Severe cervical glandular cell lesions with coexisting squamous cell lesions.

Abstract

In the current report, the authors present the results of a reevaluation of cytologic smears and histologic specimens obtained from patients with severe cervical glandular cell lesions (adenocarcinoma in situ [AIS] or adenocarcinoma [ADCA] of the cervix) and coexisting Grade 1, Grade 2, or Grade 3 cervical intraepithelial neoplasia or squamous cell carcinoma. The goal of the current study was to assess whether knowledge of the specific cytologic characteristics of the cervical glandular cell lesions could have made the cytologic diagnosis of these combined neoplasms more accurate. Cytologic smears and histologic specimens obtained from 36 patients with combined severe cervical lesions were evaluated for the presence of a range of microscopic cytologic and histologic features that were considered indicative of glandular cell changes. The findings of the current study suggest that the proper identification of characteristic cytomorphologic features of cervical glandular lesions would have resulted in more accurate diagnoses of combined severe cervical lesions. In the set of samples reevaluated by the authors, consideration of these features would have increased the accuracy of cytologic diagnosis from 55.6% to 75.0%. The presence of AIS was predicted in the majority of cytologic specimens, and in most cases, the identity of the predominant subtype of AIS could also be predicted. The current analysis revealed that consideration of specific cytomorphologic features of glandular lesions of the cervix increased the authors' accuracy in diagnosing combined severe lesions of the cervix. More accurate identification of intraepithelial glandular cell lesions may eventually lead to decreases in cervical adenocarcinoma incidence, just as increases in diagnostic accuracy have led to decreases in the incidence of squamous intraepithelial lesions and invasive squamous carcinoma of the cervix.