ENDOCERVICAL ADENOCARCINOMA IN-SITU - AN ANALYSIS OF CELLULAR-FEATURES

Cytologists increasingly encounter atypical endocervical cells, becaus e of the increasing incidence of endocervical adenocarcinoma and the u se of improved endocervical sampling devices. These atypical endocervi cal cells can cause diagnostic problems, especially in recognizing ade nocarcinoma in situ (AIS) and distinguishing it from a variety of nonn eoplastic changes. We analyzed 33 cervical smears from 22 patients wit h confirmed AIS and compared these to 19 cervical smears from 17 patie nts having atypical endocervical cells of undetermined significance an d negative follow-up, including at least one tissue biopsy per case, t o further investigate the cytologic features of AIS. The AIS smears ty pically had crowded three-dimensional cellular aggregates, with marked ly hyperchromatic nuclei having altered polarity. Frequently, a minor component of AIS formed strips of distinctly columnar cells oi sheets. Individual AIS cells occurred in 22 (67%) smears, but these were usua lly inconspicuous. The AIS smears also had increased nuclear to cytopl asmic ratios (100%), enlarged nuclei (94%), feathering (88%), rosettes (85%), nucleoli (76%), apoptosis (73%), mitoses (64%), multiple nucle oli (18%), and ciliated atypical cells (3%). Cytologic features occurr ing significantly (P less than or equal to 0.001) more often in AIS ca ses were a predominance of three-dimensional crowded aggregates (79% v s. 32%), altered nuclear-polarity in most groups (88% vs. 16%), marked hyperchromasia (91% vs. 16%), apoptosis (73% vs. 26%), an increased n uclear to cytoplasmic ratio (100% vs. 63%), feathering (88% vs. 26%), and individual atypical cells (67% vs. 16%). In summary, we identified a number of architectural and cellular features that occur-red signif icantly more often in AIS cases than in cases having atypical endocerv ical cells of undetermined significance and negative follow-up. (C) 19 97 Wiley-Liss, Inc.