W1L2 - Adenocarcinoma of FGT Flashcards
Aetiology of Glandular Lesions
HPV infection - 90% contain HPV - Types 16 and 18 account for 80-90% Contraceptive pill Diethylstilboestrol 50% of AIS associated with coexisting CIN Immunosuppression There is no precursor lesion for AIS
Adenocarcinoma in Situ (AIS) Basic Info
Average interval between dx and detectable AIS and early invasion is at least 5 years
Appox 55% of patients with AIS have a coexisting squamous lesion
Nearly all lesions are asymptomatic and are usually dx during cervical screening
AIS Features
Architectural abnormalities Includes hyperchromatic crowded groups Crowded strips and rosettes Nuclei protrude from margins giving clusters a frayed look referred to as 'feathering' Nuclear enlargement, elongation Inconspicuous or macronucleoli Distinctively dark chromatin May be apoptotic bodies and mitotic figures NO TUMOUR DIATHESIS
AIS - Differential Dx
Normal endocervical cells Reactive endocervical epithelium Reactive squamous metaplasia Endometrial cells Tubular metaplasia SCC +/- crypt involvement
How do normal endocervical cells differ from AIS?
Sheets +/- gland openings
May see strips or rosette formation
Honeycomb pattern
No pseudostratification
Reactive Endocervical Cells - Features
Mildly crowded sheets and strips Nuclear enlargement (3-5x normal) Normal N/C ratio Mild hyperchromasia Regular chromatin distribution \+/- prominent nucleoli Aligned elongated cells
Reactive Squamous Metaplasia - Features
Sheets, single cells and some clumps No strips or rosettes Nuclear enlargement Hyperchromasia Regular chromatin Alignment of cells
Tubal Metaplasia
Benign replacement of the normal endocervical epithelium with cells characteristic of the fallopian tube
Common after 35 yrs old
Assoc with estrogen
Clinically insignificant
Tubal Metaplasia - Features
Sheets Strips +/- pseudostratification Ciliated cells (not always present) Large nuclei Hyperchromasia Granular chromatin
Difference between SCC and Adenocarcinoma - Aggregates
SCC - aggregates thick, crowded, disorderly, ragged - may be protruding nuclei with wispy tails - cytoplasm dense with smooth borders Adenocarcinoma - aggregates less thick (2-3 cells deep) - +/- residual honeycomb pattern - nuclear palisading and feathering - finely vacuolated with wispy borders
Difference between SCC and Adenocarcinoma - Nuclei
SCC
- pleomorphic
- irregular thickening and irregular borders
- usually finely granular chromatin pattern +/- irregular chromatin distribution
- small nucleoli
Adenocarcinoma
- more uniform and less marked hyperchromasia
- irregular thickening but smooth borders
- coarse granules but usually evenly distributed
- prominent enlarged nucleoli
Types of Adenocarcinoma
Endocervical carcinoma (80-90%) Mixed adenocarcinoma (35%) Endometrioid carcinoma (4%) Mucinous/Intestinal carcinoma (rarely pure 3%) Clear cell carcinoma (rare) Papillary carcinoma (rare) Adenosquamous carcinoma (rare)
Morphology of Endocervical Adenocarcinoma
Often very cellular bloodstained smears
Lots of sheets/clumps and not many single cells
Evidence of tumour diathesis
Cytology of Endocervical Adenocarcinoma
Nuclear crowding and overlapping Feathering Pseudostratified strips of cells High N/C ratio Dense course granular chromatin pattern Prominent nucleoli Dirty background
Syncitia
Small irregular aggregates of cells lacking obvious cell borders
Hyperchromatic crowded groups, glandular differentiation may be difficult to identify
Loose disorderly 2D sheets and palisades are more common than 3D cell balls
