9
Glandular Lesions of the Uterine Cervix
C
Fig. 9.10 Histologic sections of endocervical adenocarcinoma in situ. (A) The transformation between normal endocervical epithelium and
adenocarcinoma in situ (arrow). (B) The piling up of cells with cribriformed glands with intraepithelial lumina. (C) The marked pseudostratification of nuclei,
nuclear enlargement, and overall epithelial disorganization of this neoplastic process. In this section, apoptotic bodies are noted (arrow) consistent with
abnormal cell turnover (H&E x (A) HP, (B) MP, (C) HP).
identified feathered hyperchromatic crowded groups seen in
conventional smears, may be a more characteristic feature of AIS
presenting in LBP. Liquid-based fixation has been postulated to
blunt the feathered edges of such groups, which in conventional
slides were accentuated due to the flattening and smearing of
the specimen. Nuclear chromatin is more often noted to be
finely granular, and nucleoli are more prominent, both results
of early and more complete fixation than can routinely take
place in conventional slides. Although perhaps not less sensitive
for the detection of glandular entities (grouped together), exact
classification of glandular lesions as AIS, as opposed to atypical
glandular cells, not otherwise specified (AGC, NOS), or atypi-
cal glandular cells, favor neoplasia (AGC, favor neoplastic), has
been found by this author to be at times more challenging in
LBP specimens than with conventional slides. Other studies have
documented changes in appearances of AIS and AGC on liquid-
based specimens. One study described improvements in nuclear
features on LBP, but more "subtle" architectural changes.46
Although most endocervical adenocarcinomas in situ are
of the usual "endocervical" type, recapitulating the character-
istic endocervical epithelium described and illustrated in the
histology section (Fig. 9.1), it is important to recognize that
rarely other variants of Mullerian differentiation can occur. These
include endometrioid, serous, and intestinal variants. Of these,
the most significant from a differential diagnostic point is the
endometrioid pattern (Fig. 9.13). In a study of cases of adeno-
carcinoma in situ of the endocervix, this pattern contained small
cells in densely packed groups, having coarse nuclear chromatin,
and showing lack of pleomorphism.47,48 These groups were more
commonly misinterpreted as of benign endometrial or endocer-
vical origin. Criteria were developed to identify these cases as
abnormal (at least to the level of atypical glandular cells):
(1) The absence of endometrial stromal cells and
endometrial-like tubules;
(2) Coarse chromatin patterns;
(3) Extreme nuclear crowding;
(4) Mitotic figures; and
(5) Marginal feathering.48
Serous forms of AIS are hypothesized to exist but are reportedly
rare. They may show typical "hobnail" groupings and report-
edly may also have ciliated cells intermixed.49 However, personal
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