Cervical smears with atypical glandular cells: diagnostic and treatment algorithms
ESC Congress Library. asaturova a. 05/28/14; 50644; A-229
Mrs. aleksandra asaturova
Mrs. aleksandra asaturova
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Abstract
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Objectives: The purpose of our survey was to compare cytological and histological features of cervical samples and to develop the diagnostic and treatment algorithms for such patients.


Methods: 36 patients (reproductive age) were recruited for the investigation due to atypical glandular cells (AGC) cytological diagnosis and were examined clinically (including colposcopy), cytologically (liquid-based cytology, ВD Sureph T.M), immunocytochemically (p16INK4a, Ki-67, CINtec PLUS Cytology Kit), hystologically (hematoxylin and eosin staining of paraffin sections). Also PCR-RT was done for HPV detection (samples were obtained from transformation zone and endocervical low part with Endobrush®).


Results: the wide transformation zone around the external os with atypical changes, hypertrophy, cervical cicatricial deformity and multiple retention cysts were detected in 55.6% (20 patients). High risk HPV type (18) was revealed in 11.1% patients, low-risk types (6,11) - in 2 patients. All cytological smears showed atypical glandular cells involving endocervical cells complexes demonstrating hyperchromic enlarged nuclei with different shape and polarity disturbance. AGC and cervicitis were frequently diagnosed simultaneously. Also the squamous abnormalities (ASCUS, L-SIL, H-SIL) were revealed with AGC in 10% of cases. Immonohystochemical staining with double-labeling staining (p16INK4a, Ki-67) were done in 6 liquid-based smears while 5 smears were positive for both markers and 1 was positive only for Ki-67. The biopsy and cervical curettage were performed in 20 patients; the histological diagnoses involved endocervical adenocarcinoma (n=1), microinvasive squamous carcinoma (n=1), atypical proliferation of endocervical epithelium with immature squamous metaplasia (n=2), giant condyloma acuminatum (n-1), chronic cervicitis (n=15). So AGC accompanied cervical lesions with different oncogenic potential. Our data showed that AGC was frequently diagnosed in patients with chronic endocervicitis (in 75% of cases), although the proliferative index in such smears was low. So these patients should be treated with anti-inflammatory therapy without endocervical curettage. At the same time simultaneous detection AGC and the squamous lesions with high p16INK4a and Ki-67 expression (10 % in our investigation) is an indication for endocervical curettage. Moreover, sometimes cone biopsy should be done in such patients because the squamous lesions frequently localize in cervical crypts. Endocervical adenocarcinoma was diagnosed in 5 % of patients who were sent into an oncological hospital.


Conclusion Thus, when AGC is revealed with high p16INK4a and Ki-67 expression, it can be an indication for endocervical curretage and target biopsy while low proliferative index points to chronic cervicitis and such cases require only anti-inflammatory treatment.


 

Objectives: The purpose of our survey was to compare cytological and histological features of cervical samples and to develop the diagnostic and treatment algorithms for such patients.


Methods: 36 patients (reproductive age) were recruited for the investigation due to atypical glandular cells (AGC) cytological diagnosis and were examined clinically (including colposcopy), cytologically (liquid-based cytology, ВD Sureph T.M), immunocytochemically (p16INK4a, Ki-67, CINtec PLUS Cytology Kit), hystologically (hematoxylin and eosin staining of paraffin sections). Also PCR-RT was done for HPV detection (samples were obtained from transformation zone and endocervical low part with Endobrush®).


Results: the wide transformation zone around the external os with atypical changes, hypertrophy, cervical cicatricial deformity and multiple retention cysts were detected in 55.6% (20 patients). High risk HPV type (18) was revealed in 11.1% patients, low-risk types (6,11) - in 2 patients. All cytological smears showed atypical glandular cells involving endocervical cells complexes demonstrating hyperchromic enlarged nuclei with different shape and polarity disturbance. AGC and cervicitis were frequently diagnosed simultaneously. Also the squamous abnormalities (ASCUS, L-SIL, H-SIL) were revealed with AGC in 10% of cases. Immonohystochemical staining with double-labeling staining (p16INK4a, Ki-67) were done in 6 liquid-based smears while 5 smears were positive for both markers and 1 was positive only for Ki-67. The biopsy and cervical curettage were performed in 20 patients; the histological diagnoses involved endocervical adenocarcinoma (n=1), microinvasive squamous carcinoma (n=1), atypical proliferation of endocervical epithelium with immature squamous metaplasia (n=2), giant condyloma acuminatum (n-1), chronic cervicitis (n=15). So AGC accompanied cervical lesions with different oncogenic potential. Our data showed that AGC was frequently diagnosed in patients with chronic endocervicitis (in 75% of cases), although the proliferative index in such smears was low. So these patients should be treated with anti-inflammatory therapy without endocervical curettage. At the same time simultaneous detection AGC and the squamous lesions with high p16INK4a and Ki-67 expression (10 % in our investigation) is an indication for endocervical curettage. Moreover, sometimes cone biopsy should be done in such patients because the squamous lesions frequently localize in cervical crypts. Endocervical adenocarcinoma was diagnosed in 5 % of patients who were sent into an oncological hospital.


Conclusion Thus, when AGC is revealed with high p16INK4a and Ki-67 expression, it can be an indication for endocervical curretage and target biopsy while low proliferative index points to chronic cervicitis and such cases require only anti-inflammatory treatment.


 

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