Biscotti C V, Gero M A, Toddy S M, Fischler D F, Easley K A
Department of Anatomic Pathology, Cleveland Clinic Foundation, OH 44195, USA.
Diagn Cytopathol. 1997 Nov;17(5):326-32. doi: 10.1002/(sici)1097-0339(199711)17:5<326::aid-dc4>3.0.co;2-8.
Cytologists increasingly encounter atypical endocervical cells, because of the increasing incidence of endocervical adenocarcinoma and the use of improved endocervical sampling devices. These atypical endocervical cells can cause diagnostic problems, especially in recognizing adenocarcinoma in situ (AIS) and distinguishing it from a variety of nonneoplastic changes. We analyzed 33 cervical smears from 22 patients with confirmed AIS and compared these to 19 cervical smears from 17 patients having atypical endocervical cells of undetermined significance and negative follow-up, including at least one tissue biopsy per case, to further investigate the cytologic features of AIS. The AIS smears typically had crowded three-dimensional cellular aggregates, with markedly hyperchromatic nuclei having altered polarity. Frequently, a minor component of AIS formed strips of distinctly columnar cells or sheets. Individual AIS cells occurred in 22 (67%) smears, but these were usually inconspicuous. The AIS smears also had increased nuclear to cytoplasmic ratios (100%), enlarged nuclei (94%), feathering (88%), rosettes (85%), nucleoli (76%), apoptosis (73%), mitoses (64%), multiple nucleoli (18%), and ciliated atypical cells (3%). Cytologic features occurring significantly (P < or = 0.001) more often in AIS cases were a predominance of three-dimensional crowded aggregates (79% vs. 32%), altered nuclear polarity in most groups (88% vs. 16%), marked hyperchromasia (91% vs. 16%), apoptosis (73% vs. 26%), an increased nuclear to cytoplasmic ratio (100% vs. 63%), feathering (88% vs. 26%), and individual atypical cells (67% vs. 16%). In summary, we identified a number of architectural and cellular features that occurred significantly more often in AIS cases than in cases having atypical endocervical cells of undetermined significance and negative follow-up.
由于宫颈腺癌发病率的上升以及宫颈取样设备的改进，细胞学家越来越多地遇到非典型宫颈细胞。这些非典型宫颈细胞会引发诊断问题，尤其是在原位腺癌（AIS）的识别以及将其与各种非肿瘤性改变区分开来方面。我们分析了22例确诊为AIS患者的33份宫颈涂片，并将其与17例具有意义未明的非典型宫颈细胞且随访阴性患者的19份宫颈涂片进行比较，每个病例至少有一次组织活检，以进一步研究AIS的细胞学特征。AIS涂片通常有密集的三维细胞聚集体，细胞核明显深染且极性改变。AIS的一个次要成分通常形成明显的柱状细胞条带或片状。单个AIS细胞出现在22份（67%）涂片中，但通常不明显。AIS涂片还具有核质比增加（100%）、细胞核增大（94%）、羽毛状（88%）、玫瑰花结（85%）、核仁（76%）、凋亡（73%）、有丝分裂（64%）、多个核仁（18%）以及纤毛非典型细胞（3%）。在AIS病例中显著更常见（P≤0.001）的细胞学特征包括三维密集聚集体占优势（79%对32%）、大多数组细胞核极性改变（88%对16%）、明显的核深染（91%对16%）、凋亡（73%对26%）、核质比增加（100%对63%）、羽毛状（88%对26%）以及单个非典型细胞（67%对16%）。总之，我们确定了一些结构和细胞特征，这些特征在AIS病例中比在具有意义未明的非典型宫颈细胞且随访阴性的病例中显著更常见。
