![]() Typical appearance of glandular neoplasia may be examined as a scanned LBC slide įigure 9c-23 (a-c). ![]() As with squamous cell carcinoma there are certain cytological features that may suggest the presence of invasion.Invasive adenocarcinoma has a variety of cytological appearances depending on the cell type and degree of differentiation.The term ‘glandular neoplasia’ in the UK system refers either to invasive or in situ adenocarcinoma.Although the typical appearance of AIS can be recognised, there are no cytological criteria for excluding invasion.Invasive and in situ endocervical adenocarcinoma Alternatively, poorly differentiated AIS may look similar to non-keratinising squamous cell carcinoma. The cells are in three-dimensional clusters, nuclei enlarged and round with prominent multiple nucleoli. The cytoplasm is columnar, delicate and may be vacuolated due to mucin secretion.ĪIS may be poorly differentiated and show features more often seen in invasive adenocarcinoma from which it cannot be distinguished. In well-differentiated endocervical adenocarcinoma or AIS the cytoplasm resembles that of the normal glandular epithelium from which it arises. Nucleoli are usually small or inconspicuous and may not be present. The chromatin pattern is fine or moderately granular with even distribution. In typical AIS the nuclei are round to oval or elongated. The nuclear features depend on the degree of differentiation and the type adenocarcinoma. Rosette formation, where all the nuclei line up like petals to form acini, is also a feature of a glandular neoplasia. Some groups have areas where a lumen (acinus) appears to be forming this is a feature that helps to indicate the glandular origin of the cells. The nuclei tend to be elongated, and the loosely cohesive cells at the surface of the curved cell groups tend to be tapered and spread out rather like feathers on a wing tip: a feature known as feathering. Isolated cells are not a feature of AIS and its recognition largely depends on the architecture of the cell groups. The cells present as sheets, strips or clusters – with some loss of cohesion at the surface of the cell groups. The nuclei are crowded and situated at different levels in the epithelium ( pseudostratification ) although the polarity of columnar cells is largely maintained. In AIS the architecture of the groups is disturbed: the normal honeycomb pattern of endocervical cells seen from above and their ‘picket fence’ appearance from the side due to the basally situated nuclei of columnar cells is lost. In glandular neoplasia normal endocervical cells are usually present along with the abnormal ones allowing the cytologist to compare them with each other. The management of CGIN is different from that of CIN and may be difficult to visualise at colposcopy. It is important to recognise the cytological features of glandular neoplasia and to be able to distinguish it from HSIL although AIS/CGIN frequently coexists with high-grade CIN. As with squamous cell carcinoma, there are cytological features to suggest that adenocarcinoma may be invasive. In the UK system, high-grade CGIN (AIS) and endocervical adenocarcinoma are collectively described as glandular neoplasia: when glandular neoplasia is diagnosed on cytology invasive carcinoma may already be present. Adenocarcinoma in situ (AIS) of cervix - high-grade CGINĪlthough typical cytological features of AIS can be described and recognised, it is impossible to exclude the presence of invasion when these features are seen.
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