MICROINVASIVE ADENOCARCINOMA OF THE CERVIX - A CYTOHISTOPATHOLOGIC STUDY OF 40 CASES

Cervical smears obtained from 40 women with a histologic diagnosis of microinvasive adenocarcinoma (MIA) were reexamined for features of inv asion. In our study MIA was defined as stromal invasion by adenocarcin oma cells to 5 mm or less beyond a surface epithelium and without lymp hovascular involvement. In 24 cervices, squamous carcinoma in situ was a coincidental histologic finding. All 40 smears contained atypical g landular cells (AGC) forming pseudosyncytial clusters, and 12 showed a dditional features suggestive of invasion; pleomorphic nuclei, coarse irregular chromatin, karyorrhectic nuclei, and cell detritus. The inva sive features tended to occur together and were found more than twice as frequently in this group than in the remaining 28 smears. There was little difference between the two groups in the frequency of supercro wded cell clusters, acini, cell strips, isolated cells, nuclear hyperc hromasia, macronucleoli, or normal cervical glandular cells. Fourteen smears from the 24 cervices with squamous carcinoma in situ contained cells from a high-grade squamous intraepithelial lesion. It is conclud ed that cervical cytologic examination has a sensitivity of 30% (12/40 ) for the identification of stromal microinvasion in adenocarcinoma in situ. Cell detritus, present in 5/12 smears is considered highly spec ific for invasion but lacks sensitivity. Due to the more proximal loca tion and ease of sampling, cytologic examination has a sensitivity of 58% (14/24) for histologically confirmed coexisting squamous lesions. (C) 1997 Wiley-Liss, Inc.