Cytology discrimination point of adenoma malignum and lobular endocervical glandular hyperplasia

Abstract

Objective: We reviewed the cytologic features of benign endocervical glandular cells, glandular dysplasia, and adenocarcinoma in situ (AIS) to determine diagnostic features of adenoma malignum and lobular endocervical glandular hyperplasia (LEGH).
Study Design: We studied the appearance of cell clusters and backgrounds, cell morphology, including nuclear features and staining patterns of intracytoplasmic mucin on Pap smears, in 85 cases of endocervical glandular lesions. We also studied the validity of histological scoring for discriminating between glandular dysplasia and adenocarcinoma in situ, proposed by Ioffe et al., in cytological diagnosis. The frequency of large monolayered sheets of cells in adenoma malignum, was 21%, in glandular dysplasia 50%, and in LEGH 42%. Clusters showing two to three layers of nuclear pseudostratification were seen in 17% of AIS, 11% of microinvasive adenocarcinoma, 5% of LEGH, and 12% of adenoma malignum. Clusters with more than four layer nuclear pseudostratification were only 0.3%, and 2% in LEGH and adenoma malignum. It was 9% in AIS and 35% in microinvasive adenocarcinoma. Irregular nuclear contour, coarse chromatin texture, and prominent nucleoli were observed in adenoma malignum. We saw no distinct nuclear abnormalities in LEGH, however in about 1/3 of LEGH and 2/3 of adenoma malignum, intranuclear cytoplasmic inclusions were also seen. Yellowish intracytoplasmic mucin was identified in both LEGH and adenoma malignum. Following Ioffe et al., the combined score was 3.5 in glandular dysplasia, 3.8 in LEGH, 4.2 in adenoma malignum, and 6 in adenocarcinoma.
Conclusion: LEGH and adenoma malignum are distinguished from other benign endocervical glandular lesion by yellowish intracytoplasmic mucin and intranuclear cytoplasmic inclusion. Adenoma malignum is distinguished from LEGH by the morphology of cell clusters, distinct nuclear abnormalities, i.e., irregular shape and size variation, coarse chromatin architexture and prominent nucleoli.