Selvaggi S M, Haefner H K
Department of Anatomic Pathology, Loyola University Medical Center, Maywood, IL 60153, USA.
Diagn Cytopathol. 1997 Feb;16(2):168-73. doi: 10.1002/(sici)1097-0339(199702)16:2<168::aid-dc15>3.0.co;2-k.
The detection of atypical glandular cells of undetermined significance (AGUS) has risen recently due to the use of new endocervical canal sampling devices, in particular the cytobrush. From April 1993-June 1994, a diagnosis of AGUS ranging from adenocarcinoma in situ (AIS) to invasive adenocarcinoma was initially made on cervical smears from 6 women for whom histologic follow-up data were available. The purpose of this study was to determine if benign cervical glandular lesions can be reliably distinguished from adenocarcinoma on cytology. Review of the smears and histologic slides from 3 patients showed microglandular endocervical hyperplasia on cervical cone specimens. Cervical smears from 2 of these patients showed clusters of small-to-medium-sized cells with nuclei containing coarse, granular chromatin and prominent nucleoli. Cytoplasmic vacuoles and engulfment of neutrophils were present, findings suggestive of endometrial adenocarcinoma. The third patient's smear showed clusters of large cells with ample, vacuolated cytoplasm and vesicular nuclei containing prominent nucleoli, findings suggestive of endocervical adenocarcinoma. In 3 cases evaluated by cervical conization, histologic slides showed tubal metaplasia. The cervical smears showed clusters and sheets of cells with round-to-oval-shaped nuclei containing evenly distributed, finely granular chromatin and inconspicuous nucleoli. Pseudoglandular formation was present in 2 cases, a finding suggestive of AIS. Since the cytologic features of microglandular endocervical hyperplasia and tubal metaplasia overlap those of adenocarcinoma, a differential diagnosis is prudent on cytologic smears of AGUS.
由于采用了新的子宫颈管取样装置，尤其是细胞刷，意义不明确的非典型腺细胞（AGUS）的检出率近来有所上升。从1993年4月至1994年6月，对6名女性的宫颈涂片最初诊断为AGUS，范围从原位腺癌（AIS）到浸润性腺癌，这些女性均有组织学随访数据。本研究的目的是确定在细胞学上能否可靠地区分良性宫颈腺性病变与腺癌。对3例患者的涂片和组织学切片进行回顾，宫颈锥切标本显示为微腺型子宫颈内膜增生。其中2例患者的宫颈涂片显示为中小细胞簇，细胞核含有粗糙的颗粒状染色质和明显的核仁。存在细胞质空泡和中性粒细胞吞噬现象，这些表现提示为子宫内膜腺癌。第3例患者的涂片显示为大细胞簇，细胞质丰富、有空泡，泡状核含有明显的核仁，这些表现提示为子宫颈内膜腺癌。在通过宫颈锥切术评估的3例病例中，组织学切片显示为输卵管化生。宫颈涂片显示为细胞簇和细胞片，细胞核呈圆形至椭圆形，含有均匀分布的细颗粒状染色质和不明显的核仁。2例出现假腺管形成，这一表现提示为AIS。由于微腺型子宫颈内膜增生和输卵管化生的细胞学特征与腺癌的特征重叠，因此对AGUS的细胞学涂片进行鉴别诊断时应谨慎。
