PART TWO
Diagnostic Cytology
Fig. 9.21 Examples of cases interpreted as "atypical endocervical cells, not otherwise specified" show the spectrum of changes that can be associated
with reactive and/or neoplastic follow-up. In (A) a loosely cohesive pseudostratified strip of endocervical cells is present. Nuclei are slightly enlarged, but
nucleus-to-cytoplasmic ratios are generally lower than noted in classic adenocarcinoma in situ. The chromatin pattern is generally smooth without the coarse
pattern of neoplastic lesions. This case showed benign follow-up. (B) A disorganized group of endocervical cells with enlarged hyperchromatic nuclei. Although
no architectural features of AIS were identified, the case was found to represent AIS on follow-up. (C) A smooth contoured hyperchromatic crowded group of
columnar endocervical cells. Abundant inflammation is associated. Although the nuclei are larger than normal and show some coarse chromatin, this case was
found to be associated with an irritated endocervical polyp. (D) Nuclear atypia with prominent nucleoli is illustrated, but with a low nucleus-to-cytoplasmic
ratio. On histologic follow-up this was found to represent a ‘repair-like” AIS (liquid-based preparation, Papanicolaou x HP).
Key features of "atypical endocervical cells, not otherwise
specified"
• Two-dimensional sheets or strips of cells with some
crowding and nuclear overlap;
• Three-dimensional hyperchromatic crowded groups;
• Nuclear enlargement (3-5 times that of a normal
endocervical cell nucleus);
• Variation (pleomorphism) in nuclear size and shape;
• Mild nuclear hyperchromasia with or without coarse
chromatin;
• Presence of nucleoli;
• Presence of mitoses;
• Possible abundance of cytoplasm, but with usually
with an increased N:C; and
• Presence of distinct cell borders.
When moving to the category of AEC, favor neoplastic, the
degree of suspicion of AIS or invasive carcinoma increases, with
more severe examples of the nuclear criteria noted above, and
with additional architectural features being present, which may
include feathered groups and rosette formation (Fig. 9.22).
As is pointed out in TBS 2001, liquid-based cytology speci-
mens can lead to interpretation issues with glandular atypias
just as they can with the already-mentioned diagnostic glandular
lesions of AIS and invasive carcinoma. The particular feature that
may degrade interpretation in these specimens is, again, the pres-
ence of more crowded hyperchromatic groupings and the lack of
spreading out that occurs in the making of a conventional smear.
This can lead to difficulty in identifying key nuclear and cytoplas-
mic features that could have otherwise made the interpretation
more definitive, either toward benign/reactive or neoplastic.
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