PART TWO
Diagnostic Cytology
Fig. 9.30 In cytology specimens from patients having intrauterine contraceptive devices, approximately 25% will have
Actinomyces
organisms present
derived from the chronic inflammatory response in the endometrium (A). Irritation of the cells of the high endocervical canal and lower uterine segment can
cause exfoliation of cells undergoing reactive and degenerative changes. These include "endometrioid” clusters of cells with breakdown (B), large cytoplasmic
("bubble gum”) vacuoles (C), and prominent macronucleoli (D) (liquid-based preparation, Papanicolaou x HP).
• Apoptotic bodies may be seen in disordered (anovula-
tory) endometrium;
• Cytoplasm may be wispy and attenuated at group
margins;
• Endometrial stromal fragments may be seen isolated
or in association with endometrial glandular cells;
and
• Endometrial cells are smaller than endocervical cells.
Endocervical Polyps
Endocervical polyps are common. In addition, they can present
with worrisome clinical symptoms including vaginal bleed-
ing and discharge. The surfaces of polyps are often irritated or
even ulcerated which can lead to significant cytologic changes
in endocervical cells sampled directly or exfoliated.91,92 Polyp
surfaces are also often involved by the benign proliferative pro-
cess of microglandular hyperplasia, an overgrowth of benign
endocervical tissue, with a papillary growth pattern. Sampling
of this type of process can lead to large hyperchromatic crowded
groups of endocervical cells, which in association with reactive
changes can lead to overinterpretations as atypical endocervical
cells or worse (Fig. 9.34A). Ulcerated areas can lead to atypi-
cal reparative changes in endocervical cells as described earlier.
In addition, areas of degenerative cellular changes can lead to
chromatin abnormalities that can mimic the coarse changes of
AIS and the heterogeneity of invasive adenocarcinoma. Found
also in this setting can be evidence of tissue necrosis that can
present as a bloody, necrotic, or inflammatory background dia-
thesis (Figs. 9.34B-D). Lack of the classic architectural features
described earlier for AIS and invasive lesions, including well-
developed pseudostratified strips, feathered groups, and rosette
formation, will be helpful in distinguishing the degenerative
changes associated with "polyp change" from these neoplastic
processes (Fig. 9.35).
Endocervical polyps may also shed surface cells that can
mimic similar cytologic changes as can be noted in endometrial
neoplastic lesions. Three-dimensional groups of degenerating
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