4. Normal endocervical cells
• Sheets, strips
• well-preserved architecture: honeycomb or
palisading
• Nuclei: may show variation in size (2 x
enlarged) and shape
• Ovulation: secretory and with “naked” nuclei
11. Cervical polyps
• Common
• Asymptomatic
• cause intermittent or post-coital bleeding
• Histology: central connective tissue stalk linked by
endocervical , metaplastic cells
• No specific cytology pattern except large sheets of
endocervical cells
• Sometimes show atypical or reactive nuclei (AGC)
15. Microglandular hyperplasia
• Benign localized proliferation of endocervical glands
• Incidental finding or associated with polyp
• Young women associated with pregnancy and contraceptive use
• Histology: closely packed irregular glands, lined by benign
endocervical cells
• Cytology features: non-specific
– 2D or 3D sheets of cuboidal and columnar glandular cells with finely
vacuolated cytoplasm
– May have cytologic atypia due to hyperchromatic crowded groups,
pseudostratified strip, nuclear enlargement, hyperchromasia (not to over-
diagnosis as adenoca or AIS)
17. Cells of the Lower Uterine Segment (LUS)
• Isthmus of cervix: short transistional
zone between endocervical and
endometrium
• Cone biopsy shortens the
endocervcial canal: easier access to
LUS
• Cells: mainly endometrial
• less responsive to hormonal
stimulation
• Endocervical brushes ↑ detection,
No need to report
• LUS do not shed ‘spontaneously’
• Cytology: glandular + stromal
element, large irregular branched
groups, round nuclei, fine chromatin,
nuclear crowding,
• May be mistaken for AIS, adenCA
•
• Source: www.bpac.org.nz/resources/bt/2009/october.asp
20. Glandular Abnormalities
• Cervical cytology
– screening test for Squamous intraepithelial lesion
(SIL),
– low sensitivity for glandular lesions because of
sampling & interpretation
21. Bethesda system 2001 classified
3 types of atypical endocervical cells:
• 1. Atypical glandular cells, not otherwise specified
(AGC, NOS)
• 2. Atypical glandular cells, favour neoplastic (AGC,
favour neoplastic)
(If the endocervical origin of glandular cells is sure, specific
atypical endocervical cells (NOS, or neoplasic)
• 3. Endocervical adenocarcinoma in situ (AIS)
22. Atypical endocervical cells vs reactive
• Reactive endocervical cells may
show 2 x ↑ in nuclear size and
conspicuous nucleoli
• The Bethesda 2001 (TBS 2001)
defined atypical endocervical
cells as “endocervical-type cells
that display nuclear atypia that
exceed obvious reactive /
reparative changes, but lack
unequivocal features of
endocervical adenocarcinoma.
Reactive endocervical cells
23. Criteria of Atypical Glandular Cells-NOS (AGC, NOS)
• Architecture
– Loss of orderly architecture with minimal nuclei overlapping and
crowding
• Cytology
– Nuclear enlargement 3 to 5 times the size of normal endocervical
nuclei. (2 times nuclear enlargement: reactive)
– Increase N/C ratio
– smooth nuclear membrane
– Uniformly distributed granular chromatin
– Nucleoli may be presence
– Mild hyperchromasia
– Some variation in nuclear size and shape
24. AGC (NOS) F/51 Follow up: CxBx: Acute and chronic inflammation with focal erosion
25. Criteria of Atypical glandular cells, favour
neoplastic (AGC, favour neoplastic)
• Architecture
– Hyperchromatic crowded groups
– Sheets, strips, irregular clusters, rosette, papillary
– Atypical single cells
• Cytology
– Increased N/C ratio,
– Nucleoli usually absent
– Hyperchromasia
– Even chromatin with coarse granularity
– Irregular nuclear membranes
(Differentiate from Adenocarcinoma in situ (AIS): e.g. lack feathering or rosette)
30. Cytological of Endocervical
adenocarcinoma
• Architecture
• 3-D clusters with vacuolated cytoplasm
• 2-D sheets, strips or strands, papillary form
• Isolated cells may be present
• Cytology
• Dominant cancer cell: columnar shape
• Nuclei appearance: hyperchromiasia, anisokaryosis,
clearing of chromatin, loss of polarity, macronucleoli, ↑ N/C
ratio
• Background
• Tumor diathesis may present
33. Morphology of Benign endometrial cells
• Include both the glandular and stromal cells
• Exfoliate in ball or gland-like clusters, single rare
• 1st half of menstrual cycle: glandular cells surrounding a core of
stromal cells (“exodus”)
• Nuclei: small, round or bean-shaped, regular, degenerated
(nuclei detail not clear)
• Nucleoli: inconspicuous
• Scant cytoplasm, cell borders not well defined
• LBP: 3-D cell ball, better chromatin detail, apoptosis
38. TBS 2001 describes 3 types of Endometrial lesions
• Benign endometrial cells in women over 40
years of age
• Atypical endometrial cells, NOS (not further
classified as favour neoplastic because of
difficulty and not reproducible)
• Endometrial adenocarcinoma
39. Benign Endometrial Cells in a woman >=40 years
(F/47 prolonged mense, FU: Simple endometrial hyperplasia, no cytological atypia)
40. Cytology of atypical endometrial cells, NOS
• Architecture
– Small groups: 5 to 10 cells per group
• Cytology
– Nuclei slightly / relatively enlarged
– Mild hyperchromasia
– Small nucleoli
– Occasionally vacuolated cytoplasm
– Cell borders ill-defined
• Clean background
41. Atypical endometrial cells (NOS)
(F/62. PMB Follow up endometrial biopsy: at least complex hyperplasia with atypia)
42. Cytology of Endometrial adenocarcinoma
• Architecture
– Irregular aggregates: usually small tight clusters
– Isolated cells usually seen
– Compared with endocervical adenoCA (direct scrapping), fewer
abnormal cells (exfoliated)
• Cytology
• Size varies (best differentiated: smallest)
–
– Small to prominent nucleoli
Small to prominent nucleoli
– Nuclei enlarged and irregular shape,eccentrically placed
– Granular, reticular, clearing
– Cytoplasm: scant, often vacuolated, may have intracytoplasmic
neutrophils
• Background
– Finely granular or “watery” tumor diathesis may be present
45. Morphologic features for differentiating endocervical from
endometrial adenocarcinoma (modified from Ayala MJ, 2011)
Cytological
features
Endocervical AdenoCA Endometrial AdenoCA
Microarchitecture Palisading, sheets, papillary,
strips, single cells (less)
Acini, small, 3-D clusters, single
cells (frequent)
Shape of cells columnar Cuboidal, rounded
Cell size larger smaller
Cytoplasm Granular Vacuolated with occasional
polymorph infiltration
Nuclear size larger smaller
Nuclear chromatin coarse fine
Macronucleoli common Rare in low grade
No. of abnormal cells more less
Tumor diathesis Usually present Less prominent, watery or granular
47. Extrauterine adenocarcinoma
• CA metastatic to cervix: unusual
• Most frequent extragenital origin: ovary, breast, GI
tract
• Clinical correlation and ancillary tests are needed to
reach a correct diagnosis
• Cytology
– clean background
– morphology unusual to that of endocervical or endometrial
– degenerative changes
