 S. Karger AG, Basel
2015
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