非典型鳞状细胞不能排除高级别鳞状上皮内病变，伴有深染拥挤的细胞团和累及宫颈腺体的高级别鳞状上皮内病变。

The association of atypical squamous cells, cannot exclude a high grade squamous intraepithelial lesion, hyperchromatic crowded groups and high grade squamous intraepithelial lesions involving endocervical glands.

机构信息

Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.

出版信息

Diagn Cytopathol. 2021 Sep;49(9):1008-1011. doi: 10.1002/dc.24805. Epub 2021 May 21.

DOI:10.1002/dc.24805

PMID:34019341

Abstract

BACKGROUND

Hyperchromatic crowded groups (HCGs) are often classified as atypical squamous cells, cannot exclude a high grade squamous intraepithelial lesion (ASC-H) on ThinPrep Pap tests. This study reports on the association of HCG's with high grade squamous intraepithelial lesions (HSIL) involving endocervical glands.

METHODS

Over a 3-year period (January 1, 2018-December 31, 2020), 115 (0.2%) of 63,817 Pap tests were diagnosed as ASC-H. Histologic follow-up was available in 76 (66%) cases; 42 (55%) cervical biopsies; and 34 (45%) cervical cones/LEEPs.

RESULTS

Based on the histologic results, 49 ASC-H cases showed HSIL/CIN 3 and form the basis of this study. ThinPrep Pap tests showed two cell patterns; atypical immature squamous metaplastic cells and HCGs, each of which was difficult to distinguish from HSIL. On histologic correlation all 10 ASC-H Pap Tests with individual atypical immature squamous metaplastic cells showed HSIL/CIN 3 without endocervical gland involvement and 37 (95%) of the 39 Pap Tests with HCGs showed HSIL/CIN 3 with endocervical gland involvement.

CONCLUSION

The results of this study support the premise that a subset of HCGs represent endocervical gland involvement by HSIL as opposed to a glandular lesion; in particular endocervical adenocarcinoma in-situ.

摘要

背景

巴氏涂片检查中出现的浓染拥挤细胞团（HCG）常被归类为非典型鳞状细胞，不能排除高级别鳞状上皮内病变（ASC-H）。本研究报告了 HCG 与累及宫颈腺体的高级别鳞状上皮内病变（HSIL）之间的相关性。

方法

在 3 年期间（2018 年 1 月 1 日至 2020 年 12 月 31 日），63817 例巴氏涂片检查中有 115 例（0.2%）诊断为 ASC-H。76 例（66%）患者有组织学随访结果；其中 42 例进行了宫颈活检，34 例进行了宫颈锥切术/环形电切术（LEEP）。

结果

根据组织学结果，49 例 ASC-H 病例显示为 HSIL/CIN3，这是本研究的基础。液基薄层细胞学检查显示两种细胞模式；非典型不成熟鳞状化生细胞和 HCG，两者均难以与 HSIL 区分。组织学相关性研究显示，10 例 ASC-H 巴氏涂片检查中，每例均有单个非典型不成熟鳞状化生细胞，均显示为 HSIL/CIN3，且无宫颈腺体受累；39 例巴氏涂片检查中有 HCG 的病例中，有 37 例（95%）显示 HSIL/CIN3 并伴有宫颈腺体受累。