9
Glandular Lesions of the Uterine Cervix
Fig. 9.20 (A) Endocervical adenocarcinoma presents as strips of cells and honeycombed configurations. Note the closely-packed and overlapping nature of
the nuclei in the sheet of cells. The background shows necrotic diathesis material. (B) An ill-formed rosette (arrow). Note the coarsely granular hyperchromatic
chromatin pattern. (C) An isolated, highly atypical cell is present, and isolated atypical goblet cells are present in (D), indicative of intestinal differentiation in the
lesion ((A, C, D) liquid-based preparation, (B) conventional smear; Papanicolaou x (A, B) MP, (C, D) HP).
Table 9.2 Data compiled for the 2001 Bethesda Conference by KR Lee
(unpublished)
Follow-up result
Any high-grade
lesion
High-grade
glandular lesion
AGUS, favor
5-39%
1-8%
reactive
AGUS, NOS
9-41%
0-15%
AGUS, favor
27-96%
10-93%
neoplastic
T h is t a b le d e t a ils t h e f o l l o w - u p p r e v a le n c e o f a ll h ig h - g r a d e ( s q u a m o u s a n d
g la n d u la r ) a n d h ig h - g r a d e g la n d u la r n e o p la s ia f o l lo w in g in t e r p r e t a t io n s o f
a t y p ic a l g la n d u la r c e lls o f u n d e t e r m in e d s ig n if ic a n c e (A G U S ) w it h s u b c la s s ific a -
t io n s o f: f a v o r r e a c tiv e , n o t o t h e r w is e s p e c if ie d (N O S ) , a n d f a v o r n e o p la s ia . T h e s e
d a t a f o r m t h e b a s is f o r t h e c o m b in a t io n o f t h e ' f a v o r r e a c t iv e ' a n d " n o t
o t h e r w is e s p e c if ie d ' s u b c a te g o r ie s in t h e 2 0 0 1 B e t h e s d a t e r m in o lo g y . 10 D a ta
a r e b a s e d o n a r e v ie w o f 1 6 s tu d ie s r e p o r te d in t h e lit e r a tu r e .
truly reactive or reparative should be classified into the overall
negative for intraepithelial lesion or malignancy (NILM) cate-
gory. This leaves current TBS AGC terminology modifiers as "not
otherwise specified" or "favor neoplastic." Classification into
cell of origin (endocervical, endometrial, or other) should be
done when possible, with the generic "glandular" designation
held for cases in which this cannot be resolved.
Atypical endocervical cells are defined in TBS 2001 as
"endocervical-type cells (that) display nuclear atypia that
exceeds obvious reactive or reparative changes, but that lack
unequivocal features of endocervical adenocarcinoma in situ
or invasive adenocarcinoma."9 Criteria that can be present
with atypical endocervical cells (AEC), not otherwise specified,
include endocervical type cells in sheets or strips with some
crowding and nuclear overlap, nuclear enlargement (3-5 times
the size of normal endocervical cell nuclei) with variability
of size and shape, mild hyperchromasia and nucleoli, and
mitoses. The nucleus to cytoplasmic ratio may be increased
(Fig. 9.21).
227
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