PART TWO
Diagnostic Cytology
Fig. 9.11 At low magnification (A), a characteristic “feathered" appearance of the groups is noted in endocervical AIS. Nuclei protrude from the margins
of the groups. In (B) an epithelial ‘rosette,” or intraepithelial lumen, is noted (arrow). (C, D) Higher magnifications of feathered groups. Nuclei are pulled out from
their attachment points on the basement membrane which gives a serrated edge to each grouping. Although these features can be seen in both conventional
and liquid-based specimens, the former accentuates feathering through the cell smearing process. Liquid-based fixation tends to blunt the serrated group
edges (liquid-based preparation, Papanicolaou x (A) LP, (B) MP, (C, D) HP).
experience of this author would suggest that ciliated cells are
far more commonly found in benign processes, with some
putatively malignant conditions actually representing "false-
positive" benign mimickers.50 Intestinal variants show the pres-
ence of goblet cells; however, one study notes that goblet cells
may be difficult to identify in cytologic preparations and these
lesions show otherwise similar nuclear and architectural features
when compared to the usual type of "endocervical" AIS.51
Endocervical Adenocarcinoma
A very comprehensive review of endocervical adenocarcinoma
and its histologic variants was put forth by Young and Clem-
ent in 200252 (Table 9.1). The "typical endocervical type" of
endocervical adenocarcinoma constitutes about 80% of pri-
mary cervical adenocarcinomas, and is most often "mucin-
poor" (Fig. 9.14). Variants exist in which variable amounts of
mucin are present, up to and including so-called "mucinous"
variants showing abundant intracytoplasmic mucin. These neo-
plasms are generally moderately differentiated and composed of
glands of medium size. Cells have a characteristic eosinophilic
cytoplasm, are columnar, and show architectural stratification.
Invasive components may show small irregularly spaced glands
or glands in lobular units. Occasional solid areas may be noted.
Usual types of endocervical adenocarcinomas may show pap-
illary surface features, but should not be confused with the
villoglandular variant that shows predominantly tall thin sur-
face papillae that have stromal fibrous cores (Fig. 9.15). In this
variant, invasive components show elongated branching glands
separated by fibrous stroma, occasionally showing a desmoplas-
tic or myxoid stromal reaction. Individual cells show features
similar to well, or at worst, moderately differentiated usual
types of adenocarcinomas, and also often show adjacent areas
of AIS. Typically only minimal invasion is noted in these tumors
and they are generally noted to have a better prognosis than
usual types. The authors mention that this designation should
be reserved for tumors with no areas showing the more usual
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