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.