8
Benign Proliferative Reactions, Intraepithelial Neoplasia, and Invasive cancer of the Uterine cervix
Fig. 8.118 Keratinizing squamous cell cancer. Elongated and bizarre
shaped cells and nuclei. Cytoplasm showing fibrillary keratin structures.
Nuclei are irregularly shaped and have a coarsely granular hyperchromatic
chromatin (Papanicolaou x OI).
Fig. 8.119 Keratinizing squamous cell cancer. Keratin ‘pearl" in cytologic
specimen. Nuclei vary in size and shape. Irregularly distributed nuclear
chromatin. Some nucleoli can be recognized (Papanicolaou x OI).
Cytologically, the cells from a verrucous carcinoma may not
be indicative of a severe epithelial abnormality, and cytologic
diagnosis of the clinically overt lesion is often negative for
malignancy.
Adenosquamous Carcinoma
Adenosquamous cancer has a malignant squamous compo-
nent and a malignant adenomatous component (Fig. 8.121).
The squamous component usually is of the nonkeratinizing or
small-cell type. Rarely a keratinizing squamous component may
be found. The cytologic features of cells from the squamous can-
cer component and cells from the adenocarcinomatous compo-
nent are similar to those described for these respective cancer
types (Fig. 8.122). In the cytologic specimen, both cell types can
be found within the same cell cluster. This is in contrast to the
rare situation in the cervix when both a squamous cell carci-
noma and a separate adenocarcinoma occur.
Fig. 8.120 Verrucous carcinoma. Papillary excrescences composed of
only minimally atypical squamous cells (H&E x MP).
Key features of adenosquamous carcinoma
• Cells in syncytial arrangement and singly lying cells of
squamous cell type next to glandular type cells in large
dense clusters;
• Cells have a predominantly cyanophilic cytoplasm
with scattered cells showing eosinophilic cytoplasm;
• Round-to-oval nuclei, with considerable variation in
size;
• N/C high;
• Unevenly distributed, coarsely granular, and dense-
ly hyperchromatic nuclear chromatin in cells of
squamous cell type;
• Cells in clusters usually have less hyperchromatic
nuclear chromatin;
• Nucleoli are present but frequently obscured by hyper-
chromatic nuclear chromatin in squamous type cells;
and
• Macronucleoli are frequent in glandular type cells.
Small-Cell Cancer
Small-cell cancer used to be categorized as a subtype of
squamous cell cancer. More recently, however, on the basis of
immunocytochemical and electron microscopic evidence, these
tumors are considered to be of neuroendocrine derivation. They
should therefore be grouped together with the carcinoid tumors.
In view of the differential diagnostic problems these tumors
may present in cytologic specimens, they are discussed here in
more detail. In comparison with keratinizing and nonkeratiniz-
ing squamous cell cancer, small-cell cancer usually has a more
proximal location in the cervical canal.
Small-cell cancer grows rather diffusely in large masses sepa-
rated by thin strands of stromal cells (Fig. 8.123). Boundaries
with the surrounding stroma are often ill defined. Cells show
a relatively high variation in size. There is no evidence of indi-
vidual cell keratinization or epithelial pearl formation. Mitoses
usually are numerous. In some tumors, cells show a positive
reaction to neuroendocrine markers. In cytologic specimens,
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