9
Glandular Lesions of the Uterine cervix
Fig. 9.29 In these examples of atypical repair, the nuclear features are more pleomorphic than noted in the examples in Fig. 9.28. Nuclei are larger, have
irregular nuclear envelopes, and have more heterogeneous chromatin. Isolated cells are seen more commonly than with typical reparative reactions. These
changes can be virtually indistinguishable from those seen in invasive endocervical adenocarcinomas, and hence close communication between pathologist
and clinician is vital in correctly triaging such cases (liquid-based preparation, Papanicolaou stain x HP)
Direct Sampling of Endometrium
Circumstances that allow for inadvertent sampling of the lower
uterine segment or uterine corpus can lead to overinterpreta-
tions of cytologic findings as being from endocervical neoplas-
tic processes. Such circumstances are most commonly patients
who are post-cone biopsy procedures where the endocervical
canal may be shortened, or in circumstances of overly vigor-
ous sampling.88-90 As detailed in Chapter 10, endometrial cells
typically identified in cervical cytology specimens are spontane-
ously exfoliated, usually during menses and, as such, tend to be
architecturally in 3-dimensional tightly clustered arrangements,
and show features of degenerative change. When directly sam-
pled, the intact normally pseudostratified columnar architecture
is preserved in much the same way that columnar endocervical
epithelium appears when directly sampled. Directly sampled
endometrial cells will be arranged in flat honeycombed sheets
and pseudostratified strips of cells (Fig. 9.32). In addition, intact
tubular structures are commonly noted (Fig. 9.33). Cytoplasm
from directly sampled endometrium tends to be more wispy
and attenuated than the contracted dense cytoplasm noted in
shed endometrial cells. In secretory phase, cytoplasmic vacuoles
can be prominent. When proliferative endometrium is sampled,
the groups may show numerous mitotic figures, and with an-
ovulatory cycling, apoptosis may also be noted. These features
can be strong mimickers of endocervical lesions such as AIS
(Fig. 9.32D). When confronted with this cytologic differential
diagnosis, attention to nuclear and overall cell size is important
as endometrial cells will be substantially smaller on average than
those of AIS. A background of endometrial stromal cells, iso-
lated or in groups (Fig. 9.33C), along with the tubular structures
mentioned above, can be a helpful discriminatory finding.
Key features of directly sampled endometrium
• Honeycombed 2-dimensional sheets of cells;
• Pseudostratified strips of columnar cells;
• Isolated columnar cells;
• Organoid structures—tubules and glands may be
intact;
• Mitoses common in proliferative endometrium;
• Vacuoles may be seen in secretory endometrium;
235
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