9
Glandular Lesions of the Uterine Cervix
.
•- -
,K
'-i L -
1
SwV
m b ' * * ‘* 3
A
B
Fig. 9.14 The most common, or "endocervical type," of adenocarcinoma of the cervix. Irregularly shaped, mucin-poor, glandular arrangements of cells
penetrate the cervical stroma (A). In (B), irregular pseudostratification of the epithelium with mitoses (arrow) can be seen. Necrotic debris is identifiable in the lumen.
This material is responsible for the diathesis debris noted in the cytologic specimen. No cilia are present in the vast majority of adenocarcinoma types (H&E x MP).
Fig. 9.15 Villoglandular endocervical adenocarcinoma is a well-differentiated neoplasm with a better prognosis than the more common "endocervical
type" of adenocarcinoma. Villous fronds with stromal cores are present (A) and can also be seen as smooth contoured groups in the correlative cytology sample
(B) ((A) H&E stain, (B) conventional smear; Papanicolaou x (A) MP, (B) HP).
Key features of endocervical adenocarcinoma
• Large numbers of abnormal cells present with many
isolated cells;
• Cells present in "directly sampled" architectural patterns:
- Disorganized honeycomb sheets;
- Pseudostratified and stratified strips;
- Isolated cells with columnar configuration;
- Papillae or villous formations possible in variants;
• Cells from high canal lesions may present in "exfolia-
tive" patterns:
- Spherical hyperchromatic crowded groups;
- Syncytial groups;
- Isolated round to oval cells;
• Architectural features of AIS may be retained in well-
differentiated lesions:
- Feathered group edges;
- Rosette formation;
- Pseudostratified strips;
• Necrotic and bloody tumor diathesis commonly
present;
• Nuclei enlarged (greater than 2-3 times the size of an
intermediate squamous cell nucleus) and may show
pleomorphism of size and shape;
• Nucleus-to-cytoplasmic ratio is increased;
• Chromatin is coarsely granular with heterogeneity and
clearing;
• Macronucleoli are common;
• Mitoses and apoptotic bodies are commonly seen;
• Cytoplasm is generally granular and finely vacuolated;
and
• Variants types can show abundant mucin, signet ring,
goblet cell, and/or serous types of differentiation.
In liquid-based preparations, adenocarcinomas show accen-
tuated 3-dimensionality of groups due to the liquid medium
immersion and fixation. This feature may make evaluation of
223
previous page 224 ComprehensiveCytopathology 1104p 2008 read online next page 226 ComprehensiveCytopathology 1104p 2008 read online Home Toggle text on/off