9
Glandular Lesions of the Uterine Cervix
Fig. 9.3 When viewed on end, typical “honeycombed" arrangements are noted for benign endocervical cells of the type illustrated in Fig. 9.1. These are
shown as (A) 2-dimensional, or flat, sheets, and (B) with a transition from picket-fence to honeycombed appearance (liquid-based preparation, Papanicolaou x HP).
B
Fig. 9.4 Two histologic sections found higher in the endocervical canal than that shown in Fig. 9.1. As the mucosa nears the lower uterine segment,
pseudostratification and the presence of the three cell types noted in tubal metaplasia can often be found. (A) Note the presence of a prominent ciliated
mucosal border (arrows). (B) Peg cells are noted within the epithelium (arrows) (H&E x HP).
Fig. 9.5 In this tight grouping of endocervical epithelial cells, mucin-
containing peg cells (arrows) are noted along with densely packed
intercalated cells (liquid-based preparation, Papanicolaou x HP).
both lines. When measured by sensitive detection methods,
adenocarcinomas of endocervical origin and their precursors
are virtually always associated with high-risk HPV types (94 and
100%, respectively).11 The finding of a small percentage of HPV-
negative invasive adenocarcinomas points to a low-incidence
alternate pathway, most likely akin to endometrial neopla-
sia.11 HPV infection of these primitive cells is thought to be
the primary and necessary event leading along the lengthy path-
way that culminates, in a very small number of cases, as invasive
carcinomas. The overall oncogenic sequence and the underlying
molecular biology of cellular transformation have been previ-
ously covered in Chapter 1 and will not be repeated here. Being
of specific importance to endocervical neoplasia, however, some
additional features are worth reviewing. In addition to HPV asso-
ciation, there are distinctly identified risk factors associated with
the development of glandular (as opposed to squamous) lesions.
The two types of cancers share cofactors associated with the sex-
ually transmitted nature of an HPV-associated disease, such as
number of sexual partners and age of first intercourse. However,
epidemiologic studies have determined that other cofactors for
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