Lecture 10 Glandular epithelium

Question 1

Where in the female genital tract can the glandular epithelium be found?

Answer 1

Glandular epithelium in the female genital tract includes the lining of the endocervix,
endometrium and the fallopian tube.

Question 2

Provide the definition of Atypical Endocervical Cells.

Answer 2

Endocervical cells display nuclear atypia that exceeds obvious reactive or reparative
changes but lack unequivocal features of endocervical adenocarcinoma in situ (AIS) or
invasive adenocarcinoma.

Question 3

Discuss the endocervical cells.

Answer 3

Endocervix does not form true tubular or acinar glands – no glandular unit with
neck, body and fundus
 Grooves and clefts – crypts – lined by a single layer of endocervical columnar
cells
 Endocervical cells presence on a smear - a measure of adequacy (10 well
visualised and well preserved cells)
 The cells are tall and columnar, can be secretory or ciliated
 “Pencil thin” endocervical cells are elongated and slender – thought to be an
effect of Lugol’s Iodine
 Secretory endocervical cells – have relatively abundant cytoplasm, contains
multiple vacuoles
 Ciliated endocervical cells – look like ciliated bronchial cells – terminal bar and
cilia staining red optimally
 Endocervical cells – seen singly or in strips or sheets – “honeycomb” appearance
when seen en face and palisading with basally located nuclei when seen side on
 The nucleus is round/oval with vesicular chromatin – slightly larger than nucleus
of a intermediate cell ± 55µm2
 Nuclei are usually single, occasional bi or multinucleation
 Chromatin – delicate and evenly distributed
 Cytoplasm – delicate and often lyses

Question 4

define AIS

Answer 4

High-grade endocervical glandular lesion that is characterised by nuclear enlargement,
hyperchromasia, stratification and mitotic activity but without invasion

Question 5

Describe the cytomorphological features of Invasive Adenocarcinoma of the Uterine Cervix.

Answer 5

Background :necrotic ,tumour diathesis
abudant colunar cells with tall elongated ,course dark chromatin nuclei
feathering,rossete effect
enlarged pleomorphism and High N/C ratios

Question 6

Tabulate the differences between Invasive Adenocarcinoma of the cervix versus that of the endometrium.

Answer 6

refer to image in notes

Most distunighusging factors of invasive adenocarcinoma of the endometrium is that the diathesis is watery ,nuclei are rather hypo chromatic than hyper

Question 7

Discuss the 2 clinical groups of patients most likely to develop Type I and Type II endometrial adenocarcinoma of the endometrium.

Answer 7

Type 1 is seen in patients who are younger or pre/perimenopausal with lifestyle effects such obesity ,diabetes,hypertension/estrimerism

type 2 is seen in patients who are older or postmenopausal with lifestyle effects such as being thin

Question 8

How does The Bethesda System report on the presence of endometrial cells in women younger and older than 40? Why?

Answer 8

ask for perspective ;page 131

in women below 40 years of age the risk of endometrila cancer is low

The presence of benign endometrial cells (BECs) on cytologic analysis has been linked to significant endometrial disease in women older than 50 years who are noted as postmenopausal and may have clinical symptoms such as postmenopausal bleeding.

Question 9

Describe the cytomorphology of Endometrial Adenocarcinoma.

Answer 9

Background – typically watery diathesis – clinical feature is a watery discharge
which is seen on the slides as a finely granular, basophilic diathesis
 Background of atrophy, often marked inflammation
 Cell arrangement ranges – loose clusters seen in low grade adenocarcinomas
and with increasing grade the cell balls are tighter almost like those seen during
menstruation
 Cytoplasm – typically scant, cyanophilic and often vacuolated – intracytoplasmic
neutrophils are common
 Nuclei – enlarge and loss of polarity
 Chromatin – abnormal, irregular with clearing – more and more hyperchromatic
 Nucleoli – enlarge (range: depends on grade), multiple, may be macro and take
on irregular shapes

Question 10

Give possible reasons why benign glandular cells are occasionally found on post hysterectomy smears.

Answer 10

As a result our study showed that the finding of glandular cells in posthysterectomy vaginal smears is more frequent than expected and most of them could be related to inflammatory and regenerative processes due to the removal of the uterus in the absence of a clearly identified underlying cause.