|Posted by jrpaz on May 9, 2010 at 6:55 AM|
Case of a 60 years old female with vaginal spoting. The review of a conventional pap smear reveal glandular cell changes compatible with the diagosis of AIS.
AIS( Adenocarcinoma in situ) of the endocervix is a lession defined in Bethesda and is a qualitative upnotch from AGC favor neoplasia' so the discussion on this page can be used for both lessions if we think of AGC as a baby AIS.
AIS is peculiar in cytology in that the diagnosis requieres a grouping (architectural) criteria and a cyolological (single cell nuclei) criteria.
. The groups loose their typical honeycomb arrangement and become disorganized.
. The cells tend to overlap and become crowded. In these sheets one can observe pseudostratification of the nuclei.
. Other criteria found in endocervical AIS are for example, " feathering " in which the glandular cells are very elongated, with scant cytoplasm and somewhat elongate nuclei.
. The other so call typical arrangement is the rosette formation. These rosettes consist of a small group of cells, 'connected' at the base of the cytoplasm while the nuclei eccentrically located. Pseudostratification of the nuclei can be observed.
The criteria consist of slight nuclear pleomorphism, granular chromatin and rare abnormal mitosis. The nuclear borders may be slightly irregular. The nucleoli are usually small (no macronucleoli). Mucin secretion is rare.(We will be discussing SMILE in the near future).
Remember, the nuclear atypia of endocervical adenocarcinoma in situ is not as mark as those found in cytological atypias of the squamous epithelial type (HGSIL or CIS).