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Gupta N, Jain V, Srinivasan R, Singh T. Tall-columnar glandular cells in SurePath™ liquid-based cytology Pap sample: Learning from mimics/pitfalls. Cytopathology 2024; 35:510-514. [PMID: 38712698 DOI: 10.1111/cyt.13385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 04/15/2024] [Accepted: 04/24/2024] [Indexed: 05/08/2024]
Abstract
We offer a comprehensive depiction of the cytomorphological characteristics of lobular endocervical glandular hyperplasia (LEGH) as observed in SurePath™ liquid-based cytology (LBC), subsequently confirmed on cone biopsy. Lobular endocervical glandular hyperplasia (LEGH), a precursor to gastric-type adenocarcinoma (GAE) of the endocervix, is rare and reports of it in cervical cytology are scarce. We provide a thorough description of the cytomorphological features of LEGH observed in SurePath™ liquid-based cytology (LBC), later confirmed by cone biopsy. To the best of our knowledge, this is the first report documenting cytology of LEGH in LBC of a Pap sample.
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Affiliation(s)
- Nalini Gupta
- Department of Cytology and Gynaecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vanita Jain
- Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Radhika Srinivasan
- Department of Cytology and Gynaecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Tulika Singh
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Yeo MK, Bae GE, Kim DH, Seong IO, Suh KS. Cytopathologic features of human papillomavirus–independent, gastric-type endocervical adenocarcinoma. J Pathol Transl Med 2022; 56:260-269. [PMID: 36128862 PMCID: PMC9510040 DOI: 10.4132/jptm.2022.07.05] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 07/05/2022] [Indexed: 11/17/2022] Open
Abstract
Background Gastric-type endocervical adenocarcinoma (GEA) is unrelated to human papillomavirus (HPV) infection and is clinically aggressive compared with HPV-associated usual-type endocervical adenocarcinoma (UEA). The cytological diagnosis falls short of a definitive diagnosis of GEA and is often categorized as atypical glandular cells (AGCs). To improve cytologic recognition, cytological findings of HPV-independent GEA were analyzed and the results compared with HPV-associated UEA. Methods Cervical Papanicolaou (Pap) smears from eight patients with a histopathologic diagnosis of GEA and 12 control cases of UEA were reviewed. All slides were conventionally prepared and/or liquid-based prepared (ThinPrep) and stained following the Pap method. A mucinous background, architectural, nuclear, and cytoplasmic features were analyzed and compared with UEA. Results Preoperative cytologic diagnoses of the eight GEA cases were AGCs, favor neoplastic in three cases, adenocarcinoma in situ in one case, and adenocarcinoma in four cases. Cytologically, monolayered honeycomb-like sheets (p = .002) of atypical endocervical cells with vacuolar granular cytoplasm (p = .001) were extensive in GEA, and three-dimensional clusters (p = .010) were extensive in UEA. Although the differences were not statistically significant, background mucin (p = .058), vesicular nuclei (p = .057), and golden-brown intracytoplasmic mucin (p = .089) were also discriminatory findings for GEA versus UEA. Conclusions Although GEA is difficult to diagnose on cytologic screening, GEA can be recognized based on cytologic features of monolayered honeycomb sheets of atypical endocervical cells with abundant vacuolar cytoplasm and some golden-brown intracytoplasmic mucin. UEA cases are characterized by three-dimensional clusters.
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Affiliation(s)
- Min-Kyung Yeo
- Department of Pathology, Chungnam National University School of Medicine, Daejeon, Korea
| | - Go Eun Bae
- Department of Pathology, Chungnam National University School of Medicine, Daejeon, Korea
| | - Dong-Hyun Kim
- Department of Pathology, Chungnam National University School of Medicine, Daejeon, Korea
| | - In-Ock Seong
- Department of Pathology, Chungnam National University School of Medicine, Daejeon, Korea
| | - Kwang-Sun Suh
- Department of Pathology, Chungnam National University School of Medicine, Daejeon, Korea
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Baltisser I. [Cytological findings in glandular lesions of the uterine cervix]. DER PATHOLOGE 2020; 41:155-158. [PMID: 33113048 DOI: 10.1007/s00292-020-00836-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Due to further developments in the diagnosis of glandular cervical changes with the definition of several new entities, the exact classification of these can only be achieved with the help of cytomorphology and additive methods. OBJECTIVES AND METHODS The aim of this work is to give an overview of the status and future perspectives of cytomorphological diagnostics and biomarkers in this setting. Our own expertise and literature data were considered and evaluated. We especially covered the benign group including microglandular hyperplasia, tubal metaplasia, and reactive withdrawal induced changes, as well as adenocarcinoma in situ of usual type and invasive adenocarcinoma of usual type. RESULTS AND CONCLUSIONS Immunocytochemical markers may occasionally take a role in the evaluation of benign endocervical glandular proliferations, the mainstay of their interpretation occurs morphologically in the conventional routinely stained smears. Adenocarcinoma in situ of usual type has very characteristic cytological criteria, which are reproducible in daily work, and p16 positivity is a very useful marker for this HPV-related lesion. The present classification of invasive adenocarcinomas of the endocervix requires knowledge of new immunohistochemical and molecular technologies. Due to HPV vaccination we can expect a decrease of HPV associated adenocarcinomas and a relative increase of HPV negative, clinically more aggressive adenocarcinomas. The cytological features of some groups of non-HPV-associated adenocarcinomas are not specific. In these instances, the different biomarkers are more helpful.
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Affiliation(s)
- Irena Baltisser
- Institut für histologische und zytologische Diagnostik AG, Dammweg 1, 6000, Aarau, Schweiz.
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Schwock J, Starova B, Khan ZF, Mirkovic J, Parra-Herran C, Ko HM, Rouzbahman M, Ghorab Z. Cytomorphologic Features of Gastric-Type Endocervical Adenocarcinoma in Liquid-Based Preparations. Acta Cytol 2020; 65:56-66. [PMID: 33152741 DOI: 10.1159/000511003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 08/17/2020] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Gastric-type endocervical adenocarcinoma (GAS) is a recently described, uncommon, and aggressive tumor with distinct morphologic features and HPV-independent etiology. Data on GAS in liquid-based cytology (LBC) Papanicolaou (Pap) test preparations from a North American patient population are scant. We systematically assessed the cytomorphologic characteristics of GAS in LBC from patients in Ontario and examined if glandular cell nuclear area could represent a readily assessable feature which may aid in GAS detection. STUDY DESIGN Pap test slides preceding the diagnosis of GAS were retrieved locally or requested from outside laboratories. A structured review of 15 cytomorphologic features was performed using the available LBC Pap test slides of GAS and a set of usual-type endocervical adenocarcinomas (UEA). Morphometry of the glandular cell nuclear area was performed, and normalized values were compared to UEA and benign endocervical cells. RESULTS At least 1 Pap test (5 ThinPrep®, 11 SurePath®, and 1 direct smear) was available for 14 patients. Original LBC Pap test diagnoses were negative for intraepithelial lesion or malignancy (NILM) (7), adenocarcinoma/carcinoma (6), atypical glandular cells (2), and adenocarcinoma in situ (1). Review detected abnormal glandular cells in 6/7 NILM cases. Honeycomb-like sheets, nuclear enlargement, and microvesicular cytoplasm were the single most common architectural, nuclear, and cytoplasmic features, respectively. Microvesicular cytoplasm (100 vs. 17%), honeycomb-like sheets (87 vs. 8%), prominent nucleoli (93 vs. 25%), and anisonucleosis (93 vs. 50%) were most discriminatory for GAS versus UEA, respectively. Yellow mucin, intranuclear cytoplasmic pseudoinclusions, and goblet/Paneth-like cells were uncommon, but unique for GAS. Glandular cell nuclear area normalized to neutrophils was found to be significantly increased in GAS compared to benign endocervical cells. CONCLUSIONS GAS is under-recognized and may mimic reactive endocervical cells. Awareness of the tumor type and its cytomorphology is critical for early detection. Identification of glandular cells with uniform nuclear enlargement in conjunction with any of the other cytologic features may help avoid false-negative Pap results. Neutrophils may serve as convenient size reference and visual aid.
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Affiliation(s)
- Joerg Schwock
- Division of Pathology, University Health Network, Toronto, Ontario, Canada,
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada,
| | - Blerta Starova
- Department of Laboratory Medicine, William Osler Health System, Brampton, Ontario, Canada
| | - Zanobia F Khan
- Department of Pathology, Lakeridge Health, Oshawa, Ontario, Canada
| | - Jelena Mirkovic
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Department of Pathology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Carlos Parra-Herran
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Hyang Mi Ko
- Division of Pathology, University Health Network, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Marjan Rouzbahman
- Division of Pathology, University Health Network, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Zeina Ghorab
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Department of Pathology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Ishii S, Ito T, Yamada M, Yamazaki N, Ikebata K, Fujiyama J, Furuta N, Komatsu K, Takeuchi K, Sugiyama Y, Takazawa Y. Characteristic Cytological Findings of Lobular Endocervical Glandular Hyperplasia Associated with Adenocarcinoma of the Uterine Cervix. Acta Cytol 2020; 64:556-562. [PMID: 32814324 DOI: 10.1159/000509667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 06/24/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To investigate the cytological findings of lobular endocervical glandular hyperplasia (LEGH) associated with adenocarcinoma and to clarify its characteristics and the coexisting adenocarcinoma using histochemistry and immunohistochemistry. METHODS Eighteen surgical cases of LEGH of the uterine cervix were retrospectively reviewed and classified into 3 groups: pure (pure type), atypical (atypical type), and LEGH with adenocarcinoma (mixed type). The mixed type is defined as LEGH or atypical LEGH with in situ or invasive adenocarcinoma. Cytological findings of conventional endocervical smear specimens (Papanicolaou stain) were analyzed. Histochemistry (periodic acid-Schiff reaction) and immunohistochemistry (M-GGMC-1, Muc-6 glycoprotein, and Ki-67) were performed using tissue specimens. RESULTS Cytologically, the pure type (7 cases) is characterized by glandular cell clusters that tended to form monolayered sheets with uniformly small nuclei and contain golden-yellowish mucin, whereas atypical (5 cases) and mixed (6 cases) types are characterized by glandular cell clusters similar to those of the pure type, but with complex glandular structures and mucin localization on the surface of glandular cell clusters. Ki-67 labeling index was significantly higher in atypical and mixed types than that in the pure type. Gastric-type mucinous carcinoma (MC-G) was observed in 2 out of 6 cases with mixed type. CONCLUSIONS LEGH is found to be associated with adenocarcinoma types other than MC-G. Complex glandular structures or mucin localization on the surface of glandular cell clusters may be useful cytological findings to detect atypical and mixed types of LEGH.
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Affiliation(s)
- Shuhei Ishii
- Division of Pathology, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takahiko Ito
- Department of Cytology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Marisa Yamada
- Department of Cytology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Naoko Yamazaki
- Department of Cytology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Koichi Ikebata
- Department of Cytology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Junzo Fujiyama
- Department of Cytology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Noriyuki Furuta
- Department of Cytology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Kyoko Komatsu
- Department of Cytology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Kengo Takeuchi
- Division of Pathology, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yuko Sugiyama
- Department of Cytology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yutaka Takazawa
- Division of Pathology, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan,
- Department of Cytology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan,
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Okuyama R, Hashimoto H, Miura T, Sugita M, Arai M, Tsunoda H, Sasajima Y, Horiuchi H. Two cases of adenocarcinoma in situ arising in lobular endocervical glandular hyperplasia indicating localization of mucin on the cluster surface as an early cytological finding of malignant transformation. Diagn Cytopathol 2017; 45:842-847. [DOI: 10.1002/dc.23740] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 04/07/2017] [Accepted: 04/13/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Rikiya Okuyama
- Department of Laboratory Medicine; NTT Medical Center Tokyo; Tokyo Japan
| | | | - Tamaki Miura
- Department of Diagnostic Pathology; NTT Medical Center Tokyo; Tokyo Japan
| | - Masatoshi Sugita
- Department of Obstetrics and Gynecology; NTT Medical Center Tokyo; Tokyo Japan
| | - Masakazu Arai
- Department of Laboratory Medicine; NTT Medical Center Tokyo; Tokyo Japan
| | - Hajime Tsunoda
- Department of Obstetrics and Gynecology; NTT Medical Center Tokyo; Tokyo Japan
| | - Yuko Sasajima
- Department of Diagnostic Pathology; NTT Medical Center Tokyo; Tokyo Japan
- Department of Diagnostic Pathology; Teikyo University; Tokyo Japan
| | - Hajime Horiuchi
- Department of Laboratory Medicine; NTT Medical Center Tokyo; Tokyo Japan
- Department of Diagnostic Pathology; NTT Medical Center Tokyo; Tokyo Japan
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Gastric-type adenocarcinoma in situ of uterine cervix: cytological and histopathological features of two cases. Virchows Arch 2016; 469:351-6. [DOI: 10.1007/s00428-016-1978-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 05/21/2016] [Accepted: 06/15/2016] [Indexed: 11/25/2022]
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Kawakami F, Mikami Y, Sudo T, Fujiwara K, Hirose T, Itoh T. Cytologic features of gastric-type adenocarcinoma of the uterine cervix. Diagn Cytopathol 2015; 43:791-6. [DOI: 10.1002/dc.23304] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 04/13/2015] [Accepted: 06/19/2015] [Indexed: 11/07/2022]
Affiliation(s)
- Fumi Kawakami
- Department of Diagnostic Pathology; Kobe University Hospital; Kobe Japan
- Department of Diagnostic Pathology; Hyogo Cancer Center; Kobe Japan
| | - Yoshiki Mikami
- Department of Diagnostic Pathology; Kumamoto University Hospital; Kumamoto Japan
| | - Tamotsu Sudo
- Department of Gynecologic Oncology; Hyogo Cancer Center; Kobe Japan
- Section of Translational Research; Hyogo Cancer Center; Kobe Japan
| | - Kiyoshi Fujiwara
- Department of Gynecologic Oncology; Hyogo Cancer Center; Kobe Japan
| | - Takanori Hirose
- Department of Diagnostic Pathology; Hyogo Cancer Center; Kobe Japan
- Department of Community Medicine and Social Healthcare Science; Division of Pathology for Regional Communication; Kobe University Graduate School of Medicine; Kobe Japan
| | - Tomoo Itoh
- Department of Diagnostic Pathology; Kobe University Hospital; Kobe Japan
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Glandular neoplasms of the cervix. Diagn Cytopathol 2010. [DOI: 10.1016/b978-0-7020-3154-0.00024-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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