EXPANDED CYTOLOGIC CRITERIA FOR THE DIAGNOSIS OF ADENOCARCINOMA INSITU OF THE CERVIX AND RELATED LESIONS

Abstract

Fifty-two [human] cases of adenocarcinoma in situ (AIS) of the cervix uteri, or lesions closely related to AIS, were reported over 5 yr. Whereas this lesion has commonly been considered a rare and usually incidental histologic finding, the large majority of these cases involved glandular atypia only and were prospectively diagnosed. Comparison of the findings from this larger series with the 11 cases of AIS previously described led to a shift in emphasis from cell size to sheet architecture as the primary cytologic criterion for diagnosis. The structure of AIS sheets was consistent with respect to the cytologic appearances described here, even when the cells were poorly preserved. Retrospective studies of Papanicolaou smears of other cases that were confirmed histologically as endocervical dysplasia, microinvasive or early invasive adenocarcinoma or deeply invasive adenocarcinoma indicate that these entities can be distinguished from AIS primarily on the basis of the architecture of the sheets of cells. Cellular groups comprising small, crowded nuclei were a feature of several undercalled deeply invasive adenocarcinomas, and the diagnostic significance of this material is discussed.