Ana Ovanin-Rakić

Cytology of Cervical Intraepithelial Glandular Lesions

Cytological criteria for the identification of glandular intraepithelial lesions (GIL) have not yet been fully described, especially for the precursors of adenocarcinoma in situ (AIS), thus these lesions may frequently remain unrecognized. As most patients diagnosed with AIS or mild to moderate GIL (grades I, II) are free from clinical symptoms, cytology has a very responsible role in the detection of these lesions. The aim of the study was to achieve the most appropriate cytologic diagnosis of intraepithelial lesions of endocervical columnar epithelium, analyzing the cytology findings in patients with histologically verified AIS and GIL (I, II). The value of cytology in the detection and differential diagnosis was assessed in 123 patients with definitive histologic diagnosis of glandular lesions (AIS, n = 13; GIL I, n = 11; and GIL II, n = 7), and glandular lesions associated with squamous component (AIS associated with cervical intraepithelial neoplasia (CIN) or invasive squamous cell carcinoma (SCC), n = 58; GIL I or GIL II associated with CIN, n = 28; and GIL associated with microinvasive squamous carcinoma (MIC), n = 6). In 95.1% of patients, lesions were detected by cytologic analysis that indicated additional diagnostic procedure. In terms of differential diagnosis, cytology showed higher accuracy in predicting lesion severity vs. type of epithelial alteration (75.6% vs. 55.3%) and abnormalities of columnar epithelium (95.7%; vs. 74.2%). The accuracy of cytology was higher in pure (AIS, 61.5% and GIL I, II, 22.2%) than in mixed lesions (25.9% and 20.6%). Continuous improvement in cervical specimens and cytodiagnostic skills, better understanding of intraepithelial adenocarcinoma and precursors, and their inclusion in the classification of cytologic and histologic findings are expected to upgrade the detection of these lesions, and to reduce the invasive cervical adenocarcinoma morbidity and mortality.

Abnormal glandular cells in a cervical smear

Minimal-deviation adenocarcinoma (MDA), previously known as adenoma malignum, is a fully malignant invasive adenocarcinoma of the cervix in which neoplastic cells have a deceptively benign cytological appearance. The tumour is often diagnosed at an advanced stage because initial superficial biopsies may be misinterpreted as benign. The diagnosis of carcinoma is often established only after the patient has undergone deep conization or hysterectomy because the depth of penetration of the glands is the key histological feature of MDA. Although all these tumours in the original description were extremely well differentiated endocervical adenocarcinomas, MDA has been expanded to include the endometrioid and clear-cell variants. MDA accounts for 1–3% of all cervical adenocarcinoma cases.