PART TWO
Diagnostic Cytology
Fig. 8.89 Mildly atypical columnar cells. Irregular arrangement of nuclei
and variation in nuclear size and shape. Slight hyperchromasia of regularly
distributed nuclear chromatin. One to two nucleoli are usually present
(Papanicolaou x OI).
lesions (GCLs) are less familiar and therefore are likely to be
overlooked in a relatively high number of cases.
Data from the literature indicate that in approximately 50% of
severe GCLs (range, 25-75% ), a coexisting squamous cell lesion
was present.152,153,162-170 Our most recent study170 addressed the
predictive value of the PAP smear. A data search of the Dutch
National Pathology Archive (PALGA) revealed that 721 of 1141
registered histological cervical glandular cell abnormalities
(63.2%) were in fact cases of a severe combined squamoglan-
dular cell lesion.
In addition the data search of the PALGA registry showed that
in 547 cases (51.9%) a cytological diagnosis of a severe glandu-
lar cell lesion (with or without a squamous cell component)
was made. Prediction of a severe glandular cell lesion in the PAP
smear was found to be more accurate in cases of histologically
confirmed pure glandular cell abnormalities than in cases with a
histological diagnosis of a combined lesion. The cytological pre-
diction was found to be correct in 75.2% of cases of pure adeno-
carcinoma in situ and in 47.3% of cases of adenocarcinoma in
situ with coexistent high-grade squamous intraepithelial lesion.
These figures illustrate a relatively poor "performance" in the
diagnosis of GCLs, suggesting that more attention must be given
Fig. 8.90 Co-occurrence of squamous cell carcinoma in situ and
adenocarcinoma in situ. (Papanicolaou x HP).
to specific morphologic characteristics of minor and severely
atypical cervical GCLs.
Studies addressing the prediction of severe cervical GCLs on
cervical Pap smears indicated great differences with regard to
predictive accuracy.152-161 A prerequisite for the recognition of
GCLs or combined lesions is knowledge of and agreement on
the significance of all cytomorphologic features characteristic of
the different grades and types of cervical glandular cell neopla-
sia. Furthermore cytotechnologists and cytopathologists must
always consider the possibility that two different cervical neo-
plasms are present in a given patient.
In our previous work on endocervical columnar cell intra-
epithelial neoplasia, various cytologic, architectural, cellular,
and nuclear characteristics proved useful in diagnosing intraepi-
thelial cervical GCLs and adenocarcinoma and in assessing the
severity of these lesions171-175 (Fig. 8.92).
The findings of one of our studies showed that application
of cytomorphologic features directed to cervical glandular cell
lesions such as pseudostratification, cellular crowding, gland-
like structures, feathering, vacuolated cytoplasm, and nuclear
and chromatin features increased the accuracy of diagnosing
combined severe lesions of the cervix.176 Most lesions as well
as different subtypes from glandular lesions were recognized in
178
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