CYTOLOGICAL CHANGES ASSOCIATED WITH TUBO-ENDOMETRIOID METAPLASIA OF THE UTERINE CERVIX

Two women who had undergone previous cervical surgery for the treatmen t of glandular intraepithelial neoplasia (GIN) and cervical intraepith elial neoplasia (CIN), were found to have severely dyskaryotic cells o f glandular and metaplastic type in follow-up cervical smears. A third patient was found to have similar abnormal cells in a routine screeni ng smear. All of the patients were subjected to either hysterectomy or cervical conization and in all cases histological examination showed tubo-endometrioid glands in the endocervix, well away from the uterine isthmus, with no associated endometrial stromal tissue. All of the ce rvical smears were reviewed and cytological features that facilitate t he distinction between tubo-endometrioid metaplasia and squamous or gl andular dyskaryosis were identified. These features include the smalle r size of affected cells, more marked nuclear hyperchromasia, inconspi cuous nucleoli, the formation of glandular structures, the lack of dis crete squamous dyskaryosis and the absence of the typical 'feathering' noted with GIN. The possibility of tubo-endometrioid metaplasia shoul d be considered when atypical glandular or metaplastic cells are noted in cervical smears, particularly, but not exclusively, in women who h ave been treated for CIN or GIN. In the presence of these changes clin icians should rebiopsy the cervix before embarking on further unnecess ary surgery which may adversely affect fertility and pregnancy, partic ularly in younger patients.