Fig. 8.93 Carcinoma in situ (HGSIL) and adenocarcinoma in situ/adenocarcinoma in histology and cytology. (A) Carcinoma in situ in collision with
adenocarcinoma in situ/adenocarcinoma (H&E x MP). (B) Increased magnification of the boxed area in (A). Left: endocervical lining with severely atypical
glandular cells from adenocarcinoma in situ (left) in collision with severely atypical squamous cells from carcinoma in situ (top) (H&E x HP). (C) Cells derived
from carcinoma in situ (top left) and small strips composed of pseudostratified atypical glandular cells derived from adenocarcinoma in situ (top right and
bottom middle) (Papanicolaou x MP). (D) Severely atypical squamous cells exhibiting nuclear overlap, polymorphism, hyperchromasia, and a coarse granular
chromatin pattern (Papanicolaou x HP). (E) Strip-like arrangement composed of pseudostratified glandular cells that contain elongated nuclei and vary in size
(Papanicolaou x MP). (F) Acinic structure derived from adenocarcinoma in situ. The cytoplasm is directed toward the center of the structure: the elongated
peripherally located nuclei vary in size and shape. The chromatin is finely granular (Papanicolaou x HP).
Fig. 8.94 Intestinal adenocarcinoma in situ. (A) ‘Back-to-back" cellular arrangement and prominent cytoplasmic vacuolation are evident (H&E x HP).
(B) Cervical glandular cells with abundant cytoplasmic vacuolation can be seen (Papanicolaou x HP).
Fig. 8.95 Endocervical/endometrioid adenocarcinoma in situ. (A) Endometrioid type (right) and endocervical components can be seen (left) (H&E x MP).
(B) On the right-hand side, relatively small cells corresponding to the endometrioid component can be seen; on the left-hand side, a rosette-like structure
derived from the endocervical component of adenocarcinoma in situ can be seen (Papanicolaou x HP).
atrophy was found. After correction of the estrogen deficiency,
the epithelial abnormality reverted to normal in a statistically
significant percentage of patients. Findings were epithelial atro-
phy in 58% of patients and no epithelial abnormalities in 37%.
Two patients had CIN grade 1, and two patients CIN grade 2.
One patient showed evidence of HPV infection. In our own
experience, the lesion disappeared completely in 18% of cases,
and moderate-to-severe atypia was reduced to slight atypia in
55% of cases. The estrogenic stimulus induced a marked increase
in maturation in 68% of smears. The smears were easier to read
because of a reduction in the admixture of inflammatory cells
and the degree of cytolysis of the cytoplasm of atrophic cells,