9
Glandular Lesions of the Uterine Cervix
Fig. 9.12 Four examples of pseudostratified groups of cells. In (A), the luminar surface is shown with a long arrow, and the basal portion of the epithelium
is shown with a short arrow. In (B), a mitotic figure is noted (arrow), and in (C), apoptotic nuclear debris is present (arrow). (D) shows a typical "bird tail”
arrangement with splayed (feathered) border (liquid-based preparation, Papanicolaou x HP).
type of adenocarcinoma and should always be morphologically
low grade, to ensure that a better than expected prognosis is not
given to a more aggressive neoplasm.52
So-called "adenoma malignum" or minimal deviation adeno-
carcinoma is a mucinous carcinoma with bland histologic
appearance (Figs 9.16, 9.17). It is the tumor most commonly
noted to be non-HPV-associated for which an alternative patho-
genesis is suggested.11 Microscopically it consists of close to
widely dispersed glands within the stroma which vary in size
and may be round to irregular with occasional papillary infold-
ing. Glands are lined by mucin-producing cells showing cuboi-
dal configuration and bland nuclear features. In most cases,
however, areas of more malignant epithelium will be noted and
a desmoplastic stromal reaction is commonly identified.
Intestinal variants of endocervical adenocarcinoma show
goblet or signet ring cells which may be intermixed with
Paneth and argentaffin cells. Young and Clement note that true
endometrioid carcinomas of the endocervix are rare, accounting
for about 7% in a recent series.53 When present, these tumors
show endometrioid tubular and villous formation akin to
endometrial adenocarcinomas (Fig. 9.18). Clear cell and serous
carcinomas of the endocervix closely resemble their counter-
parts in other locations in the gynecologic tract. Clear cell carci-
noma of the cervix shows one or a mixture of tubulocystic, solid,
and papillary architecture. Serous carcinoma shows the typical
hobnailing papillae and slit-like glandular spaces seen in ovar-
ian neoplasms of this type.
In the most common forms of endocervical adenocarcinoma,
the stated Bethesda System cytologic criteria for diagnosis may
overlap with those for AIS.9 Particularly in well-differentiated
variants of invasive adenocarcinoma, cytologic features distin-
guishing in situ from invasive lesions may be subtle and include
changes in nuclear chromatin and background patterns. In addi-
tion, AIS is often found in association with invasive carcinoma
and hence cells may be sampled from both lesions and will be
intermixed on the slide. Because endocervical adenocarcinomas
are likely to be found within reach of the sampling device, cells
are most often configured architecturally as "traumatically" or
directly sampled presentations. These architectural patterns
include abundant abnormal cells, showing evidence of a colum-
nar configuration—including pseudostratified strips of cells or
honeycombed 2-dimensional sheet-like arrangements (Fig. 9.19).
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