Selvaggi S M
Department of Pathology, University of Michigan, Ann Arbor 48109-0054.
Acta Cytol. 1994 Sep-Oct;38(5):687-92.
Clinical usage of the cytobrush has led to an increase in cellular yield on endocervical cell samples. In cases of squamous cell carcinoma in situ (CIS) involving endocervical glands, clusters of abnormal cells on endocervical smears can be confused with well-differentiated adenocarcinoma in situ (AIS). The purpose of this retrospective three-year study (January 1988 through December 1990) was to evaluate the cellular features of endocervical gland involvement by CIS on cell samples obtained with the cytobrush. Of the 45 cases of CIS diagnosed on cytology, 25 (56%) had histologic correlation and form the basis of this study. In 10 (40%) of the 25 cases two distinct cell patterns were noted. Pattern A was composed of round to oval clusters of abnormal cells with smooth cell borders. Cells at the periphery were flattened, while those within the center had a spindling or whorling arrangement. The cells showed an increased nuclear/cytoplasmic ratio and contained hyperchromatic nuclei and granular chromatin. Nucleoli were not discernible. Pattern B consisted of sheets of columnar cells with peripheral palisading and nuclear pseudostratification, findings that might be interpreted as AIS. The cellular characteristics were similar to those of pattern A. Histologically all cases (10 cervical cones) showed transformation zone and/or endocervical canal involvement by CIS with extension into endocervical glands. In 8 (32%) of the 25 cases, neither cell pattern was present on cytology. In 7 of these cases (87.5%), 7 cervical cones did not show CIS within endocervical glands; supporting findings for patterns A and B represented gland involvement by CIS. In the remaining 7 cases (28%), 6 (85.7%) showed pattern A, and 1 (14.3%) showed pattern B; of these, 5 (71%) showed CIS within endocervical glands (5 cervical cones). Histologically, none of the 25 cases showed endocervical AIS. Endocervical gland involvement by CIS has characteristic cell patterns on endocervical cell samples obtained with the cytobrush that permit the distinction from well-differentiated AIS.
细胞刷的临床应用提高了宫颈管细胞样本的细胞产量。在累及宫颈管腺体的原位鳞状细胞癌（CIS）病例中，宫颈管涂片上的异常细胞团可能会与高分化原位腺癌（AIS）相混淆。这项为期三年的回顾性研究（1988年1月至1990年12月）的目的是评估通过细胞刷获取的细胞样本中CIS累及宫颈管腺体的细胞特征。在45例经细胞学诊断为CIS的病例中，25例（56%）有组织学相关性，构成了本研究的基础。在这25例病例中的10例（40%）观察到两种不同的细胞模式。模式A由圆形至椭圆形的异常细胞团组成，细胞边界光滑。外周的细胞扁平，而中心的细胞呈纺锤状或涡状排列。细胞显示核/质比增加，核深染，染色质呈颗粒状。未见核仁。模式B由柱状细胞片组成，外周呈栅栏状，核呈假复层排列，这些表现可能被解释为AIS。细胞特征与模式A相似。组织学上，所有病例（10个宫颈锥切标本）均显示转化区和/或宫颈管受累于CIS，并延伸至宫颈管腺体。在这25例病例中的8例（32%），细胞学检查未出现任何一种细胞模式。在其中7例（87.5%）中，7个宫颈锥切标本未显示宫颈管腺体内有CIS；支持模式A和B的发现代表CIS累及腺体。在其余7例（28%）中，6例（85.7%）显示模式A，1例（14.3%）显示模式B；其中5例（71%）显示宫颈管腺体内有CIS（5个宫颈锥切标本）。组织学上，25例病例中均未显示宫颈管AIS。CIS累及宫颈管腺体在通过细胞刷获取的宫颈管细胞样本上有特征性的细胞模式，这有助于将其与高分化AIS区分开来。
