Table of Contents

1 Introduction to Endocervical Glandular Lesions....... 1
Prevalence....................................................................... 2
Etiology of Endocervical Adenocarcinoma
and AIS............................................................................ 4
Clinical Features of Endocervical
Adenocarcinoma and AIS............................................. 5
Diagnosis of Endocervical Neoplasia.......................... 6
References....................................................................... 7
2 Processing, Reporting, and Sensitivity
of Cervical Cytology with an Emphasis
on Glandular Lesions..................................................... 11
Obtaining the Cervical Cytology Sample.................... 11
The Requisition.............................................................. 15
Image Analysis-Assisted Screening.............................. 16
Specimen Reporting Format and Terminology
for Reporting Glandular Lesions Identified
on Cervical Cytology...................................................... 17
Sensitivity of Cervical Cytology for the Presence
of Glandular Abnormalities.......................................... 19
References....................................................................... 20

3 Normal Histology and Cytology
of the Endocervix and Endometrium.......................... 25
Histology of the Normal Endocervix........................... 25
Cytology of the Normal Endocervix............................ 29
Histology of the Normal Lower Uterine
Segment and Endometrium.......................................... 32
Cytology of Endometrium............................................. 34
References....................................................................... 40
4 Cytology of Endocervical Glandular Neoplasia......... 41
Histology and Cytology of Glandular Lesions
of the Cervix: Neoplastic and Equivocal..................... 41
Adenocarcinoma, Usual Type, Invasive
and In Situ....................................................................... 41
The Cytologic Features of the Usual Type
of In Situ and Invasive Cervical Adenocarcinoma..... 43
Endocervical Adenocarcinoma In Situ,
Usual Type................................................................... 43
Invasive Endocervical Adenocarcinoma,
Usual Type................................................................... 51
Other Variants of Endocervical Adenocarcinoma:
Histologic and Cytologic Presentation........................ 54
Mucinous Type............................................................ 55
Villoglandular Type.................................................... 58
Endometrioid Type..................................................... 59
Clear Cell Type........................................................... 61
Serous Type................................................................. 61
Mesonephric Type....................................................... 62
Adenosquamous Type................................................ 63
Endocervical Gland Dysplasia and Atypical
Endocervical Cells.......................................................... 64
References....................................................................... 67
5 Cytologic Mimics of Endocervical Glandular
Neoplasia......................................................................... 69
Histology of Benign Glandular Lesions
of the Cervix.................................................................... 69
Histology of Metaplasias and Ectopias....................... 69

Histology of Endocervical Glandular
Hyperplasia..................................................................... 72
Histology of Reactive, Infectious,
and Inflammatory Lesions............................................. 75
Cytology of Reactive Endocervical Cells
and Repair....................................................................... 77
Cytology of Tubal and Tubo-Endometrioid
Metaplasia....................................................................... 81
Cytology of Pregnancy-Induced Changes................... 85
Cytology of Changes Due to Intrauterine Device....... 87
Other Mimics of Endocervical
Glandular Neoplasia...................................................... 90
References....................................................................... 91
6 Cytology of Endometrial Cells and Lesions................ 95
Exfoliated Endometrium............................................... 95
Directly Sampled Endometrium................................... 101
Atypical Exfoliated Endometrial Cells....................... 106
Exfoliated Endometrial Adenocarcinoma.................. 107
Post-hysterectomy Vaginal Smears Following
Surgery for Malignancy................................................. 113
References....................................................................... 114
7 Cytology of Extracervical Adenocarcinoma............... 117
Cytomorphology of Metastatic Tumors....................... 118
Work-up........................................................................... 124
The Future....................................................................... 128
References....................................................................... 129
8 Management of Glandular Lesions Identified
on Cervical Cytology and Histology
with Suggestions for Continuous Quality
Improvement in the Cytology Laboratory.................. 133
Rational for Management Guidelines......................... 133
Management Guidelines for the Cytologic
Interpretation of “Atypical Glandular Cells”
or “Adenocarcinoma In Situ”........................................ 135

Management Guidelines for the Cytologic
Interpretation of “Atypical Glandular Cells”
or “Adenocarcinoma In Situ” in Special
Populations: Pregnant Women
and Women Aged 21–24 Years..................................... 137
Management of Benign Glandular Cells..................... 137
Continuous Quality Improvement
in the Cytology Laboratory........................................... 138
References....................................................................... 139
Index....................................................................................... 141