PART TWO
Diagnostic Cytology
Fig. 8.92 Carcinoma in situ (HGSIL) and adenocarcinoma in situ (AIS) in histology and cytology. (A) Left: portion of the adenocarcinoma in situ lesion:
Severely atypical glandular epithelium, exhibiting pseudostratification. Right: HGSIL (H&E x HP). (B) Left: acinic structure composed of severely atypical cervical
glandular cells derived from adenocarcinoma in situ. Right: highly abnormal squamous cells that contain polymorphic nuclei consistent with carcinoma in situ
(Papanicolaou x HP). (C) Left: polypoid structure composed of severely atypical cervical glandular cells with elongated nuclei, derived from adenocarcinoma in
situ. Right: highly abnormal squamous cells with polymorphic nuclei consistent with carcinoma in situ (Papanicolaou x HP)
altering the balance (or imbalance) between the host tissue and
the abnormal epithelium.
Dysplasia and Carcinoma in Situ in Postmenopausal
Patients
Dysplasia and carcinoma in situ occurring during postmeno-
pause are often difficult to diagnose because of the lack of
mature squamous and columnar cells in the smears. Owing to
the lack of estrogenic stimulation, cells remain rather small,
often the size of parabasal cells or relatively immature squa-
mous metaplastic cells. Aggregates of small cells with densely
staining nuclei are a common finding in smears from women in
postmenopause. Relative nuclear enlargement due to a reduced
development of the cytoplasm, which is in turn caused by a low
estrogenic stimulus, may mimic the nucleocytoplasmic ratio
found in epithelial lesions (Figs 8.98 and 8.99). These cells are
often erroneously diagnosed as dysplastic cells or cells consist-
ent with carcinoma in situ.
To avoid unnecessary biopsies, it is advisable to repeat the
cytologic examination after a short course of oral or local
hormonal estrogenic medication. In the majority of cases, the
supposedly dysplastic change will have disappeared through
maturation of the epithelium under the estrogenic stimulus
(Fig. 8.100; see also Fig. 8.18). Because abnormal epithelial cells
are less sensitive to the maturation stimulus from the estrogenic
hormones, true abnormal cells can be recognized much more
easily between the now-matured surrounding epithelial cells
(Fig. 8.101). With this relatively simple procedure in cases of
epithelial atrophy with pseudoabnormalities, unnecessary biop-
sies can be avoided. In view of the higher rate of complications
in cases of surgical interventions involving atrophic tissues,
this must be considered an important benefit to these women.
Kaminski and co-workers reviewed 115 consecutive patients
who were older than 50 years and who had known abnormal
cytologic findings, diagnosed at routine cervical screening.181
A strong association between epithelial abnormalities and
180
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