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Case 9

View the images and select the correct diagnosis from the list below.

It's a fine line 

Pap smear taken from a 35-year-old woman, day 17, wearing an IUD:







Select the correct diagnosis:

You answered: NILM: reactive cellular changes associated with an IUD  
Sorry, that is INCORRECT

The correct diagnosis is: Endocervical adenocarcinoma in situ, intestinal type 

CYTOPATHOLOGY:

  • The smear contains abnormal clusters of slightly enlarged gland cells with nuclear hyperchromasia, elongation, crowding and stratification.  There is a suggestion of nuclear protruding beyond the epithelial cluster margins ('feathering").  Some of the cells have distended mucin vacuoles and resemble intestinal cells.
  • These features are suspicious of endocervical adenocarcinoma in situ.

DISCUSSION: 

  • The cone biopsy reveals endocervical adenocarcinoma in situ, intestinal type.
  • Based on cytoplasmic characteristics, various subtypes of AIS have been described, including endocervical, intestinal, endometrioid, and mixed adenosquamous.
  • Intestinal type AIS is characterized by mucin-containing cytoplasm and resembles intestinal goblet cells.
  • It is important to pay attention to nuclear features such as hyperchromasia, elongation, stratification and crowding in order to avoid mistaking these cells for reactive cellular changes such as those seen with an IUD or with metaplasia.
  • The mucin content gives these cells a lower N:C ratio than a typical endocervical AIS, and could be a potential pitfall if the nuclear features are not appreciated.
  • Separation of intestinal type mucinous adenocarcinoma of the cervix from metastatic colonic carcinoma may be difficult and should be considered in the differential diagnosis.  History and immunohistochemical stains may be helpful.

BACK TO IMAGES


HISTOLOGY

REFERENCES:

Modem RR, Otis CN, Florence RR, Pantanowitz L.  Intestinal type adenocarcinoma in situ of the cervix.  Diagn Cytopathol. 2007 Sep; 35(9):584-5.

Nguyen G-K, Daya DE.  Cervical Adenocarcinoma and Related Lesions: Cytodiagnostic Criteria and Pitfalls.  Pathol Annu (Pt 2) 1993; 28:53-75.

You answered: Atypical endoervical cells, favour metaplasia   
 
Sorry, that is INCORRECT

The correct diagnosis is: Endocervical adenocarcinoma in situ, intestinal type 

CYTOPATHOLOGY:

  • The smear contains abnormal clusters of slightly enlarged gland cells with nuclear hyperchromasia, elongation, crowding and stratification.  There is a suggestion of nuclear protruding beyond the epithelial cluster margins ('feathering").  Some of the cells have distended mucin vacuoles and resemble intestinal cells.
  • These features are suspicious of endocervical adenocarcinoma in situ.

DISCUSSION: 

  • The cone biopsy reveals endocervical adenocarcinoma in situ, intestinal type.
  • Based on cytoplasmic characteristics, various subtypes of AIS have been described, including endocervical, intestinal, endometrioid, and mixed adenosquamous.
  • Intestinal type AIS is characterized by mucin-containing cytoplasm and resembles intestinal goblet cells.
  • It is important to pay attention to nuclear features such as hyperchromasia, elongation, stratification and crowding in order to avoid mistaking these cells for reactive cellular changes such as those seen with an IUD or with metaplasia.
  • The mucin content gives these cells a lower N:C ratio than a typical endocervical AIS, and could be a potential pitfall if the nuclear features are not appreciated.
  • Separation of intestinal type mucinous adenocarcinoma of the cervix from metastatic colonic carcinoma may be difficult and should be considered in the differential diagnosis.  History and immunohistochemical stains may be helpful.

BACK TO IMAGES


HISTOLOGY


REFERENCES:

Modem RR, Otis CN, Florence RR, Pantanowitz L.  Intestinal type adenocarcinoma in situ of the cervix.  Diagn Cytopathol. 2007 Sep; 35(9):584-5.

Nguyen G-K, Daya DE.  Cervical Adenocarcinoma and Related Lesions: Cytodiagnostic Criteria and Pitfalls.  Pathol Annu (Pt 2) 1993; 28:53-75.

 

You answered: Endocervical Adenocarcinoma in situ  
That is CORRECT !!   


CYTOPATHOLOGY:

  • The smear contains abnormal clusters of slightly enlarged gland cells with nuclear hyperchromasia, elongation, crowding and stratification.  There is a suggestion of nuclear protruding beyond the epithelial cluster margins ('feathering").  Some of the cells have distended mucin vacuoles and resemble intestinal cells.
  • These features are suspicious of endocervical adenocarcinoma in situ.

DISCUSSION: 

  • The cone biopsy reveals endocervical adenocarcinoma in situ, intestinal type.
  • Based on cytoplasmic characteristics, various subtypes of AIS have been described, including endocervical, intestinal, endometrioid, and mixed adenosquamous.
  • Intestinal type AIS is characterized by mucin-containing cytoplasm and resembles intestinal goblet cells.
  • It is important to pay attention to nuclear features such as hyperchromasia, elongation, stratification and crowding in order to avoid mistaking these cells for reactive cellular changes such as those seen with an IUD or with metaplasia.
  • The mucin content gives these cells a lower N:C ratio than a typical endocervical AIS, and could be a potential pitfall if the nuclear features are not appreciated.
  • Separation of intestinal type mucinous adenocarcinoma of the cervix from metastatic colonic carcinoma may be difficult and should be considered in the differential diagnosis.  History and immunohistochemical stains may be helpful.

BACK TO IMAGES


HISTOLOGY


REFERENCES:

Modem RR, Otis CN, Florence RR, Pantanowitz L.  Intestinal type adenocarcinoma in situ of the cervix.  Diagn Cytopathol. 2007 Sep; 35(9):584-5.

Nguyen G-K, Daya DE.  Cervical Adenocarcinoma and Related Lesions: Cytodiagnostic Criteria and Pitfalls.  Pathol Annu (Pt 2) 1993; 28:53-75.

You answered: Atypical endometrial cells, NOS  
Sorry, that is INCORRECT 


The correct diagnosis is: Endocervical adenocarcinoma in situ, intestinal type 

CYTOPATHOLOGY:

  • The smear contains abnormal clusters of slightly enlarged gland cells with nuclear hyperchromasia, elongation, crowding and stratification.  There is a suggestion of nuclear protruding beyond the epithelial cluster margins ('feathering").  Some of the cells have distended mucin vacuoles and resemble intestinal cells.
  • These features are suspicious of endocervical adenocarcinoma in situ.

DISCUSSION: 

  • The cone biopsy reveals endocervical adenocarcinoma in situ, intestinal type.
  • Based on cytoplasmic characteristics, various subtypes of AIS have been described, including endocervical, intestinal, endometrioid, and mixed adenosquamous.
  • Intestinal type AIS is characterized by mucin-containing cytoplasm and resembles intestinal goblet cells.
  • It is important to pay attention to nuclear features such as hyperchromasia, elongation, stratification and crowding in order to avoid mistaking these cells for reactive cellular changes such as those seen with an IUD or with metaplasia.
  • The mucin content gives these cells a lower N:C ratio than a typical endocervical AIS, and could be a potential pitfall if the nuclear features are not appreciated.
  • Separation of intestinal type mucinous adenocarcinoma of the cervix from metastatic colonic carcinoma may be difficult and should be considered in the differential diagnosis.  History and immunohistochemical stains may be helpful.

BACK TO IMAGES   

                                

HISTOLOGY


REFERENCES:

Modem RR, Otis CN, Florence RR, Pantanowitz L.  Intestinal type adenocarcinoma in situ of the cervix.  Diagn Cytopathol. 2007 Sep; 35(9):584-5.

Nguyen G-K, Daya DE.  Cervical Adenocarcinoma and Related Lesions: Cytodiagnostic Criteria and Pitfalls.  Pathol Annu (Pt 2) 1993; 28:53-75.

 
From the Cytopathology files of the BC Cancer Agency
Submitted by: Brenda Smith, BSc and Tom Thomson, MD
SOURCE: Case 9 ( )
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