CYTOLOGICAL ASPECTS OF UTERINE CERVICAL ADENOCARCINOMA, ADENOSQUAMOUSCARCINOMA AND COMBINED ADENOCARCINOMA SQUAMOUS CARCINOMA - APPRAISAL OF DIAGNOSTIC-CRITERIA FOR IN-SITU VERSUS INVASIVE LESIONS

This paper reports the cytological findings based on air-dried smears in a retrospective series of 143 cases of endocervical adenocarcinoma, combined adenocarcinoma-squamous carcinoma and adenosquamous carcinom a drawn from the files of the BC Cancer Registry. Cervical cytology sm ears were available before biopsy in 131 patients, but in 18 cases the cytology showed no abnormality. Malignant changes or high-grade atypi a of glandular and/or squamous cells (defined as moderate or severe dy skaryosis) were detected in 103 cases. In 46 cases, only a high-grade squamous abnormality was detected. Low-grade glandular and/or squamous lesions were detected in nine cases and one showed atypical endometri al-type glands. The cervical smears of 64 cases were reviewed in detai l to determine the important cytomorphological criteria of in situ and invasive adenocarcinoma in air-dried smears, the technique used for p reparing PAP smears in British Columbia. Endocervical cells were absen t in four cases. Numerous (>10) groups of glandular cells were present in 51 cases. Important clues to the diagnosis of adenocarcinoma inclu ded crowding of nuclei, stratification of nuclei, loss of polarity, sy ncytial balls and papillary groups of glandular cells, nuclear enlarge ment, nuclear pleomorphism, and the presence of free-lying atypical gl andular cells. Nuclear hyperchromatism, chromatin pattern, nuclear bor ders, nuclear membranes, and numbers and morphology of nucleoli were n ot helpful criteria in our material. Criteria enabling reliable distin ction between in situ and invasive adenocarcinoma and/or mixed adenoca rcinoma-squamous carcinoma could not be established.