Exfoliative cytology of in situ and microinvasive adenocarcinoma of the uterine cervix

The histology and exfoliative cytology of 15 cases of adenocarcinoma in situ and 5 cases of microinvasive adenocarcinoma of the uterine cervix were reviewed. The exfoliative cytology in both groups showed no remarkable differences and consisted of large epithelial fragments, cellular strips, groups and isolated examples of malignant columnar cells situated in a necrotic-material-free background.     

Comparative cytologic features of adenocarcinoma in situ of the uterine cervix

The cytologic findings in 30 cases of adenocarcinoma in situ (AIS) and related lesions of the cervix were compared with those in 13 cases of cervical invasive adenocarcinoma and 8 cases of cervical nonneoplastic conditions that mimicked AIS cytologically. Although there was considerable overlap, the presence of large cells with irregular nuclei and uneven chromatin distribution in smears containing no normal endocervical cells helped to distinguish invasive adenocarcinoma from AIS. The presence of "feathering," rosettes, mitotic figures and very crowded nuclei with scant cytoplasm and without cilia helped distinguish AIS from benign conditions.     

Malacoplakia of the uterine cervix. Histologic, cytologic and ultrastructural study of a case

A rare case of malacoplakia of the uterine cervix is described. The histologic, histochemical and ultrastructural findings in this case were typical of this entity. The typical Michaelis-Gutmann bodies were quite easily identified in the cervicovaginal smear with the use of the Von Kossa stain. This method can be an important diagnostic aid in cytologically differentiating this lesion from neoplastic or parasitic processes.     

The cytologic diagnosis of adenocarcinoma in situ of the cervix uteri and related lesions. II. Microinvasive adenocarcinoma

Criteria for the cytologic diagnosis of microinvasive adenocarcinoma of the cervix have not been previously established. Such cytologic criteria were evolved through the detailed analysis of cervical smears from 40 histologically confirmed cases. The cellular features of cervical adenocarcinoma in situ (AIS) were always associated with microinvasion. Syncytia of glandular cells, small cells in very crowded sheets and papillary groupings of cells, when seen in conjunction with AIS, were suggestive of microinvasion. Dissociation of cells was common. Nuclear pleomorphism with an irregular chromatin pattern and inconspicuous-to-prominent nucleoli was frequently present. In some cases, a tumor diathesis was seen in the smear background. Using these criteria, our predictive accuracy for diagnosing microinvasive cervical adenocarcinoma is improving steadily and now approaches 50%. Ongoing investigation of these cases must include a diagnostic come biopsy to further improve the predictive accuracy for this lesion.     

Exfoliative cytology of microinvasive squamous-cell carcinoma of the uterine cervix. A retrospective study of 42 cases

The cervical scraping smears from 42 cases of microinvasive squamous-cell carcinoma of the uterine cervix with stromal invasion less than 3 mm were reviewed. Microinvasion could be suggested in approximately 60% of the cases by examination of the smears. The cytologic prediction of microinvasion was 14% in cases having stromal invasion less than 1 mm; it increased to 72.7% and 88.2% when stromal invasions were 1.1 to 2 mm and 2.1 to 3 mm in depth, respectively.     

Cytology of microinvasive squamous-cell carcinoma of the uterine cervix

The cervical cytology in 53 cases with histologically confirmed microinvasive squamous-cell carcinoma of the uterine cervix was studied. The smears were originally correctly diagnosed as showing microinvasion in 42% of the cases and were underinterpreted in 45%. On review, four of the underdiagnosed smears did show features of microinvasion. The depth of invasion did not have much influence on the cellular features. The patients underdiagnosed by cytology showed a tendency to have a smaller surface lesion and to have a history of a prior cervical manipulation within four weeks of the cytologic examination. The mean age of the overdiagnosed cases was distinctly higher than that of other cases. The colposcopic diagnosis correlated well with the cytologic diagnosis; both diagnostic modalities were considered to reflect well the change within the surface epithelium but to be less sensitive in recognizing the subtle changes of early invasion.     

Pemphigus vulgaris and microinvasive squamous-cell carcinoma of the uterine cervix

Although patients with disseminated pemphigus vulgaris may have involvement of the uterine cervix, such involvement is often detected only after vaginal discharge or bleeding. When a cervical smear is obtained, distinctive cytologic abnormalities may be observed; these may be attributed to the changes of pemphigus or to an associated reparative/inflammatory reaction. This study documents the first two cases of microinvasive squamous-cell carcinoma of the uterine cervix developing in association with uterine cervical pemphigus. The gross pathologic, cytologic and histologic features of these lesions are illustrated. The cytologic criteria that may be helpful in distinguishing between cells derived from microinvasive squamous-cell carcinoma and pemphigus of the uterine cervix are described.     

The cytologic diagnosis of adenocarcinoma in situ of the cervix uteri and related lesions. III. Pitfalls in diagnosis

Potential pitfalls in the cytologic diagnosis of adenocarcinoma in situ (AIS) of the cervix are illustrated by the presentation of three cases of benign cervical lesions initially diagnosed as AIS: cervical endometriosis, tubal metaplasia of the endocervix and changes due to a previous biopsy. The differential diagnosis of endocervical glandular abnormalities is discussed.     

Stage at diagnosis and mortality in patients with adenocarcinoma and adenosquamous carcinoma of the uterine cervix diagnosed as a consequence of cytologic screening

OBJECTIVE: To determine if cytologic screening is associated with early stage at diagnosis of and decreased mortality from invasive adenocarcinoma and adenosquamous carcinoma of the uterine cervix. STUDY DESIGN: We retrospectively reviewed the medical records of all 169 women diagnosed with invasive adenocarcinoma or adenosquamous carcinoma of the cervix in a prepaid health plan during 1988-1994. Differences in stage and survival were assessed in relation to screening history and symptoms. RESULTS: Among the 169 cases, late-stage disease was present in 19/169 women (11.2%) at the time of diagnosis, and 24/269 (14.2%) women died of the disease during the three-year follow-up period. Women whose cancer was screen detected numbered 48/169 (28.4%) and were less likely to present with late-stage disease than non-screen-detected women: 2/48 (4.2%) versus 17/121 (14.0%) (P = .05). A mortality advantage at three years from diagnosis was associated with screen-detected cancers: 1/48 (2.1%) versus 23/121 (19.0%) (P = .002), and this advantage persisted after controlling for stage at diagnosis. CONCLUSION: Invasive adenocarcinomas and adenosquamous carcinomas of the cervix detected by screening are found at an earlier stage and are associated with lower disease-specific mortality than those not detected by screening.     

Cervicovaginal cytology in uterine adenocarcinoma and adenosquamous carcinoma. Comparison of cytologic and histologic findings

To investigate the diagnostic accuracy and to characterize the findings in false-negative cases, the results of cervicovaginal cytology in 56 adenocarcinomas and 25 adenosquamous carcinomas (42 cervical, 36 endometrial, 2 metastatic and 1 arising synchronously from both cervix and endometrium) were reviewed, including review of the actual slides in 56 cases. Overall, 80% of the initial cytologic diagnoses resulted in diagnostic curettage (i.e., cytology was effectively positive); 84% of the postreview diagnosis were effectively positive. Nine cytology slides showed no malignant cells; eight of these negative smears showed repair, five were atrophic, two showed a high estrogen effect and one had enlarged atypical bare nuclei. These false-negative diagnoses were associated with an endometrial primary site (P less than .01), endometrioid histology (P less than .005), low-grade or intermediate-grade histology (P less than .005), small size of tumor (P less than .05) and absence of cervical involvement (P less than .005) in those cases in which a hysterectomy was performed. False-negative diagnoses were not associated with an absence of endocervical cells or with scanty cellularity. Of 39 cervical and 28 endometrial carcinomas with a positive cytologic diagnosis (initially or after review of the available slides), cytology correctly identified the primary site in 18% and 54% of the cases, respectively. Cytology incorrectly classified the anatomic site of four cervical and three endometrial carcinomas and considered one case arising in both the endometrium and cervix to be endometrial. Routine cervicovaginal cytology does have a role in screening for uterine glandular carcinoma; to maximize its diagnostic sensitivity, we suggest using a recommendation for curettage in the report of positive cases so that all of the varied cytologic diagnoses associated with glandular carcinomas will receive a uniform clinical response. In those cases with preserved cancer cells, a correlation can be made with the histologic type of the carcinoma, rather than with the anatomic site.     

Comparison of suspicious and positive colposcopic, cytologic and histologic findings in the uterine cervix

One hundred thirty-five cases of suspicious or positive colposcopic or cytologic findings were histologically analyzed. In cases of colposcopically detectable atypical changes or suspicious findings as well as of cytologic dysplasias or carcinomas, the histologic diagnoses were almost the same. The results demonstrated that colposcopy and cytology with a quick staining method are of value. Biopsy can quickly follow in cases of suspicious findings.