Cytologic features of villoglandular adenocarcinoma of the uterine cervix - Comparison with typical endocervical adenocarcinoma with a villoglandularcomponent and papillary serous carcinoma

BACKGROUND. To the authors' knowledge, the cytologic features of villogland ular adenocarcinoma (VGC) have been described in very few publications. The malignant cells are difficult to separate from reactive glandular cells an d the majority of VGCs are missed on screening cytology. METHODS. The cytologic findings of a retrospective study of four cases of p ure VGC are described and are contrasted with those of papillary serous ade nocarcinoma and typical mucinous endocervical adenocarcinoma with a focal c omponent of VGC. RESULTS. Although atypical glandular cells of endocervical origin were repo rted when the smears from the VGC cases were examined in the screening prog ram, none of the cases was recognized as malignant prior to histologic diag nosis. The smears showed many groups of endocervical glandular cells. Impor tant architectural features included large cohesive groups and sheets of ce lls showing nuclear crowding and loss of the normal honeycomb pattern. True papillary structures comprising stromal cores covered by well polarized co lumnar cells with a smooth surface were characteristic. It is important to note that a "feathered edge" appearance of the cell groups was absent. The neoplastic cells were mildly atypical, showing a slight increase in the nuc lear-cytoplasmic ratio but minimal hyperchromatism. The cytology smears of four cases of typical adenocarcinoma of endocervical type that had a focal VGC pattern showed cell groups with irregular borders and "feathered" edges comprised of distinctly atypical columnar cells with elongated and irregul ar hyperchromatic nuclei. Free-lying atypical cells and ball-like clusters of atypical cells also were present in the latter cases but not in pure VGC s. The primary high grade papillary serous adenocarcinomas of the cervix ex hibited extreme cytologic atypia that was interpreted readily as malignant. CONCLUSIONS. The diagnosis of VGC on cytology smears often is missed. Papil lary fragments, nuclear crowding, and subtle atypia may suggest the diagnos is. Cancer (Cancer Cytopathol) 1999;87:5-11, (C) 1999 American Cancer Socie ty.