PART TWO
Diagnostic Cytology
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Fig. 9.16 Well-differentiated endocervical adenocarcinoma ("adenoma malignum") closely mimics normal endocervical epithelium (compare to
Fig. 9.1); however, it deeply penetrates the cervical stroma (A). A high magnification of the lesion shows basally placed nuclei and vacuolated apical cytoplasm (B).
In most cases, a careful search will find some areas showing nuclear atypia, including enlargement, irregular nuclear contours, and the presence of nucleoli (C)
(H&E x (A) LP, (B, C) HP).
central cells in hyperchromatic crowded groupings difficult to
interpret. Again, excellent and rapid fixation leads to a more
open chromatin pattern with less chromatin irregularity. Tumor
diathesis may be less prominent and when present will take on
a clumped or "clinging" nature adhering to cells, rather than
as a diffuse background appearance as seen in conventionally
prepared slides.
The cytologic features of rare variants of endocervical
adenocarcinoma have been documented. Well-differentiated
mucinous adenocarcinoma (adenoma malignum or minimal
deviation adenocarcinoma) has been described and show
abundant endocervical cells arranged in a variety of patterns
including mono- and multilayered sheets and 3-dimensional
aggregates (Fig. 9.17). The groups show significant nuclear
overlapping and some degrees of pseudostratified strip forma-
tion. The individual cells show nuclear atypia which ranges
from subtle to frankly malignant, with nucleoli present.54-56
Two reports stress the presence of "golden-yellow" appearing
mucin within cells, which was found to be a distinctive cyto-
logic feature in cases of adenoma malignum.57,58 In a report
studying the cytology from seven cases of adenoma malignum,
the authors concluded that abnormal cells would be difficult
to distinguish from reactive endocervical cells in cases where a
more poorly differentiated component was not present within
the tumor. They did state, however, that large numbers of
endocervical cells in sheets with nuclear enlargement is a key
feature to note in difficult cases.59 Suffice it to say that close
attention to cellularity and a careful search among the abun-
dant cells present for features of malignancy, or at a minimum,
atypicality are key to making an appropriate interpretation of at
least "atypical glandular cells" which would prompt appropri-
ate further investigation.
Atypical Glandular Cells
The detection of glandular lesions of the cervix is a second-
ary role (after squamous lesion detection) of the Pap test. As
has been noted earlier, endocervical neoplastic processes are a
minority of lesions as compared to the more common squa-
mous cancers and their precursors. That being said, endocervical
glandular neoplasias can and should be identified on cervical
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